What is the best fruit juice to use as a negative oral contrast agent in magnetic resonance cholangiopancreatography?

Renzulli, Matteo; Biselli, Maurizio; Fabbri, Elena; Caretti, Daniele; Sergenti, A.; Modestino, Francesco; Giannone, Ferdinando; Storchi, M.; Pierotti, Luisa; Golfieri, Rita

doi:10.1016/j.crad.2018.11.005

Cited by 12 publications

(25 citation statements)

References 27 publications

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“…The FIESTA sequence is widely used in the evaluation of different anatomical districts, such as vascular or biliary ones [ 2 , 3 ]. Nonetheless, this sequence could be very helpful in evaluating the urinary tract for many reasons: it does not need the use of contrast media; it provides images with very short acquisition times; it uses the T2 steady state contrast mechanism providing high signal-to-noise ratio images with strong signal from fluids, while suppressing background tissue for better contrast and anatomic detail evaluation; it provides the analysis of the walls, differently from the standard T1-weighted images post-contrast media, which create “luminographic” images (without the possibility to evaluate the walls of different structures, such as biliary tract); it provides images with high spatial resolution facilitating the post processing (maximum intensity projection, volume rendering, or three-dimensional navigator techniques).…”

Section: Discussionmentioning

confidence: 99%

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Inguinal ureter herniation evaluated with magnetic resonance imaging: a case report

et al. 2020

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Background The herniation of the ureter into the inguinal canal is a rare condition, but probably underreported. Acquired nephroptosis could cause herniation of the ureter and, therefore, when diagnosed, a full study of the urinary tract should be performed especially in patients with inguinal hernia. Case presentation We present the case of an 86-year-old white man with a herniated ureter likely caused by acquired nephroptosis presenting with acute urinary retention, documented with magnetic resonance imaging for the first time. Conclusions The Fast Imaging Employing Steady State Acquisition sequence on magnetic resonance imaging, for many reasons, could allow correct evaluation of the urinary tract, especially in cases of renal dysfunction that contraindicate the use of intravenous contrast agents.

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Section: Discussionmentioning

confidence: 99%

“…Most reported cases are noted at the time of surgical exploration for inguinal hernia repair, or later as a result of an operative injury [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Inguinal ureter herniation evaluated with magnetic resonance imaging: a case report

et al. 2020

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“…The following demographical data of the patient population were collected in a dedicated database: age, sex, previous cholecystectomy and any indications for MRCP other than previous diagnosis of biliary tree disease (follow-up MRCP). All the MRCP examinations were performed as per a standardised protocol that has been previously described in detail, 15,16 using the same single 1.5 T MRI superconductive scanner (HDX-t Signa; General Electric®, Milwaukee, WI, USA). The examinations were evaluated by two radiologists-one (MR) with more than 15 years of experience in hepato-bilio-pancreatic disease and the other (SB) with 8 years of experience in the same radiological field.…”

Section: Patients and Imaging Techniquementioning

confidence: 99%

“…10,14 Therefore, it is crucial to acquire appropriate knowledge about normal and variant anatomies of intrahepatic and extrahepatic biliary systems. 4 Magnetic resonance cholangiopancreatography (MRCP) is the most accurate imaging modality for assessing the intrahepatic and extrahepatic bile tracts and the CD owing to its multiple abilities [15][16][17] ; it is the preferred non-invasive technique for evaluating the biliary tract if immediate therapy for a known problem is not the primary aim. 18 Although establishing the correct diagnosis of CD variants is essential for assessing subjects at higher risks of both spontaneous and surgical bile duct injury, 1,10,14 to the best of our knowledge, no large series has focused on the evaluation of CD variants using MRCP.…”

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confidence: 99%

“…However, it is widely established that MRCP represents the most accurate imaging modality for assessment of the entire biliary tree. [15][16][17][18] The third possible limitation could be that the new EHBD classification has been arbitrarily constructed based on percentile distribution. However, the category delineations were driven by the following four key points: the use of a quantitative classification that increases the reliability of the method, the construction of a 'common-finding' category that includes most patients between the 25th and 75th percentiles, the clinical meaning of type 1 that should have included most cases of intra-pancreatic CD that are related to biliary tree disease, and finally, the easy-to-use MRCP modality and classification that enables the radiologist to perform an initial evaluation for atrisk patients by splitting the EHBD first in half and then in two other parts in the upper level.…”

