Objective: To investigate the clinical significance of magnetic resonance cholangiopancreatography (MRCP) utilizing half-Fourier acquisition single-shot fast spin-echo (HASTE) in the diagnosis of bile duct diseases. M...Objective: To investigate the clinical significance of magnetic resonance cholangiopancreatography (MRCP) utilizing half-Fourier acquisition single-shot fast spin-echo (HASTE) in the diagnosis of bile duct diseases. Methods: Forty-three patients with obstructive jaundice and 4 without were enrolled in this study. The underlying diseases included bile duct calculi ( 13 cases) , chronic cholangitis ( 14 cases) malignant tumors (18 cases) and congenital biliary cysts (2 cases). All patients underwent examinations with magnetic resonance imaging (MRI) and MRCP, and 39 were also examined with B-type ultrasonography, 33 with CT and 25 with ERCP and PTC. Three-dimensional image reconstruction was performed using volume-rendered technique ( VRE) on the basis of the data obtained by MRCP. Results: The biliary calculi were displayed as circular filling defects in MRCP images, with the proximal end of dilated bile duct taking the form of the mouth of a cup. The bile duct of patients with chronic cholangitis showed distal end dilation and thinner proximal end without discontinuity. Interception of the bile ducts was most frequent (72. 2% ) in cases of malignant bile duct obstruction, in which the ducts may also be mastoid or resembling rat tails. 72. 2% of the cases had severe dilation of the bile ducts, which occur in only 16. 0% of the benign cases, with significant difference between them (P <0. 01) . In images of intrahepatic biliary cyst, intrahepatic duct dilated in the shape of a bursa in connection with the duct. By MRCP, 20 malignant obstructions of the bile ducts were identified with 2 misdiagnoses, and in 25 cases of benign obstructions identified by MRCP, only 1 misdiagnoses occurred. Thus MRCP had the sensitivity, specificity and accuracy of 90.0% , 96.3% and 93.6% respectively in discriminating benign and malignant diseases of the bile ducts, showing a total diagnostic accuracy of 94. 0% that was similar to that of ERCP (92.0% ) but significantly higher than those of both CT (75. 0% ) and B-type ultrasonic examination (74. 0% ). Conclusion: In diagnosing obstructive jaundice, HASTE MRCP is similar to ERCP but better than CT and B-type ultrasonography , with the merits of fast imaging and high resolution as an ideal sequence for MRCP imaging.展开更多
Objective: To evaluate the value of oral Gd-DTPA as a negative contrast agent during magnetic resonance cholangiopancreatography (MRCP) to eliminate the high signals of the gastrointestinal tract. Methods: To select t...Objective: To evaluate the value of oral Gd-DTPA as a negative contrast agent during magnetic resonance cholangiopancreatography (MRCP) to eliminate the high signals of the gastrointestinal tract. Methods: To select the optimal concentration of oral Gd-DTPA for MRCP, a phantom study was performed followed by clinical trial in 15 cases undergoing MRCP before and after oral Gd-DTPA (in a total volume of 250 ml 1∶5 diluted Gd-DTPA, 1.488 g/L). MRCP images were acquired using two-dimensional single slice fast spin-echo (SSTSE) sequence and half-Fourier acquisition single slice fast spin-echo (HASTE) sequence. Results: The phantom study showed that the 1∶5 diluted oral Gd-DTPA was best in decreasing the signal intensity both in T2-weighted imaging (59.5%) and in HASTE sequence (82.45%). The high signal intensity of the stomach and intestinal fluid was completely suppressed in all the cases. The depictions of the common bile duct and pancreatic duct were markedly improved by using the oral contrast agent (P<0.05). Conclusion: Oral Gd-DTPA is effective and safe for eliminating the high signal of the gastrointestinal tract to improve the depiction of the biliary system by MRCP.展开更多
Objective:To summarize and analyze the clinical and histopathological features of chronic acalculous cholecystitis (CAC) and to investigate the diagnosis and surgical treatment of chronic acalculous cholecystit.Method...Objective:To summarize and analyze the clinical and histopathological features of chronic acalculous cholecystitis (CAC) and to investigate the diagnosis and surgical treatment of chronic acalculous cholecystit.Methods:The study subjects were 39 patients with chronic biliary symptoms but no evidence of stones in the gallbladder by B ultrasonography and magnetic resonance cholopancreatography (MRCP) (CAC group).The CCC group consisted of 66 patients taken randomly from concurrent all patients of chronic calculous cholecystitis (CCC).All patients accepted fibergastroscopy,B ultrasonography,MRCP,laboratory examination preoperatively.We retrospectively analyzed the clinical features,B ultrasonography and MRCP findings,histopathological results and clinical outcomes between the two groups.Results:All the 39 patients were diagnosed by clinical symptoms,B ultrasonography,fatty meal gallbladder contractability studies under ultrasound,fibergastroscopy and magnetic resonance cholangiopancreatography (MRCP),what's more,they were pathologically verified postoperatively.In