Purpose To determine if T1-weighted MR signal of the pancreas can be used to detect early CP. Methods A retrospective analysis was performed on 51 suspected CP patients, who had both secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) and an intraductal secretin stimulation test (IDST). There were 29 patients in normal and 22 patients in the low bicarbonate group. Bicarbonate level, total pancreatic juice volume, and excretory flow rate were recorded during IDST. Signal intensity ratio of pancreas (SIR), fat signal fraction, pancreatograms findings, and grade of duodenal filling were recorded on S-MRCP by two blinded radiologists. Results There was a significant difference in the signal intensity ratio of the pancreas to spleen (SIRp/s) between the normal and low bicarbonate groups (p < 0.0001). A significant positive correlation was found between pancreatic fluid bicarbonate level and SIRp/s (p < 0.0001). SIRp/s of 1.2 yielded sensitivity of 77% and specificity of 83% for detection of pancreatic exocrine dysfunction (AUC: 0.89). Conclusion T1-weighted MR signal of the pancreas has a high sensitivity and specificity for the detection of parenchymal abnormalities related to exocrine dysfunction and can therefore be helpful in evaluation of suspected early CP.
Grading of chronic pancreatitis (CP) is a clinical and radiologic challenge. Retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) use a version of the Cambridge criteria for ductal evaluation and CP staging, but interchangeability between the modalities lacks validation. This work compares ERCP and MRCP Cambridge scores and evaluates diagnostic performance of MRCP in a large cohort of patients with CP. MethodsA large radiology database was searched for CP patients who underwent MRCP between 2003 and 2013. Next, patients who also had an ERCP within 90 days of their MRCP were selected.These were categorized into mild, moderate, and severe CP using the standardized Cambridge classification for ERCP. Radiologists blinded to ERCP findings then rated MRCP with modified Cambridge scores. ResultsThe cohort comprised of 325 patients (mean age 51 years; 56% female). By ERCP Cambridge classification, 122 had mild CP, 109 moderate CP, and 94 severe CP. MRCP and ERCP showed total agreement of Cambridge score in only 43% of cases. With ERCP as reference, the
Secretin-enhanced MRCP (S-MRCP) provides multiple advantages compared with standard MRCP for imaging the pancreaticobiliary tree. By using secretin to induce fluid production from the pancreas, and leveraging fluid-sensitive MRCP sequences, S-MRCP increases visualization of ductal anatomy and provides insight into pancreatic function, allowing radiologists to offer additional insight for a range of pancreatic-related conditions. This narrative review provides detailed information on the practical implementation of S-MRCP, including patient preparation, logistics of secretin administration, and dynamic secretin-enhanced MRCP acquisition. Considerations are given for radiologists' interpretation and reporting of S-MRCP examinations, including assessment of dynamic compliance of the main pancreatic duct and of duodenal fluid volume. Established indications for S-MRCP are reviewed, including pancreas divisum, anomalous pancreaticobiliary junction, Santorinicele, Wirsungocele, chronic pancreatitis, main pancreatic duct stenosis, and assessment of complex postoperative anatomy. Equivocal or controversial indications are also presented, along with the authors' approach to such indications; these include acute or recurrent acute pancreatitis, pancreatic exocrine function, sphincter of Oddi dysfunction, and pancreatic neoplasms.
Purpose: To compare the cross-sectional imaging findings of IgG4-related Sclerosing Cholangiopathy (IgG4-SC) and Cholangiocarcinoma (CCA). Methods: Retrospective search of radiology and pathology databases identified 24 patients with IgG4-SCand over 500 patients with CCA from January 2009 to December 2016. Patients with no pre-treatment imaging studies available on PACS, non-contrasted imaging only, presence of mass lesions, metastatic disease or biliary stents were excluded. 17 patients with IgG4-SC and a selected group of 20 (age and gender matched) patients with CCA were obtained. Images were blinded and independently reviewed by two radiologists. Differences in proportions and means between groups were analyzed using Fishers and Mann-Whitney tests respectively. Results: Both readers identified a statistically significant difference in the presence of abrupt common bile duct narrowing between IgG4-SC and CCA (6.7% vs 68.4%, p<0.001; 33.3% vs 75%, p=0.019). No difference was seen in biliary wall thickening, wall enhancement, extrahepatic exclusive location of disease, or pancreatic duct dilation. Inter-observer variability was kappa = 0.52. Total bilirubin and CA 19–9 were unable to differentiate between IgG4-SC and CCA. Serum IgG4 was positive in 2 of 6 IgG4-SC patients who were tested. Conclusion: IgG4-SC and CCA share many clinical and imaging findings on CT and MRI. Abrupt bile duct cut sign strongly favors CCA. In the absence of this finding, IgG4-SC should be considered in the differential diagnosis in all cases of suspected extrahepatic CCA.
SUMMARY SENTENCEOur study demonstrates that live lectures and online modules are equally effective in teaching residents about CT and MRI contrast and safety. This allows residency programs flexibility in the educational intervention that works for their needs. ABSTRACT PurposeThe advent of the diagnostic radiology Core Exam and the new ACGME Milestone evaluation system for radiology residents places new emphasis on topics in MRI and CT safety and MRI and CT contrast agents. We evaluated whether lecture-based teaching or online modules would improve baseline resident knowledge in these areas, and assessed which intervention was more effective. MethodsPrior to didactic intervention, two cohorts were created from 57 radiology residents with equal numbers and matched level of training. The residents were tested on their baseline knowledge of MRI, MRI contrast safety, and CT contrast safety with a multiple-choice examination. One group attended a live, one hour lecture on the above topics. The other engaged in three short, online educational modules. After six weeks, the residents were again tested with the same questions to assess for improvement in their understanding. ResultsBoth the module and lecture cohorts demonstrated a statistically significant increase in questions answered correctly on CT contrast safety (13.1%, p<0.001, and 19.1%, p<0.001 respectively) and on MRI/MRI contrast safety (12.9%, p<0.001, and 14.4%, p<0.001). The pre-intervention and post-intervention scores, and degree of improvement post-intervention was similar for the module vs lecture groups without statistical difference (p=0.70). Resident confidence improved in both groups for both modalities. ConclusionsFocused didactic intervention improves resident knowledge on issues of MRI and CT safety and MRI and CT contrast agents. Live lectures and online modules can be equally effective tools, allowing residency programs flexibility.
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