胆道造影在胆管黏液性囊腺瘤诊断中的作用

目的 探讨经皮肝穿刺胆道造影(percutaneous transhepatic cholangiography,PTC)在胆管黏液性囊腺瘤(hepatobiliary mucinous cystadenoma)诊断中的作用,提高本病的诊断水平. 方法 总结2004-01 ～2014-06收治的10例病理诊断为肝内胆管黏液性囊腺瘤的临床表现、影像学和PTC特点,回顾性分析PTC在胆管黏液性囊腺瘤诊断中的作用. 结果 10例肝脏囊腺瘤患者中MRI或CT见肝内部分胆管和胆总管扩张,无明显占位;6例行PTC显示胆总管不显影或显影不全,经抽吸出胶冻状物质后胆总管显影. 结论 肝胆管黏液性囊腺瘤PTC表现有特殊性,具有较高的诊断价值.     

Which is the best MRI marker of malignancy for atypical cirrhotic nodules: Hypointensity in hepatobiliary phase alone or combined with other features? Classification after Gd‐EOB‐DTPA administration

Purpose:

To investigate whether the malignancy of atypical nodules in cirrhosis can be identified at gadoxetic‐acid‐disodium(Gd‐EOB‐DTPA)‐MRI by their hypointensity in the hepatobiliary(HB)‐phase alone or combined with any other MR imaging features.

Materials and Methods:

One hundred eleven atypical nodules detected in 77 consecutive Gd‐EOB‐DTPA‐MRIs were divided, based on arterial‐phase behavior, into: Class I, isovascular (n = 82), and Class II, hypervascular without portal/delayed washout (n = 29). The two classes were further grouped based on HB‐phase intensity (A/B/C hypo/iso/hyperintensity). Portal/venous/equilibrium‐phase behavior and T2w features were also collected. Histology was the gold standard. Per‐nodule sensitivity, specificity, negative and positive predictive values (NPV/PPV), and diagnostic accuracy were calculated for HB‐phase hypointensity alone, and combined with vascular patterns and T2w hyperintensity.

Results:

Histology detected 60 benign and 51 malignant/premalignant nodules [10 overt hepatocellular carcinomas (HCCs) and 41 high‐grade dysplastic nodules (HGDN)/early HCC]. Class IA contained 31 (94%) malignancies, IB one (3%), and IC only benign lesions. Class IIA had 100% malignancies, IIB three (37.5%) and IIC only two (28.5%). HB‐phase hypointensity alone (Classes I–IIA) had 88% sensitivity, 91% NPV, and 93% diagnostic accuracy, superior (P < 0.05, P < 0.006, and P < 0.05, respectively) to any other MR imaging feature alone or combined.

Conclusion:

In atypical cirrhotic nodules, HB‐phase hypointensity by itself is the strongest marker of malignancy. J. Magn. Reson. Imaging 2012;36:648–657. © 2012 Wiley Periodicals, Inc.     

Gadoxetic acid-enhanced T1-weighted MR cholangiography in primary sclerosing cholangitis

Purpose:

To investigate the value of gadoxetic acid‐enhanced three‐dimensional T1‐weighted MR cholangiography (T1w‐MRC) in comparison to three‐dimensional T2‐weighted MR cholangiopancreaticography (T2w‐MRCP) in patients with primary sclerosing cholangitis (PSC).

Materials and Methods:

Thirty‐four MR exams in 29 patients (46.0 ± 16.1 years; 19 men, 10 women) scanned within a 14‐month period were retrospectively included. Two abdominal radiologists independently evaluated image quality regarding image contrast, image quality degradation due to artifacts, and visualization quality of ducts. The order of biliary tree branches that were visualized and reader preference toward each method were recorded. Helpfulness of T1w‐MRC was scored in consensus. Confirmatory endoscopic retrograde cholangiopancreaticography (ERCP) performed within 3 months of the MR examination was available in 8 patients.

