• Investigative Magnetic Resonance Imaging
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• v.5 no.1
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• pp.49-56
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• 2001

Purpose : To evaluate value of superparamagnetic iron oxide (SPIO) as a negative oral contrast agent in MR cholangiopancreatography (MRCP). Materials and methods : Forty-eight patients with suspected biliary tract or pancreatic diseases and six healthy volunteers were enrolled in this study. All MR images were obtained using a 1.5 T MR unit. MR-CP using fat-suppressed half-Fourier acquisition single-shot turbo spin echo (HASTE) and turbo spin echo (TSE) techniques were performed and reconstructed with maximal intensity projection (MIP). To determine the most optimal concentration of SPIO to obliterate the high signal intensity of water, a phantom experiment was conducted with various concentrations of SPIO-water mixture. Two radiologists evaluated pre- and postcontrast MRCPS. The contrast enhancement was assessed on the basis of loss of signal intensity in the stomach and duodenum. Results : In the phantom experiment, a significant increase of percentage of signal intensity loss (PSIL) occurred in concentration of 22.4 ugFe/ml (Feridex1 ml diluted with water 500 ml). Postcontrast MRCP showed an improved image quality compared with precontrast images. The rate of improvement in the diagnosis of diseases of the common bile duct and pancreatic duct was 25% (12/48). Conclusion : In patients with suspected biliary tract and pancreatic diseases, the SPIO is useful as a negative oral contrast agent for MRCP and provides an improvement of image quality.

• Proceedings of the KSMRM Conference
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• 1997.10a
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• pp.54-54
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• 1997

• Journal of Magnetics
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• v.19 no.4
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• pp.365-371
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• 2014

The aim of this study was to evaluate the utility of 3-D images by comparing and analyzing reconstructed 3-D images from fast spin echo images of MRI cholangiopancreatography (MRCP) images using maximum intensity projection (MIP) with the subtraction images derived from dynamic tests of magnetic resonance mammography. The study targeted 20 patients histologically diagnosed with pancreaticobiliary duct disease and 20 patients showing pancreaticobiliary duct diseases, where dynamic breast MR (magnetic resonance) images, fast spin echo imaged of pancreaticobiliary duct, and 3-D reconstitution images using a 1.5T MR scanner and 3.0T MR scanner were taken. As a result of the study, the signal-to-noise ratio in the subtracted breast image before and after administering the contrast agent and in the reconstructed 3-D breast image showed a high ratio in the reconstructed image of lesional tissue, relevant tissue, and fat tissue. However, no statistically meaningful differences were found in the contrast-to-noise ratio of the two images. In the case of the MRCP image, no differences were found in the ratios of the fast spin echo image and reconstructed 3-D image.

• Investigative Magnetic Resonance Imaging
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• v.1 no.1
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• pp.148-153
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• 1997

Purpose: To evaluate the diagnostic role of a three-dimensional MR cholangiopancreatography (MRCP) over endoscopic retrograde cholangio-pancreatography (ERCP) in various extrah-epatic biliary disease. Materials and Methods: MRCP and ERCP were performed in 45 consecutive patients with suspected extrahepatic biliary diseases. MRCP was obtained using a reverse fast imaging with a steady-state free precession (reverse FISP: PSIF) sequence, and then images were reconstructed by standard MIP algorithm. The predictability of biliary dilatation and level of obstruction of MRCP was evaluated using ERCP as a gold standard. The accuracy distinguishing malignant from benign lesions, and overall diagnostic accuracy were compared between MRCP and ERCP. Results: The sensitivity, specificity and accuracy of MRCP in predicting biliary dilatation were 94.6%, 75.0% and 91.1%, respectively. The level of obstruction was accurate in 87.0% with MRCP. The sensitivity, specificity and accuracy of MRCP and ERCP in distinguishing malignant from benign lesions were 76.2%, 87.5% and 82.2% and 71.4%, 83.3% and 77.8%, respectively. The overall diagnostic accuracy was 60.0% with MRCP and 55.6% with ERCP. Conclusion: 3D MRCP shows a good diagnostic value compared to that of ERCP, and can replace a ERCP.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.25 no.4
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• pp.332-339
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• 2022

Purpose: Although endoscopic retrograde cholangiopancreatography (ERCP) has been used for more than five decades, its applicability in Bangladeshi children has recently become more common. Therefore, this manuscript aims to describe our experience in performing ERCPs in Bangladeshi children with hepatopancreaticobiliary diseases, focusing on presenting diseases, as well as the diagnostic and therapeutic efficacy. Methods: Between 2018 and 2021, 20 children underwent 30 ERCP procedures at the Bangladesh Specialized Hospital, Dhaka. A single trained adult gastroenterologist performed all procedures using a therapeutic video duodenoscope. The indications for ERCP, diagnostic findings, therapeutic procedures, and complications were documented. Results: The median age of the study patients was 10 years (range, 1.7-15 years). Successful cannulation of the papilla was achieved in 28 procedures and failed in 2 cases. Repeated ERCP was required in seven patients. Nine patients had biliary indications and 11 had pancreatic indications. Choledocholithiasis was the most common indication for ERCP in patients with biliary disease, while chronic pancreatitis was common among patients with pancreatic indications. Pancreatic divisum was observed in only one patient. Pancreatic and biliary sphincterotomy was performed in 14 and 9 cases, respectively. A single pigtail or straight therapeutic stent was inserted in seven cases and removed in five cases. Stone extraction was performed in six procedures, and balloon dilatation was performed in five procedures. The post-procedural period for these patients was uneventful. Conclusion: We found that ERCP is a practical and successful therapeutic intervention for treating hepatopancreaticobiliary disorders in children when performed by experienced endoscopists.

