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MRCP and MRI findings in 9 patients with autoimmune pancreatitis

World Journal of Gastroenterology 2006年第18期12卷 2919-2922页

作者： Terumi Kamisawa Pong-Yui Chen Yuyang Tu Hitoshi Nakajima Naoto Egawa Kouji Tsuruta Atsutake Okamoto noriko kamata Department of Internal Medicine Tokyo Metropolitan Komagome Hospital Bukyo-ku Tokyo Japan Department of Surgery Tokyo Metropolitan Komagome Hospital Bunkyo-ku Tokyo Japan Department of Radiology Tokyo Metropolitan Komagome Hospital Bunkyo-ku Tokyo Japan

AIM： To evaluate magnetic resonance cholangiopancreatography （HRCP） findings in conjunction with magnetic resonance （MR） images in autoimmune pancreatitis （AIP） patients. METHODS： Nine patients with AIP underwent HRI, HRCP, endoscopic retrograde cholangiopancreatography （ERCP）, computed tomography, and ultrasonography. The HRCP and MR images taken before and after steroid therapy were reviewed and compared with other imaging modalities. The HRCP findings of the AIP cases were compared to those of 10 cases with carcinoma of the head of the pancreas.RESULTS： On MRCP, the narrowed portion of the main pancreatic duct noted on ERCP was not visualized, while the non-involved segments of the main pancreatic duct were visualized. The degree of upstream dilatation of the proximal main pancreatic duct was milder than that seen in cases of pancreatic carcinoma. Stenosis or obstruction of the lower bile duct was detected in 8 patients. MR images showed enlargement of the pancreas with decreased signal intensity on T1- weighted MR images, increased signal intensity on T2- weighted MR images, and, in 3 patients, a hypointense capsule-like rim. After steroid therapy, the previously not visualized portion of the main pancreatic duct was seen, along with improvement of the bile duct stenosis. Pancreatic enlargement decreased, and the abnormal signal intensity on both T1- and T2-weighted MR images became isointense.CONCLUSION： MRCP cannot differentiate irregular narrowing of the main pancreatic duct seen with AIP from stenosis of the main pancreatic duct seen with pancreatic carcinoma. However, MRCP findings in conjunction with MR imaging of pancreatic enlargement that shows abnormal signal intensity on T1- and T2- weighted MR images are useful in supporting a diagnosis of AIP.

关键词： Autoimmune pancreatitis Magnetic resonance cholangiopancreatography Magnetic resonance

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Angle of covered self-expandable metallic stents after placement is a risk factor for recurrent biliary obstruction

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World Journal of Hepatology 2022年第5期14卷 992-1005页

作者： Kojiro Tanoue Hirotsugu Maruyama Yuki Ishikawa-Kakiya Yosuke Kinoshita Kappei Hayashi Masafumi Yamamura Masaki Ominami Yuji Nadatani Shusei Fukunaga Koji Otani Shuhei Hosomi Fumio Tanaka noriko kamata Yasuaki Nagami Koichi Taira Toshio Watanabe Yasuhiro Fujiwara Department of Gastroenterology Osaka City University Graduate School of MedicineOsaka 545-8585Japan

BACKGROUND Studies have shown that covered self-expandable metallic stents(CSEMS)with a low axial forces after placement can cause early recurrent biliary obstruction(RBO)due to precipitating sludge *** To ascertain whether the angle of CSEMS after placement is a risk factor for RBO in unresectable distal malignant biliary obstruction(MBO).METHODS Between January 2010 and March 2019,261 consecutive patients underwent selfexpandable metallic stent insertion by endoscopic retrograde cholangiopancreatography at our facility,and 87 patients were included in this *** evaluated the risk factors for RBO,including the angle of CSEMS after placement as the primary *** measured the obtuse angle of CSEMS after placement on an abdominal radiograph using the SYNAPSE PACS *** also evaluated technical and functional success,adverse events,time to RBO(TRBO),non-RBO rate,survival time,cause of RBO,and reintervention procedure as secondary *** We divided the patients into two cohorts based on the presence or absence of *** angle of CSEMS after placement(per 1°and per 10°)was evaluated using the multivariate Cox proportional hazard analysis,which was an independent risk factor for RBO in unresectable distal MBO[hazard ratio,0.97 and 0.71;95%confidence interval(CI):0.94-0.99 and 0.54-0.92;P=0.01 and 0.01,respectively].For early diagnosis of RBO,the cut-off value of the angle of CSEMS after placement using the receiver operating characteristic curve was 130°[sensitivity,50.0%;specificity 85.5%;area under the curve 0.70(95%CI:0.57-0.84)].TRBO in the<130°angle group was significantly shorter than that in the≥130°angle group(P<0.01).CONCLUSION This study suggests that the angle of the CSEMS after placement for unresectable distal MBO is a risk factor for *** novel results provide pertinent information for future stent management.

关键词： Covered self-expandable metallic stents Recurrent biliary obstruction Malignant biliary obstruction Endoscopic retrograde cholangiopancreatography Angle Axial force

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