Contribution of magnetic resonans cholangiopancretography to the diagnosis in the phenomenons of biliary obstruction pre-diagnosis

Yıl 2012, Cilt: 3 Sayı: 2, 59 - 64, 22.10.2012

Zeyneb Değerli Ömer Yılmaz Fatma Gökharman Uğur Koşar

Öz

Objective: The aim of our study was to evaluate the contribution of magnetic resonance cholangiopancretography to the diagnosis of pancreoticobiliary system pathologies in patients who had clinical and/or laboratory findings of biliary obstruction. Material–Method: One hundred and ninety eight cases were added to the study. The cases that were thought to have obstructive biliary tract pathology but incongruous with the findings of ultrasonography and/or computerized tomography were evaluated by using magnetic resonance cholangiopancreatography. Investigation was progressed with 1.5 Tesla MR appliance and (Signa HDI, General Electric, 1Milwaukee, WI, USA), HD 8 splined body array. For statistical analysis SPSS (Statistical Package for Social Sciences) for  Windows 16.0 program was used. Results: One hundred and twenty eight percent of the cases were women (64,6%), 70 % of them were men. Sixty nine out of 198 patients were operated of gall bladder. Seven patients could not be assessed by magnetic resonance cholangiopancreatography. In 43 patients, gallstone was found in saccus. Three patients who have contracted gall blader saccus lumen could not be evaluated in terms of gallstone. In 30 cases (15.2%) choledocholithiasis were detected. In 4 cases (2%) choledocta stent was detected. In 5 patients 2.5(%) structural scantiness was present . In 5 cases (2.5%) inner lumen filling defect in favour of air was reclaimed. Discussion: Magnetic resonance cholangiopancreatography is a diagnostic method which has a potential to substitute endoscopic retrograde cholangiopancreatography. Because it is a non–invasive method, it has a wider usage area currently. With increasing experience and the chance of investigation wider series of patients, evaluations with magnetic resonance cholangiopancreatography will be progressed and diagnostic success rate will increase.

Anahtar Kelimeler

Biliary obstruction, Magnetic resonance cholangiopancreatography, Endoscopic retrograde cholangiopancreatography

Biliyer obstrüksiyon ön tanısı ile başvuran olgularda manyetik rezonans kolanjiopankreotografi bulgularının tanıya olan katkısı

Öz

Amaç: Çalışmamızın amacı biliyer obstrüksiyon klinik ve/veya laboratuar bulguları ile gönderilen hastaların pankreotikobilier sistem patolojilerinin tespitinde manyetik rezonans kolanjiopankreotografi'nin tanıya katkısını değerlendirmektir.
Gereç Yöntem: Çalışmaya 198 olgu dahil edildi. Obstrüktif safra yolu patolojisi düşünülen ancak ultrasonografi ve/veya bilgisayarlı tomografi bulguları uyumsuz olan olgular manyetik rezonans kolanjiopankreotografi ile değerlendirildi. İnceleme 1.5 Tesla MR cihazı ile (Signa HDI, General Electric, 1Milwaukee, WI, USA), HD 8 kanallı body array coil'i kullanılarak yapıldı. İstatiksel analizler için SPSS (Statistical Package for Social Sciences) for Windows 16.0 programı kullanıldı.
Bulgular: Olguların 128'i (%64,6) kadın, 70'i (%35,4) erkekdi. 198 hastanın 69'unda safra kesesi opere edilmişdi. 7 hastada safra kesesi manyetik rezonans kolanjiopankreotografi ile değerlendirilemedi. 43 hastada kesede taş izlendi. Safra kesesi kontrakte olan 3 hastada kese lümeni taş açısından değerlendirilemedi. 30 (%15,2) olguda koledokolitiazis saptandı. 4 (%2) olguda koledokta stent izlendi. 5 (%2,5) hastada striktürel darlık mevcuttu. 5 (%2,5) olguda ise lümen içi dolum defekti hava lehine değerlendirildi.
Sonuç: Manyetik rezonans kolanjiopankreotografi, tanısal endoskopik retrograd kolanjiopankreotografi'nin yerine geçme potansiyeline sahip bir inceleme yöntemidir. Non-invaziv bir yöntem olması nedeniyle günümüzde giderek daha geniş bir kullanım alanı kazanmaktadır. Deneyimin artması ve daha geniş serilerle çalışma imkanı ile manyetik rezonans kolanjiopankreotografi değerlendirmesinde ilerleme sağlanacak böylece tanısal başarı artacaktır. 