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confidence: 99%

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A New Quantitative Classification of the Extrahepatic Biliary Tract Related to Cystic Duct Implantation

Renzulli

Brocchi

Marasco

et al. 2021

Journal of Gastrointestinal Surgery

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Background Knowledge regarding biliary anatomy and its variations, including the cystic duct (CD), is important in the pre-surgical setting and for predicting biliary diseases. However, no large series has focused on CD evaluation using a quantitative analysis. The primary aim of this prospective study was to create a ‘taxonomic’ classification of CD anatomy in a large cohort of subjects who underwent magnetic resonance cholangiopancreatography (MRCP). The secondary aim was to evaluate the correlations between extrahepatic bile duct (EHBD) variants and biliary diseases. Methods We enrolled patients who underwent MRCP for different clinical indications from January 2017 to May 2019. Demographical, anatomical and clinical data were evaluated using statistical analyses, as appropriate. The anatomical assessment of EHBD was performed using the standard classification for CD in low, medium, and high insertions, and the lengths of CD to the duodenal papilla (DP), and EHBD was determined to conduct a new quantitative analysis. Results The final study population comprised 1004 subjects. A new classification for EHBD as per the percentile distribution of the ratio CDDP/EHBD was designed, and the following categories were obtained: type 1 (below the 25th percentile) for CDDP/EHBD ratio ≤ 50%; type 2 (25th to 75th percentile) for CDDP/EHBD ratio 51–75% and type 3 (above the 75th percentiles) for CDDP/EHBD ratio > 75%. Type 1 of the new classification of CD implantation was significantly superior in terms of the detection of low, medial and intra-pancreatic CD that was significantly correlated with a high risk of choledochal lithiasis in comparison with the standard classification (P < 0.001). Conclusions The new classification of CD implantation enables identification of the vast majority of intra-pancreatic CDs that are correlated with a high risk of choledochal lithiasis in a single category (type 1) that is easy to identify using imaging.

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Pancreas divisum inversus

2019

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Pancreatic duct variations are usually diagnosed incidentally, in particular when using magnetic resonance cholangiopancreatography (MRCP), the most accurate imaging modality for depicting the pancreatic ductal system. However, the frequency and the embryologic development of pancreatic variants have not been well investigated. The purpose of this prospective study was to investigate the frequency of pancreatic ductal variants, providing potential explanations of their embryologic basis. The pancreatic ductal anatomies of 202 patients with mean ± SD age of 54 ± 27 years, 56% females, who underwent MRCP for different indications between April 2018 and March 2019 were prospectively collected. Normal pancreatic ductal variants were identified in 196 cases (97%), and variants of pancreas divisum in 6 cases (3%). In the type C variant of the normal pancreatic anatomy, found in 3% of cases, the dorsal duct was joined to the ventral duct while the accessory duct did not communicate with the dorsal duct. Unlike the classical type C variant, in our cases, the accessory pancreatic duct was very long (mean ± SD of 58 ± 8.5 mm) and originated in the lower portion of the pancreatic head, caudally to the duct of Wirsung. This was a new subtype of the type C variant or a new variant which could be called "pancreas divisum inversus"; the accessory pancreatic duct could be called the Isolated duct of Santorini. Reporting this new variant 2 could increase the knowledge regarding pancreatic anatomy to avoid misdiagnosis and to help in better understanding pancreatic diseases and their relative treatment.

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What is the best fruit juice to use as a negative oral contrast agent in magnetic resonance cholangiopancreatography?

Cited by 12 publications

References 27 publications

Inguinal ureter herniation evaluated with magnetic resonance imaging: a case report

Inguinal ureter herniation evaluated with magnetic resonance imaging: a case report

A New Quantitative Classification of the Extrahepatic Biliary Tract Related to Cystic Duct Implantation

Pancreas divisum inversus

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