Results:

Image quality of T1w‐MRC and T2w‐MRCP was graded good to excellent in all cases. There were advantages for both T1w‐MRC (functional information, less degradation due to artifacts) and T2w‐MRCP (higher order of visualized branches, better branch depiction). Both readers showed preference for T2w‐MRCP; however, both readers found gadoxetic acid–enhanced T1w‐MRC helpful in the majority of cases.

Conclusion:

Gadoxetic acid‐enhanced T1w‐MRC is complementary to, but should not replace, T2w‐MRCP. T1w‐MRC is a useful adjunct to T2w‐MRCP for morphologic evaluation and provides additional diagnostic information. J. Magn. Reson. Imaging 2012;36:632–640. © 2012 Wiley Periodicals, Inc.     

Short rigid scope and stereo-scope designed specifically for open abdominal navigation surgery: clinical application for hepatobiliary and pancreatic surgery

Background

We have reported the utility of an image display system using augmented reality (AR) technology in hepatobiliary surgery under laparotomy. Among several procedures, we herein report a system using a novel short rigid scope and stereo-scope, both designed specifically for open abdominal navigation surgery, and their clinical application for hepatobiliary and pancreatic surgery.

Methods

The 3D reconstructed images were obtained from preoperative computed tomography data. In our specialized operating room, after paired-point matching registration, the reconstructed images are overlaid onto the operative field images captured by the short rigid scopes. The scopes, which are compact and sterilizable, can be used in the operative field. The stereo-scope provides depth information. Eight patients underwent operations using this system, including hepatectomy in two, distal pancreatectomy in three, and pancreaticoduodenectomy in three patients. The stereo-scope was used in five patients.

Results

All eight operations were performed safely using the novel short rigid scopes, and stereo images were acquired in all five patients for whom the stereo-scope was used. The scopes were user friendly, and the intraoperative time requirement for our system was reduced compared with the conventional method.

Conclusions

The novel short rigid scope and stereo-scope seem to be suitable for clinical use in open abdominal navigation surgery. In hepatobiliary and pancreatic surgery, our novel system may improve the safety, accuracy and efficiency of operations.     

The Patterns of Glycine and Taurine Conjugates of Bile Acids in Serum in Hepatobiliary Disease

Fasting serum concentrations of glycine and taurine conjugates of cholic, chenodeoxycholic, and deoxycholic acid were measured with a high-pressure liquid chromatography-enzymatic assay in patients with hepatobiliary disease. The total glycine to taurine ratio was significantly lower in extrahepatic cholestasis (median 1.1) than in cirrhosis (median, 2.0) and controls (median, 1.7). In patients with cirrhosis the ratio was significantly correlated with the S-bilirubins, P-coagulation factors (II + VII + X), and S-total conjugated bile acids. Because of large overlaps of the ratio between the groups the glycine to taurine ratio is of hardly any diagnostic value. The ratio of cholic acid conjugates to chenodeoxycholic acid conjugates was over 1.5 in 10 of 12 cholestasis patients and below this value in all but 1 patient with cirrhosis; the separation of the groups was not improved by splitting the ratio in glycine and taurine conjugates. This study does not suggest that separate determination of glycine and taurine conjugates of bile acids in serum adds diagnostic information in hepatobiliary disease.     

Biliary cystadenoma of the liver

Hepatobiliary cystadenoma is an uncommon lesion that is difficult to diagnose preoperatively. Here we report a 34-year-old woman who presented with enlargement of a cyst that had been observed for the previous 6 months. Diagnostic imaging revealed a 7-cm diameter cystic mass with irregular multiple septation in her liver. All laboratory test results were normal except for serum carbohydrate antigen (CA) 19–9 (62.5 U/ml). Because of the malignant potential and the history of enlargement, a complete surgical excision was performed. The patient was discharged after a good recovery; 2 months after surgery her serum CA19-9 level had returned to normal (32.9 U/ml). Regardless of the diagnostic modalities used, cystadenoma and cystadenocarcinoma cannot be differentiated with accuracy. Therefore complete surgical resection is the recommended therapy.     

