Neoplastic pancreaticobiliary duct obstruction: evaluation with breath-hold MR cholangiopancreatography.

Schwartz, Lawrence H.; Coakley, Fergus V.; Sun, Yi; Blumgart, Leslie H.; Fong, Yuman; Panicek, David M.

doi:10.2214/ajr.170.6.9609160

Cited by 96 publications

(49 citation statements)

References 7 publications

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“…Some ampullary carcinomas are covered by intact epithelium, and the accuracy of biopsies is reportedly lower in the tumors with intra-ampullary growth compared with tumors with extraampullary growth or ulceration. 10,14,15 We found that the preoperative diagnosis of moderate or severe dysplasia on biopsy should be viewed as suspicion for carcinoma. EST had some limitations, including the interference with EUS staging and histologic examination due to tissue destruction, and possible complications such as hemorrhage, perforation, or pancreatitis.…”

Section: Discussionmentioning

confidence: 97%

Reappraisal of endosonography of ampullary tumors: Correlation with transabdominal sonography, CT, and MRI

Chen

Yang

Yeh

et al. 2008

J of Clinical Ultrasound

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Purpose. To reappraise the accuracy of transabdominal sonography (US), CT, MRI, and endosonography (EUS) in the diagnosis and staging of ampullary tumors.Method. We reviewed the medical records and the images of 41 consecutive patients with ampullary tumors. Tumor detection rate and accuracy of TNM (tumor-node-metastasis) staging of malignant tumors were determined. Imaging findings were correlated with histopathologic findings.Results. The detection rates for ampullary tumors were 97.6% for EUS, 81.3% for MRI, 28.6% for CT, and 12.2% for US (p < 0.001 for EUS versus CT; p < 0.001 for EUS versus US; p > 0.05 for EUS versus MRI). The accuracy in T staging for ampullary carcinomas was 72.7% for EUS, 53.8% for MRI, and 26.1% for CT (p < 0.01 for EUS versus CT; p > 0.05 for EUS versus MRI). The accuracy in N staging for ampullary carcinomas was 66.7% for EUS, 76.9% for MRI, and 43.5% for CT with no statistically significant difference between the 3 modalities. The sensitivity in detecting malignant lymph nodes was 46.7% for EUS, 25.0% for MRI, and 0% for CT (p < 0.01 for EUS versus CT; p > 0.05 for EUS versus MRI; p > 0.05 for MRI versus CT). Transpapillary stenting, advanced tumor extension (>T2), large tumor size (>2 cm), tumor differentiation, and endoscopic appearance of tumor growth did not significantly influence EUS accuracy in T or N staging (p > 0.05). A mpullary carcinomas often manifest with jaundice, abdominal pain, and anemia. They tend to have a higher resectability rate and better subsequent prognosis than other periampullary carcinomas. 1,2 It has been reported that if ampullary carcinoma invades the pancreas, the incidence of lymph node metastasis increases, and prognosis is poor. 3,4 However, there is substantial support in the literature for local resection of T1 ampullary tumors because of the very low incidence of lymph node metastasis. 5,6 Accurate staging of ampullary tumors is therefore critical for surgical planning and predicting the patient's prognosis. Conclusion. EUS was superior to CT and was equiv-Radial endosonography (EUS) provides highresolution sonograms by placing a high-frequency (7.5-12 MHz) ultrasound probe in close proximity to the periampullary region, avoiding interference from soft tissues and bowel gas. EUS can clearly delineate the pancreatic

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Section: Discussionmentioning

confidence: 97%

Reappraisal of endosonography of ampullary tumors: Correlation with transabdominal sonography, CT, and MRI

Chen

Yang

Yeh

et al. 2008

J of Clinical Ultrasound

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“…Multiple studies have demonstrated the utility of MRCP in evaluating patients with CC [106,107] . MRCP has diagnostic accuracy comparable to invasive cholangiographic techniques such as ERCP or percutaneous transhepatic cholangiography (PTC) [108][109][110][111] .…”

Section: Magnetic Resonance Imaging (Mri) and Magnetic Resonance Cholmentioning

confidence: 99%

“…On MRCP, ECC may appear as extrahepatic lesions with similar signal intensity of ICC on both T1-and T2-weighted images, in addition to proximal biliary dilatation [106,116] . A meta-analysis of 67 studies (4711 patients) evaluating MRCP performance in patients with suspected biliary diseases showed an overall sensitivity of 88% and specificity of 95% [107] . In a series of 99 patients with HCC, MRCP accurately determined the longitudinal extension of the tumor in 88% of patients [118] .…”