Anahtar Kelimeler

Biliyer obstrüksiyon, Manyetik rezonans kolanjiopankreotografi, Endoskopik retrograd kolanjiopankreotografi

Kaynakça

• Bilbao MK, Dotter CT, Lee TG, Katon RM. Complications of ERCP; a study of 10000 cases. Gastoenterology 1976; 70(3): 314–320.
• Fulcher AS. MRCP and ERCP in the diagnosis of common bile duct stones. Gastrointest Endosc 2002; 56(6):178–182.
• Andriulli A, Solmi L, Loperfido S, Leo P, Festa V, Belmonte A, et al. Prophylaxis of ERCP– related pancreatitis: a randomized, controlled trial of somatostatin and gabexatemesylate. Clin Gastroenterol Hepatol 2004; 2:713–718.
• Sackmann M, Beuers U, Helmberger T. Biliary imaging: magnetic resonance cholangiography versus endoscopic retrograde cholangiography. Journal of Hepatology 1999; 30:334–338.
• Stiris MG, Tennoe B, Aadland E, Lunde OC. MR Cholangiopancreatography and endoscopic retrograde cholangiopancreatography in patients with suspected common bile duct stones. Acta Radiol 2000; 41:269–272.
• Soto JA, Barish MA, Yucel EK, Siegenberg D, Ferrucci JT, Chuttani R. Magnetic resonance cholangiography: comparison with endoscopic retrograde cholangiopancreatography Gastroenter- ology 1996; 110:589–597.
• Varghese JC, Farrell MA, Courtney G, Osborne H, Murray FE, Lee MJ. A prospective comparison of magnetic resonance cholangiopancreatography with endoscopic retrograde cholangiopancreatography in the evaluation of patients with suspected biliary tract disease. Clin Radiol 1999; 54:513–520.
• Romagnuolo J, Bardou M, Rahme E, Joseph L, Reinhold C, Barkun AN. Magnetic resonance cholangiopancreatography: a meta–analysis of test performance in suspected biliary disease. Ann Intern Med 2003; 139:547–557.
• Kaltenthaler E, Vergel YB, Chilcott J, Thomas S, Blakeborough T, Walters SJ, et al. A systematic review and economic evaluation of magnetic resonance cholangiopancreatography compared with diagnostic endoscopic retrograde cholangiopancreatography. Health Technology Assessment 2004; 8(10):1–6.
• Moon JH, Cho YD, Cha SW, Cheon YK, Ahn HC, Kim YS, et al. The detection of bile duct stones in suspected biliary pancreatitis: Comparison of MRCP, ERCP, and intraductal US. Am J Gastroenterol 2005; 100:1051–1057.
• Kaltenthaler EC, Walters SJ, Chilcott J, Blakeborough A, Vergel YB, Thomas S. MRCP compared to diagnostic ERCP for diagnosis when biliary obstruction is suspected: a systematic review. BMC Med Imaging 2006; 6:9–24.
• David V, Reinhold C, Hochman M, Chuttani R, McKee J, Waxman I, et al. Pitfalls in the interpretation of MR cholangiopancreatography. AJR Am J Roentgenol 1998; 170:1055–1059.
• Little AF, Smith PJ, Lee WK, Hennessy OF, Desmond PV, Banting SW, et al. Imaging of the normal and abnormal pancreaticobiliary system with single–shot MR cholangiopancreatography: a pictorial review. Australas Radiol 1999; 43:427– 434.
• Barish MA, Yucel EK, Ferrucci JT. Magnetic resonance cholangiopancreatography. N Engl J Med 1999; 341:258–264.
• 16– Laing AD, Gibson RN. Magnetic resonance cholangiopancreatography. 1999;43:284–293. Australas Radiol
• Calvo MM, Bujanda L, Calderón A, Heras I, Cabriada JL, Bernal A, et al. Role of magnetic resonance cholangiopancreatography in patients with suspected choledocholitiasis. Mayo Clin Proc 2002; 77:422–428.
• Manfredi R, Brizi MG, Masselli G, Vecchioli A, Marano P. Malignant biliary hilar stenosis: MR cholangiography compared with direct cholangiography. Radiol Med 2001; 102(1–2):48– 54.
• Pavone P, Laghi A, Catalano C, Panebianco V, Fabiano S, Passariello R. MRI of the biliary and pancreatic ducts. Eur Radiol 1999; 9(8):1513– 1522.
• Manfredi R, Brizi MG, Masselli G, Vecchioli A, Marano P. Malignant biliary hilar stenosis: MR cholangiography compared with direct cholangiography. Radiol Med 2001; 102(1–2):48– 54.
• Pavone P, Laghi A, Catalano C, Panebianco V, Fabiano S, Passariello R. MRI of the biliary and pancreatic ducts. Eur Radiol 1999; 9(8):1513– 1522.
• Lincender L, Vrcic D, Sadagic E, Vegar S, Mornjakovic A, Stevic N. Magnetic resonance cholangiopancreatography (MRCP): correlation with diagnosis using ERCP. Med Arh. 2002; 56(1):25–28.