• Investigative Magnetic Resonance Imaging
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• v.18 no.2
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• pp.171-175
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• 2014

Pancreatic pseudocyst rupture into the portal vein is a very rare complication and only three reported cases were confirmed using MRI. We report the case of a 50-year-old man with fistula formation between the pseudocyst and the portal vein, confirmed noninvasively by MRI. T2-weighted MR images and magnetic resonance cholangiopancreatography showed fluid signal intensity within the portal, superior mesenteric, and splenic veins, and a direct communication between the pseudocyst and the portal vein.

• Journal of Magnetics
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• v.17 no.2
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• pp.138-144
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• 2012

3-dimensional magnetic resonance cholangiopancreatography (MRCP) images reconstructed using the maximum intensity projection technique were analyzed qualitatively in patients diagnosed with pancreatobiliary diseases to determine their diagnostic utility. Single shot fast spin echo (SSFSE), fast spin echo (FSE) and 3-dimensional reconstructive images were acquired from 20 patients diagnosed histologically with pancreatobiliary diseases using a 3.0T MR scanner. According to qualitative analysis, the fast spin echo images and 3-dimensional reconstructed images of the hepatic duct, gall bladder and common bile duct had a higher signal to noise ratio (SNR) than the single shot fast spin echo images. Fast spin echo images and 3-dimensional reconstructed images did not show any differences. The contrast to noise ratio of the hepatic duct, gallbladder and common bile duct on the fast spin echo images and 3-dimensional reconstructed images was higher than that of the single shot fast spin echo images. The fast spin echo images and 3-dimensional reconstructed images showed similar quality.

• Journal of the Korean Society of Radiology
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• v.5 no.3
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• pp.143-148
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• 2011

The purpose of this study was to examine the usefulness of SPIO contrast agent in Magnetic Resonance Cholangiopancreatography (MRCP) by performing a quantitative comparative analysis in patients undergoing MRCP for gallbladder stones with and without oral injection of SPIO (Superparamagnetic iron oxide) contrast agent. The subjects were 36 patients undergoing MRCP for suspected gallbladder stones between January 2009 and February 2010 and they were divided into halves to compare the two groups of with and without SPIO agent. For each subject in both the injected and non-injected group, T2-weighted images on a 1.5T MR scanner were obtained, using both the breath-holding and respiratory-triggered methods, respectively. The following regions were measured; for breath-hold T2-weighted images, the measurement regions were located at the central part of the gallbladder, and the areas 15 mm away from its center, toward the front and back, respectively, which were chosen to include surrounding tissues, while for respiratory-triggered T2-weighted images, at the central part of the gallbladder, and segment 5 and 6 of liver. In a quantitative analysis, average signal to noise ratio (SNR) in each of regions of interest (ROI) for each group were calculated and then average contrast to noise ratio (CNR) in each of ROI were obtained by using the SNR in the gallbladder as the basis to compare and analyze the values between the two groups. The CNR were higher for the injected group in those regions.

• Korean Journal of Radiology
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• v.23 no.2
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• pp.271-279
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• 2022

Objective: To compare the clinical and radiologic findings between perforated and non-perforated choledochal cysts in children. Materials and Methods: Fourteen patients (mean age ± standard deviation, 1.7 ± 1.2 years) with perforated choledochal cysts (perforated group) and 204 patients (3.6 ± 3.8 years) with non-perforated choledochal cysts (non-perforated group) were included between 2000 and 2019. All patients underwent choledochal cyst excision after ultrasound, CT, or MR cholangiopancreatography. Relevant data including demographics, clinical symptoms, laboratory findings, imaging findings, and outcomes were analyzed. Statistical differences were compared using the Mann-Whitney U test and Fisher's exact test. Results: Choledochal cyst perforation occurred only in children under the age of 4 years. Acute symptoms, including fever (p < 0.001), were more common in the perforated group than in the non-perforated group. High levels of white blood cells (p = 0.004), C-reactive protein (p < 0.001), and serum amylase (p = 0.002), and low levels of albumin (p < 0.001) were significantly associated with the perforated group. All 14 patients with perforated choledochal cysts had ascites, whereas only 16% (33/204) of patients in the non-perforated group had ascites (p < 0.001). In the subgroup of patients who had ascites, a large amount of ascites (p = 0.001), increase in the amount of ascites in a short time (p < 0.001), complex ascites (p < 0.001), and perihepatic pseudocysts (p < 0.001) were more common in the perforated group than in the non-perforated group. Conclusion: Children with perforated choledochal cysts have characteristic clinical and radiologic findings compared to those with non-perforated choledochal cysts. In young children with choledochal cysts, perforation should be differentiated in cases with acute symptoms, laboratory abnormalities, and characteristic ascites findings.