Section: Magnetic Resonance Imaging (Mri) and Magnetic Resonance Cholmentioning

confidence: 99%

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Aljiffry¹,

Walsh²,

Molinari³

2009

WJG

254

190

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Several advances in diagnosis, treatment and palliation of cholangiocarcinoma (CC) have occurred in the last decades. A multidisciplinary approach to this disease is therefore recommended. CC is a relatively rare tumor and the main risk factors are: chronic inflammation, genetic predisposition and congenital abnormalities of the biliary tree. While the incidence of intra-hepatic CC is increasing, the incidence of extra-hepatic CC is trending down. The only curative treatment for CC is surgical resection with negative margins. Liver transplantation has been proposed only for selected patients with hilar CC that cannot be resected who have no metastatic disease after a period of neoadjuvant chemo-radiation therapy. Magnetic resonance imaging/ magnetic resonance cholangiopancreatography, positron emission tomography scan, endoscopic ultrasound and computed tomography scans are the most frequently used modalities for diagnosis and tumor staging. Adjuvant therapy, palliative chemotherapy and radiotherapy have been relatively ineffective for inoperable CC. For most of these patients biliary stenting provides effective palliation. Photodynamic therapy is an emerging palliative treatment that seems to provide pain relief, improve biliary patency and increase survival. The clinical utility of other emerging therapies such as transarterial chemoembolization, hepatic arterial chemoinfusion and high intensity intraductal ultrasound needs further study.

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“…3D-MRCP has a higher resolution (1 mm 3 ), excellent image quality, and was superior to ERCP/PTC in assessing hilar ductal obstruction. Indeed, several previous studies demonstrated that the accuracy of 2D-MRCP in assessing the level and feature of bile duct obstruction was comparable to that of ERCP/PTC (1,6,12,17,(22)(23)(24)(25)(26). However, at the same time, in several studies where surgical and pathological findings were used as a standard of reference, 2D-MRCP showed a relatively low accuracy regarding tumoral extent of the biliary tree (25)(26)(27).…”

Section: D Mrcp In Malignant Obstructionmentioning

confidence: 99%

“…MALIGNANT BILIARY OBSTRUCTION is one of the most challenging problems encountered by clinicians today in regard to differential diagnoses and management planning (1). Traditionally, for the direct visualization of the ductal system, invasive methods such as endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) have been used.…”

mentioning

confidence: 99%

Navigator‐triggered isotropic three‐dimensional magnetic resonance cholangiopancreatography in the diagnosis of malignant biliary obstructions: Comparison with direct cholangiography

Choi

Lee

et al. 2007

Magnetic Resonance Imaging

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Purpose:To compare the diagnostic accuracy of navigatortriggered isotropic three-dimensional (3D) MR cholangiopancreatography (MRCP) using parallel imaging for malignant biliary obstruction with direct cholangiography. Materials and Methods:A total of 23 patients with malignant biliary obstruction underwent MRCP and endoscopic retrograde cholangiopancreatography (ERCP)/percutaneous transhepatic cholangiography (PTC). Two observers retrospectively evaluated 3D-MRCP and ERCP/PTC and recorded the level of obstruction and extent of tumor along with their confidence. The quality of images and morphologic appearance of stricture were also evaluated by two reviewers. The results of MRCP and ERCP/PTC were compared with surgical and histopathological data.Results: 3D-MRCP was of diagnostic quality and free of artifacts in all patients, whereas ERCP/PTC examinations failed in three patients. For the evaluation of level of obstruction, there was no statistical significance between 3D-MRCP and ERCP/PTC. 3D-MRCP was superior to ERCP/ PTC in the assessment of anatomical extent of hilar bile duct involvement, but did not show statistical significance. The accuracy of 3D-MRCP in determining tumoral extent of hilar cancer was higher than that of ERCP/PTC, but it was not statistically significant. The image quality of 3D-MRCP was superior to ERCP/PTC. There was good agreement between morphologic appearance at MRCP and those at ERCP/PTC. Conclusion: 3D-MRCP can accurately assess the level of obstruction and extent of tumor in patients with malignant biliary obstruction.

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Neoplastic pancreaticobiliary duct obstruction: evaluation with breath-hold MR cholangiopancreatography.

Abstract: The purpose of this study was to investigate the use of breath-hold single-shot fast spin-echo MR cholangiopancreatography in neoplastic pancreaticobiliary duct obstruction.

Cited by 96 publications

References 7 publications

Reappraisal of endosonography of ampullary tumors: Correlation with transabdominal sonography, CT, and MRI

Reappraisal of endosonography of ampullary tumors: Correlation with transabdominal sonography, CT, and MRI

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Navigator‐triggered isotropic three‐dimensional magnetic resonance cholangiopancreatography in the diagnosis of malignant biliary obstructions: Comparison with direct cholangiography

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