Biliary cystadenoma of the liver

Hepatobiliary cystadenoma is an uncommon lesion that is difficult to diagnose preoperatively. Here we report a 34-year-old woman who presented with enlargement of a cyst that had been observed for the previous 6 months. Diagnostic imaging revealed a 7-cm diameter cystic mass with irregular multiple septation in her liver. All laboratory test results were normal except for serum carbohydrate antigen (CA) 19-9 (62.5 U/ml). Because of the malignant potential and the history of enlargement, a complete surgical excision was performed. The patient was discharged after a good recovery; 2 months after surgery her serum CA19-9 level had returned to normal (32.9 U/ml). Regardless of the diagnostic modalities used, cystadenoma and cystadenocarcinoma cannot be differentiated with accuracy. Therefore complete surgical resection is the recommended therapy. Received for publication on Nov. 25, 1997; accepted on April 6, 1998     

Immunohistochemical demonstration of progesterone receptor in hepatobiliary cystadenoma with mesenchymal stroma

A case of hepatobiliary cystadenoma with mesenchymal stroma is documented in which unequivocal immunostaining for progesterone receptors was observed in mesenchymal cells. These cells were negative for oestrogen receptor. This suggests that the proliferation of the stromal component may be related to the presence of endogenous progesterone.     

核素显像在病毒性乙型肝炎中的临床价值探讨

目的　探讨病毒性乙型肝炎患者放射性核素肝胆显像的改变 ,分析其临床意义。方法　采用 99m Tc- EHIDA肝胆显像技术测定 40例病毒性乙型肝炎患者的肝胆运动功能 ,以 2 0例肝胆功能正常者作为对照。结果　乙型肝炎组与非肝病组对比肝脏最高计数时间、肝脏半排时间、6 0分钟排泌率、心区半清除时间和肝管、胆囊、胆总管及肠道显像时间有明显延迟和减慢 (P <0 .0 1 ) ,并与肝功能损害有密切关系。结论　乙型肝炎患者常伴有肝胆运动障碍 ,且与肝功能损伤程度有关。     

Identification of carcinoembryonic antigen (CEA) in bile of patients with malignant biliary tract disease

As a diagnostant of malignant hepato-biliary tract disease, carcinoembryonic antigen (CEA) levels in the bile and serum were evaluated in 12 patients with benign and 19 patients with malignant hepato-biliary diseases. Of the 12 patients with benign disease, 3 had a residual choledocholithiasis. CEA levels were determined in 7 patients with cancer of the head of pancreas or of the duodenal ampulla. Bile samples were obtainedvia biliary tract drainage after allowing for sufficient time to exclude the effects of pre-existing bile stasis or inflammation. The average serum CEA levels from 8 patients with benign disease were 1.5±0.23 ng/ml in contrast to 3.3±0.55 ng/ml in 18 with a malignancy (p<0.05). The average CEA levels in bile from 9 patients with benign and 19 with a malignancy were 1.7±0.31 ng/ml and 7.6±1.70 ng/ml respectively (p<0.01). In 3 with residual choledocholithasis, serum and bile CEA levels were 2.0±0.46 ng/ml and 13.1±6.47 ng/ml. The serum and bile CEA levels from 7 patients with cancer of the head of the pancreas or of duodenal ampulla were 2.5±0.32 ng/ml and 8.8±3.3 ng/ml, respectively. Although measurement of both serum and bile CEA levels in patients with hepato-biliary tract disease proved to be useful for differentiation of malignant from benign disease, the high value obtained strongly suggests the presence of a malignancy in addition to the residual choledocholithiasis and cancer of the head of the pancreas or of the duodenal ampulla.