Concept: Magnetic resonance cholangiopancreatography
Calculi in the cystic duct remnant are one of the causes of postcholecystectomy syndrome. A 36-year-old woman presented thrice to the casualty department with right upper quadrant pain at an interval of 2 months every time. Ultrasound and CT scan of the abdomen was normal except for echoes in the gallbladder region may be clips. She was treated conservatively and discharged the first two times. The second time, the MR cholangiopancreatography was normal. She had undergone endoscopic retrograde cholangiopancreatography with sphincterotomy with stent in situ outside elsewhere before presenting to us for the third time, which was removed after 6-weeks. The third time, she was taken up for laparoscopic stump exploration, which revealed a stone, which was the cause of her pain. To conclude, stump stone can be a possibility of post cholecystectomy syndrome even after 6 years, and surgeons should be aware of it.
The aim of this study was to assess factors for delineating the pancreaticobiliary junction in the presence of pediatric congenital choledochal cysts (CCC) using Magnetic resonance cholangiopancreatography (MRCP).
Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive method for diagnosing choledocholithiasis. It is said to be as accurate as the gold standard endoscopic retrograde cholangiopancreatography (ERCP) for detecting common bile duct (CBD) stones. A study was needed to look at the accuracy of MRCP compared with intraoperative cholangiography (IOC) for detecting stones in the CBD. The aim of this study was to evaluate the diagnostic accuracy of MRCP in patients with choledocholithiasis diagnosed with IOC.
Endoscopic retrograde cholangiopancreatography (ERCP) is an important treatment for inoperable hilar cholangiocarcinoma (HCC). The aim of the present study as to evaluate the clinical value of three-dimensional visualization (3DV) and 3D printing (3DP) technologies for ERCP in patients with HCC. The clinical data of 15 patients with HCC admitted for ERCP were analyzed retrospectively, including 9 males and 6 females. Thin-sliced data of computed tomography and magnetic resonance cholangiopancreatography (MRCP) were acquired and imported into Mimics Innovation Suite v17.0 software for 3D reconstruction. Standard Template Library files were exported for 3D printing. The target bile duct and Bismuth-Corlette (BC) classification were selected and performed respectively with the aid of Mimics Innovation Suite v17.0 software. The results were compared with the selected ones in ERCP. 3DV and 3DP models were successfully constructed for all patients, which presented the tumor, bile duct and the spatial relationship between them from multiple perspectives. The ERCP of all patients in the present study were performed successfully. The target bile duct screened by them had a high concordance rate of 86.7% with that in ERCP. The diagnostic accuracy of BC type results by 3DV and 3DP models was 93.3%. 3DV and 3DP technologies can accurately show the tumor and its associations with the surrounding bile duct, and it can be used to guide ERCP in HCC patients and improve the success rate of the operation.
Compressed-sensing (CS) accelerated 3D MR cholangiopancreatography (MRCP) could be acquired in both navigator-triggered (NT) and breath-hold (BH) mode, but the latter has been considered inferior in depicting pancreatic duct and diagnosing pancreatic duct-related diseases.
To evaluate the clinical feasibility and image quality of breath-hold (BH) three-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP) using a gradient and spin-echo (GRASE) technique compared to the conventional 3D respiratory-triggered (RT)-MRCP using a turbo spin-echo (TSE) sequence at 3 T.
There is no consensus on how to assess the depth of sedation for endoscopic retrograde cholangiopancreatography (ERCP). This study was carried out in order to evaluate different methods of assessment of depth of sedation: bispectral index (BiS), modified Richmond Agitation/Sedation Scale (mRASS), modified Ramsay Sedation Scale (mRSS) and modified Observer Assessment of Alertness and Sedation (mOAAS) and their applicability to clinical practice.
Biliary lithiasis is common in most western countries. Symptomatic patients will also have choledocholithiasis in 10% of the cases. For patients with intermediate probability of CBD stones, the recommended imaging studies are endoscopic ultrasound (EUS) or MRCP. This study aims to identify early factors that can be used as predictors for the presence of CBD stones, and by that to find which patient should undergo ERCP without an early EUS.
The current study evaluated the clinical usefulness of the gradient and spin-echo (GRASE) sequence with single breath-hold in 3.0 T magnetic resonance cholangiopancreatography (MRCP). We compared the acquisition time and image quality between GRASE and breath navigator-triggered 3D turbo spin echo (3D TSE).
A biliobronchial fistula is an abnormal communication between the biliary tract and the bronchial tree. It may be a rare complication after treatment of hepatocellular carcinoma with transcatheter arterial chemoembolization (TACE). We present a case of a 71-year-old man that developed a biliobronchial fistula as a complication of hepatocellular carcinoma treated with TACE. It was successfully diagnosed by hepatobiliary iminodiacetic acid (HIDA) scan and treated with endoscopic retrograde pancreatography.