Nicole Nicaise

Magnetic resonance cholangiopancreatography: interest of IV secretin administration in the evaluation of pancreatic ducts

Abstract. The aim of this study was to investigate whether IV secretin administration is useful to enhance the delineation of the main pancreatic duct (MPD) and its side branches, and if it provides additional information concerning signal voids and strictures. Twenty-seven patients referred for abdominal pain or laboratory abnormalities (group 1, n = 13) or for the follow-up of chronic pancreatitis (CP; group 2, n = 14) were studied. Magnetic resonance cholangiopancreatography was acquired at 1.5 T before and after IV secretin by a coronal 3D TSE T2-weighted sequence with maximum intensity projection postprocessing. In group 1 secretin provided a better visualization of MPD in 9 patients. In a patient with pancreas divisum, it allowed suggestion of stenosis of the accessory papilla, confirmed at endoscopic retrograde cholangiopancreatography (ERCP). In group 2 secretin provided a better visualization of MPD only in the 3 patients with mild disease. A mild dilation upstream a stricture occurred in 2 cases and a marked dilation appeared upstream a wallstent which was non-patent at ERCP. Few changes were noticed concerning side branches. These preliminary results indicate that in patients without CP, secretin improves MPD delineation avoiding invasive diagnostic ERCP. In patients with mild CP secretin does not improve the characterization of signal voids, but it may be useful to appreciate their significance and to follow-up stenosis.

Transcatheter Embolization of Pseudoaneurysms Complicating Pancreatitis

AbstractPurpose: To evaluate the therapeutic role of angiography in patients with pseudoaneurysms complicating pancreatitis. Methods: Thirteen symptomatic pseudoaneurysms were treated in nine patients with pancreatitis. Eight patients had chronic pancreatitis and pseudocyst and one had acute pancreatitis. Clinical presentation included gastrointestinal bleeding in seven patients and epigastric pain without bleeding in two. All patients underwent transcatheter embolization. Results: Transcatheter embolization resulted in symptomatic resolution in all patients. Rebleeding occurred in two patients, 18 and 28 days after embolization respectively, and was successfully treated by repeated emnbolization. One patient with severe pancreatitis died from sepsis 28 days after embolization. Follow-up was then available for eight patients with no relapse of bleeding after a mean follow-up of 32 months (range 9—48 months). Conclusion: Transcatheter embolization is safe and effective in the management of pseudoaneurysms complicating pancreatitis.

Secretin-enhanced MR pancreatography

MR cholangiopancreatography has now emerged as a noninvasive diagnostic technique that can replace diagnostic endoscopic retrograde cholangiopancreatography in many instances. Recent technical issues include the use of fast single-shot T2-weighted single-slice projections in combination with a negative oral contrast agent and secretin stimulation for assessment of pancreatic flow dynamics and duodenal filling. Potential clinical applications include the evaluation of patients with recurrent pancreatitis and inconclusive CT examination as well as the evaluation of chronic pancreatitis complications whenever endoscopic treatment is suggested. In combination with cross-sectional MR sequences, secretin-enhanced MR pancreatography offers the possibility of a comprehensive examination of the pancreas that provides parenchymal, ductal, and functional information within a single diagnostic modality.

Right diaphragmatic rupture and hepatic hernia: An indirect sign on computed tomography

Abstract. We report a case of blunt traumatic right diaphragm rupture with hepatic hernia. The diagnosis was first suggested by an abnormal hepatic location depicted on axial CT. This finding can be considered as a potentially new indirect sign of right diaphragm rupture in patients with blunt trauma. The diagnosis was then confirmed by reformatted CT and MR images.

The ultraflex diamond stent for benign biliary obstruction

The Ultraflex Diamond stent presents three features that might be of interest when treating biliary strictures: ease of insertion, high flexibility, and presentation of relatively large meshes. Limited clinical studies have shown its efficacy in relieving duct obstruction (in contrast with some other stent models, correct positioning of the Ultraflex Diamond stent provides adequate biliary drainage in almost all cases), and satisfactory long-term patency rates. The main improvement awaited is an efficient means to prevent late stent obstruction. The addition of coverage to this stent is feasible and could be the first step toward this goal.

Rupture of pseudoaneurysm: a cause of delayed hemorrhage after endoscopic cystoenterostomy; angiographic diagnosis and treatment

extensive necrosis of the mucosa and multiple vascular microthrombosis found in duodenal biopsy specimens confirmed our suspicion of ischemia. Our patient had a good clinical response to conservative treatment, probably because of the limited extension of the bowel ischemia. Indeed, a second endoscopy, performed 2 weeks after admission, revealed a significant improvement. This course seems to be similar to that described for ischemic colitis, in which rapid resolution of lesions occurs in most cases.9 This report emphasizes that the clinician should look for an ischemic episode when a PNH patient presents acute abdominal pain. Unfortunately for these patients, bowel thrombosis tends to be recurrent and the overall prognosis remains poor.

Cholangiographie par résonance magnétique dans le diagnostic de lithiase de la voie biliaire principale

RésuméLa cholangiopancréatographie par résonance magnétique (CPRM) est une nouvelle technique d’imagerie pour le diagnostic des maladies bilio-pancréatiques. L’intérêt croissant pour cette modalité diagnostique est lié d’une part à son caractère non invasif et d’autre part à la présentation de l’information qui est similaire à celle des techniques d’opacification directe. L’avènement de la cholécystectomie par cœlioscopie a remis à l’avant-plan le diagnostique pré-opératoire de l’obstacle biliaire lithiasique. La CPRM présente des résultats prometteurs dans le diagnostic des obstructions biliaires et de la lithiase de la voie biliaire principale (VBP) et fournit une cartographie de l’arbre biliaire utile à l’acte chirurgical, réduisant le risque de traumatisme biliaire. Notre propos a été de présenter la technique, les résultats publiés dans la littérature et de discuter la place actuelle de la CPRM dans le bilan pré-cholécystectomie.SummaryMagnetic resonance cholangiopancreatography (MRCP) is a new imaging technique for examining patients with suspected biliary or pancreatic disease. The increasing interest on MRCP relies on its non invasiveness and on the projectional display of the biliary tree and pancreatic ducts in a way similar to contrast radiography. Since the advent of laparoscopic cholecystectomy (LC) there has been renewed interest in the diagnosis of common bile duct (CBD) stones. The detection of ductal dilatation and biliary stones with MRCP shows promising results and additionally the technique provides a road map of the biliary tree that may be useful in reducing the risk of bile duct injury during LC. The purpose of this essay is to illustrate the findings of MRCP in CBD stones, to review published data about its accuracy in this field and discuss its potential role in the diagnostic work-up of patients referred for possible choledocholithiasis.