Wertigkeit von Magnetresonanztomographie (MRT), Magnetresonanz-Cholangiopankreatikographie (MRCP) und endoskopischer retrograder Cholangiopankreatikographie (ERCP) bei der Diagnose von Pankreastumoren

Sj, Diehl; Kj, Lehmann; J, Gaa; Hj, Meier-Willersen; Wendl, K.; Georgi, M.

doi:10.1055/s-2007-1011074

Cited by 18 publications

(6 citation statements)

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“…In one of these patients, there was a pancreas head carcinoma in which a mass could not be demarcated on MR scans, no dilatation was seen in pancreatic ductus, and stenosis caused by pancreas head carcinoma was evaluated as benign stricture (Figure 4). In the literature, it has been reported that if there was no ductal dilatation, with MRI and MRCP, the diagnosis of pancreas carcinoma would be difficult [27, 28]. In another patient, stenosis at the papilla level was evaluated as inflammatory stenosis, but it was diagnosed as Ampulla Vateri tumor histopathologically.…”

Section: Discussionmentioning

confidence: 99%

“…In the evaluation of lesions in this region, MRI/MRCP has a low performance due to artifact caused by intraaluminal gas located close to duodenal wall [13]. Therefore, ampullary region is a region that diagnostic mistakes encountered frequently, and if clinical suspicion continues, ERCP method in which ampulla visualized directly should be performed [28, 29]. In the third patient who had a wrong diagnosis, bilioenteric anastomosis had been performed because of chronic pancreatitis 10 years ago, and stenosis developed at anastomosis site was diagnosed as fibrotic stenosis.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Value of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in the Evaluation of the Biliary Obstruction

Bilgin

Toprak

Burgazli

et al. 2012

The Scientific World Journal

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Purpose. In this study, our purpose was to investigate the diagnostic efficacy of the dynamic contrast-enhanced magnetic resonance imaging (MRI) method in the patients with bile duct obstruction. Materials and Methods. 108 consecutive patients (53 men, 55 women, mean age; 55.77 ± 14.62, range 18–86 years) were included in this study. All the patients underwent conventional upper abdomen MRI using intravenous contrast material (Gd-DTPA) and MRCP in 1.5 Tesla MRI scanner. MRCP images were evaluated together with the T1 and T2w images, and both biliary ducts and surrounding tissues were examined for possible pathologies that may cause obstruction. Results. MRI/MRCP findings compared with final diagnoses, MRI/MRCP in the demonstration of bile duct obstruction sensitivity 96%, the specificity 100%, and accuracy 96.3%, in the detection of presence and level of obstruction, the sensitivity 96.7%, specificity 100%, and accuracy 97.2%, in the diagnosis of choledocholithiasis, the sensitivity 82.3%, specificity 96%, and accuracy 91.7%, and in the determination of the character of the stenosis, sensitivity 95.6%, specificity 91.3%, and accuracy 94.5% were found. Conclusion. The combination of dynamic contrast-enhanced MRI and MRCP techniques in patients with suspected biliary obstruction gives the detailed information about the presence of obstruction, location, and causes and is a highly specific and sensitive method.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in the Evaluation of the Biliary Obstruction

Bilgin

Toprak

Burgazli

et al. 2012

The Scientific World Journal

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“…imágenes convencionales de RM a la CPRM para el diagnóstico de enfermedades pancreatobiliares, siendo la RM, actualmente el paso previo a la ERCP en el diagnóstico de lesiones pancreáticas obstructivas (7,8) . La litiasis es la principal causa de obstrucción y dilatación de la vía biliar en nuestro medio, y el reconocerla no parece ser muy dificultoso a manos de un buen operador en ultrasonido, sin embargo, solo en un 70 a 80 % de los pacientes hay dilatación de los conductos biliares.…”

Section: Resonancia Magneticaunclassified

Colangioresonancia (Cprm) vs Ultrasonido (Us) Focalizado en Pacientes Con Ictericia O Sospecha De Obstruccion De La via Biliar: Resultados Preliminares

M¹,

M²,

P³

et al. 2003

Rev. chil. radiol.

