OBJECTIVE: The purpose of this study was to evaluate the MR spectrum and MR cholangiographic imaging findings of clonorchiasis. MATERIALS AND METHODS: We reviewed 26 patients with confirmed clonorchiasis by either stool tests (n=24) or surgery (n=2). MR imaging was performed on a 1.5 T system (GE Medical Systems, Milwaukee, WI) with a torso coil. Axial T1-and T2-weighted, gadolinium-enhanced dynamic images and MR cholangiography were obtained. Image analyses were used to identify abnormalities of the intrahepatic and extrahepatic bile ducts and the presence of hepatobiliary malignancy. All MR examinations were reviewed by the consensus of two abdominal radiologists. RESULT: Intrahepatic bile duct abnormalities were seen in 23 (89%) of the 26 patients. The most common finding was mild dilatation of the intrahepatic bile duct which was found in 21 (81%). "Too many intrahepatic ducts" were found in 16 (62%), wall enhancement and thickening in 21 (81%) and filling defects and ductal stricture in the intrahepatic bile duct in 6 (24%) and 3 (12%) patients, respectively. Extrahepatic ductal dilation was found in 5 (19%) and 9 (35%) revealed hepatobiliary malignancy. CONCLUSION: MR imaging revealed various findings of clonorchiasis, including dilatation, wall enhancement, stricture of the intrahepatic ducts and filling defect within the intrahepatic bile duct.
Adult ; Aged ; Cholangiography/methods ; Clonorchiasis/*diagnosis/radiography ; Female ; Human ; *Magnetic Resonance Imaging/methods ; Male ; Middle Aged

Ultrasonography is a simple, noninvasive and relatively accurate method to differentiate carcinomas from stones in the extrahepatic biliary tree. We analysed ultrasonic findings in 18 stoen cases and 10 carcinoma cases of the extrahepatic biliary tree, which were confirmed by microscopic examination or percutaneous transhepatic cholangiography during the period of May 1980 through May 1982 in Kangnam St. Mary's Hospital. The results were as follows: 1. The number of incidences of multiple echogenecities was 11 out of the 18 stone cases (61.1%) but there were no incidences of multiple echogenecities among the carcinoma cases. Eight cases, four of stoens and carcinomas each , were not detected by sonography. 2. The average diameter of the stones was below 20mm in 13 of the 18 cases (72 .2%) and the number of the stoens over 20mm in diameter was only one of the 18(5.6%), while the number of carcinomas over 20mm was three of the 10 cases (30%). 3. In the 18 patients with stoens, the degree of echogenecity was uniformly high in seven (38.9%) and mixed-moderate in seven (38.9%) . All the carcinomas, however, presented mixed-slight echogenecity. The marginal sharpness was well defined in nine of the 18 stone cases (50%), but only one among the carclnomas. 4. The obstructive site in the biliary tree in the stone cases showed a typical meniscus in 10 (55 .6%), abrupt cutting in four (22_2%) and were indiscernible in four (22.2%). But of the 10 carcinoma cases four (40%) were of abrupt cutting, two (20%) funnel
Acoustics ; Bile Ducts, Extrahepatic ; Biliary Tract ; Cholangiography ; Diagnosis, Differential ; Dilatation ; Humans ; Incidence ; Methods ; Ultrasonics ; Ultrasonography

OBJECTIVETo characterize the clinical, laboratory, imaging and pathological features of primary sclerosing cholangitis (PSC) and investigate the impact of ursodeoxycholic acid (UDCA) therapy on patient prognosis.

METHODSThe medical records of 22 patients diagnosed with PSC between 2002 and 2011 were retrospectively reviewed. The PSC diagnosis had been made in patients with suspect biochemical abnormalities following evaluation by magnetic resonance cholangiopancreatography (MRCP) and/or endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC). Fibrosis and inflammation were assessed by immunohistochemical analyses of tissue biopsies. Outcome of patients treated with UDCA (13-15 mg/kg/day, oral) were compared to that of patients without UDCA treatment by the X2 or corrected X2 tests.