all patients,there was a complete absence of gallbladder wall contractability.Mucosa epithelial defect was found in 21 patients in CAC group (53.8%) and 16 patients in CCC group (24.2%) respectively (P<0.005).Thickened arteriole wall was found in 29 patients in CAC group (74.4%) and none patient in CCC group (P<0.0001).Thickened gallbladder wall (4 mm or more in thickness) was found in 33 patients in CAC group (84.6%) and 28 patients in CCC group (42.4%) respectively (P<0.005).Bile stasis was found in 23 patients in CAC group (59.0%) and 14 patients in CCC group (21.2%) respectively by ultrasonography preoperatively and confirmed in operation (P<0.005).The outcomes of cholecystectomy,expressed as total or near total relief,was similar in the two groups.No statistically significant differences were observed between patients with CAC (90%) and CCC (80%),the P-value >0.05.Conclusion:Chronic acalculous cholecystitis could be diagnosed by symptoms,ultrasound,fatty meal gallbladder contractability studies under untrasoundand MRCP.The optimal treatment of chronic acalculous cholecystitis characterized by thickened arteriole wall and mucosa epithelial defect is cholecystectomy.展开更多
Objective： To summarize the experience of diagnosis and surgical treatment for a rare invasion manner of gallbladder carcinoma, which was combined with tumor thrombus in common bile duct （CBD）. Methods： Between Fe...Objective： To summarize the experience of diagnosis and surgical treatment for a rare invasion manner of gallbladder carcinoma, which was combined with tumor thrombus in common bile duct （CBD）. Methods： Between February 2003 and January 2005, 3 patients with gallbladder carcinoma who were identified of tumor thrombus in common bile duct in surgical procedure were retrospectively analyzed. Results： Abdominal ultrasound and magnetic resonance cholangiopancreatography （MRCP） were used for preoperative diagnosis. All 3 patients were given radical operations, which were composed of cholecystectomy, resection of the extrahepatic biliary duct, cuniform hepatectomy of gallbladder bed, skeletonization of the hepatoduodenal ligament, hilar choledochojejunostomy, and clearance of tumor thrombus from bile duct. Three patients were recovered well after surgery, which were respectively alive for 30 months, 17 months and 23 months without tumor recurrence,and 58 months, 41 months and 40 months for survival time after operation. Conclusion： Gallbladder carcinoma with tumor thrombus in common bile duct was very rare but with relatively special clinical manifestation and characteristic radiography manifestation. MRCP was one of the most potent diagnostic method. The prognosis of gallbladder carcinoma with tumor thrombus in common bile duct after surgical procedure was apparently better than gallbladder carcinoma with invasion of hilar tissues. Radical operation was feasible and safe for obtaining longer survival展开更多
文摘Objective: To investigate the clinical significance of magnetic resonance cholangiopancreatography (MRCP) utilizing half-Fourier acquisition single-shot fast spin-echo (HASTE) in the diagnosis of bile duct diseases. Methods: Forty-three patients with obstructive jaundice and 4 without were enrolled in this study. The underlying diseases included bile duct calculi ( 13 cases) , chronic cholangitis ( 14 cases) malignant tumors (18 cases) and congenital biliary cysts (2 cases). All patients underwent examinations with magnetic resonance imaging (MRI) and MRCP, and 39 were also examined with B-type ultrasonography, 33 with CT and 25 with ERCP and PTC. Three-dimensional image reconstruction was performed using volume-rendered technique ( VRE) on the basis of the data obtained by MRCP. Results: The biliary calculi were displayed as circular filling defects in MRCP images, with the proximal end of dilated bile duct taking the form of the mouth of a cup. The bile duct of patients with chronic cholangitis showed distal end dilation and thinner proximal end without discontinuity. Interception of the bile ducts was most frequent (72. 2% ) in cases of malignant bile duct obstruction, in which the ducts may also be mastoid or resembling rat tails. 72. 2% of the cases had severe dilation of the bile ducts, which occur in only 16. 0% of the benign cases, with significant difference between them (P <0. 01) . In images of intrahepatic biliary cyst, intrahepatic duct dilated in the shape of a bursa in connection with the duct. By MRCP, 20 malignant obstructions of the bile ducts were identified with 2 misdiagnoses, and in 25 cases of benign obstructions identified by MRCP, only 1 misdiagnoses occurred. Thus MRCP had the sensitivity, specificity and accuracy of 90.0% , 96.3% and 93.6% respectively in discriminating benign and malignant diseases of the bile ducts, showing a total diagnostic accuracy of 94. 0% that was similar to that of ERCP (92.0% ) but significantly higher than those of both CT (75. 0% ) and B-type ultrasonic examination (74. 0% ). Conclusion: In diagnosing obstructive jaundice, HASTE MRCP is similar to ERCP but better than CT and B-type ultrasonography , with the merits of fast imaging and high resolution as an ideal sequence for MRCP imaging.