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Between January and July, 2003, a single blinded matched trial was done to assess focalized biliary ultrasound (US) and MR cholangiography (MRCP) compared with ERCP or surgery as reference standard in patients with suspected biliary obstruction. Focalized US was performed 24 hrs before/after MRCP. Patients were triage according symptoms, signs and laboratory in high, intermediate and low risk for obstruction. Radiologists sonographers were divided in low and highly experienced. None of the radiologist who reported either US or MRCP was aware to the other test results. Sensitivity, Specificity, PPV and NPV, (LR) Likelihood Ratios and pre and post-test odds for positive and negative test were estimated.We analized 64 out of 76 sampled patients, the prevalence of obstruction was 37 % (24 out of 64 patients). US found biliary tree dilated in 50% and MRCP in 48% of the patients. Main cause of obstruction was common bile duct stones in (16) 25%. and tumors were the second more common cause. US shown a Sensitivity (S) 58.3% when a non experienced radiologist perform the exam, and 70% when an experienced radiologist doest it. Specificity (Sp) 82,5%, PPV 66.7% and NPV 76.7%. RMCP Shown S 95.8%, Sp 87.5%, PPV 82.1%, NPV 97.2% For common bile duct stones US shown a PPV 53.3% and NPV 83.6% on the other hand MRCP a PPV 70% and NPV 95.4%. MRCP perform better than focalized US in overall patients with high risk of obstruction (37.5%), detecting the cause of obstruction but using aditional sequences rising the examination time and costs. With a positive ultrasound and LR(+) 3.3 pretest odds rise from 0.37/37% to a post-test odds of 0.55/55% and with negative test result and LR(-) 0.49 pre-test odds 0.37/37% will decrease to post-test odds of 0.2/20%. With MRCP a positive test with LR(+) 7.7 initial pre-test odds 0.37/37.5% to post-test odds of 0.8/ 80% and with a negative test result LR(-) 0.05 pretest odds 0.37/37% will decrease to post-test odds of 0.03%.Ultrasound performed by experienced sonographers has a Specificity and NPV over 80%, and perform similar to MRCP for detecting biliary tree dilatation the best predictor of obstruction. In patients with low pre-test odds (low risk) of obstruction, to use focalized US and then MRCP, when the cause of obstruction is not diagnosed could be the more cost/ efective initial alternative in this patients. This data must be confirmed with further studies with cost/effectivenes analysis.

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“…Obwohl inzwischen auch an MRT-Geräten mit niedriger und mittlerer Feldstärke qualitativ gute MRCP-Bilder erzeugt werden können [1], können insbesondere bei Nutzung von Hochfeld-Magneten, starken Gradienten und schnellen Sequenzen bestimmte klinische Fragestellungen, die früher der endoskopisch-retrograden Cholangiopancreatographie (ERCP) vorbehalten waren, heute oft durch die MRCP beantwortet werden [2 ± 5], wobei der Wert des Verfahrens durch die gleichzeitige Anwendung der MRT (konventionelle axiale MRT-Aufnahmen) steigt [6,7]. Als Standard haben sich bei den hierfür notwendigen stark T 2 -gewichteten Aufnahmen zwei Verfahrensgruppen herausgebildet, nämlich erstens die Aufnahme von Paketen dünner Schichten in Atemanhaltetechnik, die anschlieûend per Maximum-Intensitäts-Projektion (MIP) zu einem 3D-Bild zusammengefügt werden müssen, und zweitens die Akquisition von dicken Schichten in verschiedener befundbezogener Angulierung, die in wenigen Sekunden ein dreidimensional anmutendes Bild der Gangstrukturen ohne Notwendigkeit der Nachrekonstruktion ergeben [8,9].…”

Section: Schlüsselwörter: Mrt ± Mrcp ± Orale Kontrastmittelunclassified

Der Stellenwert negativer oraler Kontrastmittel in der MR-Cholangiopancreatographie (MRCP)

Petersein¹,

Reisinger²,

Mutze³

et al. 2000

Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr

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Wertigkeit von Magnetresonanztomographie (MRT), Magnetresonanz-Cholangiopankreatikographie (MRCP) und endoskopischer retrograder Cholangiopankreatikographie (ERCP) bei der Diagnose von Pankreastumoren

Cited by 18 publications

References 0 publications

Diagnostic Value of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in the Evaluation of the Biliary Obstruction

Diagnostic Value of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in the Evaluation of the Biliary Obstruction

Colangioresonancia (Cprm) vs Ultrasonido (Us) Focalizado en Pacientes Con Ictericia O Sospecha De Obstruccion De La via Biliar: Resultados Preliminares

Der Stellenwert negativer oraler Kontrastmittel in der MR-Cholangiopancreatographie (MRCP)

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