RESULTSAmong the 22 PSC patients, the majority was male (n=15) and presented with fatigue, dark urine, and body weight loss (n=15). Four cases had ulcerative colitis. At admission, all 22 cases showed elevated levels of alkaline phosphatase[ALP: (348+/-184) U/L], 19 cases showed elevated alanine aminotransferase [ALT: (94.0+/-67.0) U/L] and aspartate aminotransferase [AST: (98.0+/-67.0) U/L], and 15 cases showed elevated levels of total bilirubin (99.0+/-115.0) mumol/L and direct bilirubin (74.4+/-92.4 mumol/L. ERCP examination showed segmental intrahepatic bile duct stenosis with expansion, and stiff and enlarged gallbladder bile ducts, but unclear findings for the common bile ducts and pancreatic ducts. MRCP showed beading of the intrahepatic bile duct, stiffness of the bile duct wall, and dilation of the common bile duct. Fibrosis and inflammation were observed in the bile ducts, along with hyperplasia and the typical features of "onion skin" fibrosis and fibrous obliterative cholangitis. Five of the 10 patients treated with UDCA improved, and seven of the 12 patients in the non-UDCA treatment group improved. There was no statistically significant difference in outcome between the groups (paired X2=0.333, corrected X2=0.083, P more than 0.05).

CONCLUSIONPSC patients were predominantly male and the common clinical manifestations were fatigue, dark urine, and body weight loss. At admission, serum biochemical indicators of cholangitis were increased significantly and subsequent imaging studies confirmed the suspected diagnosis by showing obvious characteristic changes. UDCA treatment did not significantly improve patient prognosis.

Adult ; Cholangiography ; methods ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis, Sclerosing ; diagnostic imaging ; pathology ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

Radiological investigation in patients with clonorchiasis is very important as this is the only method of evaluating the severity of clonorchiasis. In order to correlate the radiologic and pathologic findings of clonorchiasis, fourteen rabbits infested with Clonorchis sinensis and five control rabbits were examined radiologically by ultrasonography, computed tomography and cholangiography and the results were correlated with pathologic findings. Dilatation of the intrahepatic small bile ducts of the liver was due to obstruction by flukes: oval or elliptical small filling defects or irregular margin of the bile ducts on cholangiogram or intraluminal echoes on sonogram represented flukes per se; periductal thickening on sonogram and periductal enhancement of bile ducts on CT were due to inflammatory cell infiltration, adenomatous hyperplasia and periductal fibrosis: band like enhancement at the periphery of the liver on CT represented proliferated bile ducts, destruction of liver cells and resultant fibrosis. The study confirmed the pathological bases for the radiological findings of clonorchiasis in liver and bile ducts and will, perhaps, serve as a basis for the future radiologic-pathological correlation of clonorchiasis and in further clinical and experimental researches in the biliary tract diseases.
Bile Ducts ; Biliary Tract Diseases ; Cholangiography ; Clonorchiasis* ; Clonorchis sinensis ; Dilatation ; Fibrosis ; Humans ; Hyperplasia ; Liver ; Methods ; Rabbits* ; Trematoda ; Ultrasonography

Although ultrasonography replaced many invasive studies in biliary tract diseases, direct cholangiography does still play an important role in the diagnosis and management of choledocholithiasis. Endoscopoic retrograde cholangiography (ERC) is regarded as the best method in evaluation of exact extent of the disease and its frequent complication, cholangitis. Authors analysed 56 cases of choledocolithiasis diagnosed by ERC and compared these with ERC in 18 cases of normal, 22 cases of cholecystitis, 15 cases of clonorchiasis and 9 cases of parenchymal diseases of liver. The results are as follows; 1. ERC findings of choledocholithiasis are filling defects by stoneor stones, dilation of common hepatic as well as common bile ducts and findings of cholangitis. 2. ERC findings of cholangitis are dilatation of larger intrahepatic biliary radicles and acute peripheral tapering, decrease of arborization, increased or right angle branching pattern, straightening and rigidity as well as irregular narrowing of intrahepatic biliary trees. This findings are observed in majority of choledocholithiasis. 3. Over9mm in diameter at intraprancreatic portion of common bile duct was regarded as abnormal, with 95% sensitivity,85% specificity and 91% diagnostic accuracy by decision matrix analysis. 4. In the presence of dilatation of CBD and findings of cholangitis in ERC, one should consider choledocholithiasis in spite of absence of stone defect.
Biliary Tract Diseases ; Cholangiography ; Cholangitis ; Cholecystitis ; Choledocholithiasis ; Clonorchiasis ; Common Bile Duct ; Diagnosis ; Dilatation ; Liver ; Methods ; Sensitivity and Specificity ; Trees ; Ultrasonography

