A heavily T2-weighted gradient-echo sequence was used for magnetic resonance (MR) imaging of the biliary system in five healthy volunteers and 13 patients with obstructive jaundice. Images were obtained in the sagittal and coronal planes during sequential breath-hold intervals and were post-processed by using a maximum-intensity projection algorithm. The extrahepatic and intrahepatic bile ducts were well visualized in 11 patients. The level of obstruction and the grade of dilatation were depicted with MR cholangiography. However, the cause of obstruction could be determined with MR cholangiography in only eight cases. The part of the biliary system below the obstruction could not be visualized with MR cholangiography. In the volunteers, MR cholangiography could demonstrate the anatomy of the biliary tract in only two subjects. Possible causes for this phenomenon are the limited spatial resolution of MR imaging, partial volume effects, or flow within the bile ducts. MR cholangiography may be a useful adjunctive tool for noninvasive evaluation of patients with obstructive jaundice. However, further technical advances are necessary to improve image quality.
So far no cases of nephrogenic systemic fibrosis (NSF) have been published on macrocyclical gadolinium-based contrast media (Gd-CM), assumed as low NSF risk CM due to their complex stability. In our haemodialysis-dependent patient, the first symptoms indicating NSF appeared about 16 months after the exposure to Gadovist, a macrocyclical Gd-CM, and 1 month after x-ray angiography with iodinated CM (Ultravist). This indicates that in addition to excretory renal failure and Gd-CM exposure, the loss of biosynthetic renal function could be essential for NSF development. A hypothesis of possible pathways involved in the development of NSF is presented.
On 78 patients with dysfunction of haemodialysis vascular access (predominantly poor flow) systematic radiographic evaluation was performed. In all cases arteriography was carried out, followed by venous angiography in patients exhibiting occlusion of the arteriovenous fistula or the graft, respectively. In 11 cases (14%) occlusion or significant stenosis of far proximal venous vessels (axillary and/or subclavian vein) could be detected. It is suggested that consecutive deterioration of central venous runoff may induce or aggravate malfunctioning of the shunt and, moreover, may contribute to recurrent thrombosis of arteriovenous fistulae or grafts.
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