Background Iatrogenic bile duct injuries are unusual but possibly associated with fatal complications with increased incidence since the introduction of laparoscopic cholecystectomy. Appropriate estimation of these injuries is essential for proper management. Imaging is vital for the initial diagnosis, extent assessment and consequently, treatment guidance of bile duct injury with an ideal outcome. In this study, MRCP was carried out in 37 cases (28 females and 9 males, age range from 19 to 58 years) with suspected BDI following laparoscopic cholecystectomy. MRCP images were assessed for bile duct transection injury, strictures, biliary leakage, and intrahepatic biliary radicles (IHBR) dilatation. In positive cases, Strasberg classification system was used with the definitive diagnosis was done regarding the surgical findings and/or findings on endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC). Results Our study includes 37 cases with biliary injuries. On MRCP our cases were stratified regarding the Strasberg-Bismuth classification into five types (A to E). Most BDIs were type E2 (29.7%), followed by type E1 (18.9%), type A (16.2%), type E3 (10.8%), type E4 (8.2%), type C (5.4%), and type D and finally type E5 and B injuries with each one representing 2.7%. Twenty cases presented with biliary leakage and seventeen with bile duct obstruction, whether duct ligation or stricture. Conclusion MRCP is an essential imaging modality for assessment of iatrogenic BDIs enabling the radiologists to classify these injuries and helps to govern the management.
Background Owing to significant morbidity and mortality with the development of vascular complications in patients with acute invasive fungal rhinosinusitis (AIFRS), early identification, and rapid medical or surgical interventions that are essential for improving patients’ outcomes. For the purpose of presurgical mapping and management planning, magnetic resonance imaging (MRI) is essential for the early identification and improved delineation of disease extent. Objective To evaluate variable MRI manifestations in the detection of the vascular complications in patients with AIFRS and its impact on patients’ survival. Methods A retrospective study, included 24 patients with histopathological proven AIFRS to review the para nasal sinus MRI findings. MRI were evaluated for the sinus involvement and the extrasinus extension into the orbit and/or the brain. Vascular structures were assessed for the development of vascular complications, like ICA for thrombosis, attenuation or pseudoaneurysm, cavernous sinus and superior ophthalmic veins for thrombosis. Results Of the reviewed 24 patients, 16 had cavernous sinus thrombosis, 15 had ICA thrombosis, 10 had ophthalmic vein thrombosis, 4 had ICA attenuation and only two cases had pseudoaneurysm of the ICA. Vascular thrombosis was more common with mucormycosis with cavernous sinus and ophthalmic vein thrombosis which were significantly increased among non survivor patients (90%, 70%), as compared to the survivor patients (50%, 14.29%), with P = 0.04 and 0.005 respectively. Conclusions Vascular complications are common in patients with AIFRS. MRI is helpful in accurate detection of vascular complications in patients with AIFRS.
Background Diagnosis of tumour thrombosis and differentiating it from benign thrombosis are essential for managing patients, planning treatments, and minimising unneeded anticoagulation therapy. Bland thrombi occur in both cancer and non-cancer patients; tumour thrombi and bland can coexist. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is useful in detecting and diagnosing tumour thrombosis and distinguishing it from benign thrombosis. Objective This study’s aim was to assess the value of 18F-FDG PET/CT in distinguishing benign from malignant portal vein thrombosis (PVT) in liver cirrhosis patients. Methods A retrospective study was conducted on 38 patients who had PVT that was histopathologically confirmed and performed 18F-FDG PET/CT scans at our institute between January 2021 and April 2022. For all patients, sociodemographic data, visual analysis, semiqualitative analysis (SUVmax value), and associated hepatic pathology were collected. Results The SUVmax values were significantly higher in the tumour thrombosis group (6.26 ± 1.94), compared to the bland thrombosis group (1.79 ± 0.69), (P < 0.001). The ROC curve of semiqualitative analysis (SUVmax) revealed a sensitivity of 96.3% and a specificity of 36.4%, at area under curve of 0.827 with SUVmax > 3.5 as the pathological cut-off value to distinguish tumour from bland thrombi. Conclusions By using semiqualitative analysis, 18F-FDG PET/CT is a valuable new technique in differentiating between neoplastic and bland PV thrombi, with optimal cut-off SUVmax value > 3.5 as a criterion.
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