文摘Objective: To evaluate the value of oral Gd-DTPA as a negative contrast agent during magnetic resonance cholangiopancreatography (MRCP) to eliminate the high signals of the gastrointestinal tract. Methods: To select the optimal concentration of oral Gd-DTPA for MRCP, a phantom study was performed followed by clinical trial in 15 cases undergoing MRCP before and after oral Gd-DTPA (in a total volume of 250 ml 1∶5 diluted Gd-DTPA, 1.488 g/L). MRCP images were acquired using two-dimensional single slice fast spin-echo (SSTSE) sequence and half-Fourier acquisition single slice fast spin-echo (HASTE) sequence. Results: The phantom study showed that the 1∶5 diluted oral Gd-DTPA was best in decreasing the signal intensity both in T2-weighted imaging (59.5%) and in HASTE sequence (82.45%). The high signal intensity of the stomach and intestinal fluid was completely suppressed in all the cases. The depictions of the common bile duct and pancreatic duct were markedly improved by using the oral contrast agent (P<0.05). Conclusion: Oral Gd-DTPA is effective and safe for eliminating the high signal of the gastrointestinal tract to improve the depiction of the biliary system by MRCP.
文摘Objective:To summarize and analyze the clinical and histopathological features of chronic acalculous cholecystitis (CAC) and to investigate the diagnosis and surgical treatment of chronic acalculous cholecystit.Methods:The study subjects were 39 patients with chronic biliary symptoms but no evidence of stones in the gallbladder by B ultrasonography and magnetic resonance cholopancreatography (MRCP) (CAC group).The CCC group consisted of 66 patients taken randomly from concurrent all patients of chronic calculous cholecystitis (CCC).All patients accepted fibergastroscopy,B ultrasonography,MRCP,laboratory examination preoperatively.We retrospectively analyzed the clinical features,B ultrasonography and MRCP findings,histopathological results and clinical outcomes between the two groups.Results:All the 39 patients were diagnosed by clinical symptoms,B ultrasonography,fatty meal gallbladder contractability studies under ultrasound,fibergastroscopy and magnetic resonance cholangiopancreatography (MRCP),what's more,they were pathologically verified postoperatively.In all patients,there was a complete absence of gallbladder wall contractability.Mucosa epithelial defect was found in 21 patients in CAC group (53.8%) and 16 patients in CCC group (24.2%) respectively (P<0.005).Thickened arteriole wall was found in 29 patients in CAC group (74.4%) and none patient in CCC group (P<0.0001).Thickened gallbladder wall (4 mm or more in thickness) was found in 33 patients in CAC group (84.6%) and 28 patients in CCC group (42.4%) respectively (P<0.005).Bile stasis was found in 23 patients in CAC group (59.0%) and 14 patients in CCC group (21.2%) respectively by ultrasonography preoperatively and confirmed in operation (P<0.005).The outcomes of cholecystectomy,expressed as total or near total relief,was similar in the two groups.No statistically significant differences were observed between patients with CAC (90%) and CCC (80%),the P-value >0.05.Conclusion:Chronic acalculous cholecystitis could be diagnosed by symptoms,ultrasound,fatty meal gallbladder contractability studies under untrasoundand MRCP.The optimal treatment of chronic acalculous cholecystitis characterized by thickened arteriole wall and mucosa epithelial defect is cholecystectomy.
文摘Objective： To summarize the experience of diagnosis and surgical treatment for a rare invasion manner of gallbladder carcinoma, which was combined with tumor thrombus in common bile duct （CBD）. Methods： Between February 2003 and January 2005, 3 patients with gallbladder carcinoma who were identified of tumor thrombus in common bile duct in surgical procedure were retrospectively analyzed. Results： Abdominal ultrasound and magnetic resonance cholangiopancreatography （MRCP） were used for preoperative diagnosis. All 3 patients were given radical operations, which were composed of cholecystectomy, resection of the extrahepatic biliary duct, cuniform hepatectomy of gallbladder bed, skeletonization of the hepatoduodenal ligament, hilar choledochojejunostomy, and clearance of tumor thrombus from bile duct. Three patients were recovered well after surgery, which were respectively alive for 30 months, 17 months and 23 months without tumor recurrence,and 58 months, 41 months and 40 months for survival time after operation. Conclusion： Gallbladder carcinoma with tumor thrombus in common bile duct was very rare but with relatively special clinical manifestation and characteristic radiography manifestation. MRCP was one of the most potent diagnostic method. The prognosis of gallbladder carcinoma with tumor thrombus in common bile duct after surgical procedure was apparently better than gallbladder carcinoma with invasion of hilar tissues. Radical operation was feasible and safe for obtaining longer survival