OBJECTIVE: To describe the technical feasibility and usefulness of extrahepatic biliary stone removal by balloon sphincteroplasty and occlusion balloon pushing. MATERIALS AND METHODS: Fifteen patients with extrahepatic bile duct stones were included in this study. Endoscopic stone removal was not successful in 13 patients, and two patients refused the procedure due to endoscopy phobia. At first, all patients underwent percutaneous transhepatic biliary drainage (PTBD). A few days later, through the PTBD route, balloon assisted dilatation for common bile duct (CBD) sphincter was performed, and then the stones were pushed into the duodenum using an 11.5 mm occlusion balloon. Success rate, reason for failure, and complications associated with the procedure were evaluated. RESULTS: Eight patients had one stone, five patients had two stones, and two patients had more than five stones. The procedure was successful in 13 patients (13/15). In 12 of the patients, all stones were removed in the first trial. In one patient, residual stones were discovered on follow-up cholangiography, and were subsequently removed in the second trial. Technical failure occurred in two patients. Both of these patients had severely dilated CBD and multiple stones with various sizes. Ten patients complained of pain in the right upper quadrant and epigastrium of the abdomen immediately following the procedure, but there were no significant procedure-related complications such as bleeding or pancreatitis. CONCLUSION: Percutaneous extrahepatic biliary stone removal by balloon sphincteroplasty and subsequent stone pushing with occlusion balloon is an effective, safe, and technically feasible procedure which can be used as an alternative method in patients when endoscopic extrahepatic biliary stone removal was not successful.
Treatment Outcome ; Middle Aged ; Male ; Humans ; Gallstones/*therapy ; Female ; Feasibility Studies ; Cholangiography ; *Bile Ducts, Extrahepatic ; Balloon Occlusion/methods ; Balloon Dilatation/*methods ; Aged, 80 and over ; Aged

Benign schwannomas arise in neural crest-derived Schwann cells. They can occur almost anywhere in the body, but their most common locations are the central nervous system, extremities, neck, mediastinum, and retroperitoneum. Schwannomas occurring in the biliary tract are extremely rare and mostly present with obstructive jaundice. We recently experienced a case of extrahepatic biliary schwannomas in a 64-yr-old female patient who presented with intra- and extrahepatic bile duct and gallbladder stones during a screening program. To the best of our knowledge, extrahepatic biliary schwannomas associated with bile duct stones have not been reported previously in the literature.
Adult ; Bile Ducts/pathology ; Bile Ducts, Extrahepatic/*metabolism/*pathology ; Central Nervous System/pathology ; Cholangiography/methods ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Neurilemmoma/*diagnosis/*pathology ; Tomography, X-Ray Computed

BACKGROUND: Residual and recurrent bile duct stones after biliary surgery cause many difficult problems. and reoperation on biliary tract has limitation due to its high morbidity and mortality. In recent years, various non-operative modalities for management in residual and recurrent stone have been developed. METHODS: We analyzed 69 cases of residual and recurrent bile duct stones which were managed with non-operative modalities at the Department of surgery, Dae Dong Hospital from Jan. 1994 to Dec. 1997, and evaluated the efficacy of these modalities. RESULTS: Female exceeded male with a ratio 1.76:1. and the peak incidence of age group was 6th decade. The most common diagnostic procedure was T-tube cholangiography (53.6%). Interval between previous operation and second procedure for residual or recurrent stones was within 6 months in most cases (82%). Cholecystectomy with T-tube choledochostomy was performed most frequently in previous operation. Residual and recurrent stones were found only at common bile duct in 34 cases (49.3%) most commonly. Common bile duct stones were managed most frequently with endoscopic sphincterotomy (39.5%), but the complete removal rate was heighest in choledochoscopic stone removal (100%). Complete removal rate of intrahepatic duct stone was heighest with interventional radiologic stone removal as well as choledochoscopic stone removal (43.6%), but average number of session was smaller in choledochoscopic stone removal (2.5) than interventional radiologic stone removal (3.5). Associated complication with non-operative management modalities were very low, except three cases of hepaticocutaneous jejunostomy. The latter required reoperation due to continuous bile fistula in two cases, and long jejunal loop in one case. CONCLUSIONS: Choledochoscopic stone removal is most effective method in the management of residual and recurrent bile duct stones.
Bile Ducts* ; Bile* ; Biliary Tract ; Cholangiography ; Cholecystectomy ; Choledochostomy ; Common Bile Duct ; Female ; Fistula ; Humans ; Incidence ; Jejunostomy ; Male ; Methods ; Mortality ; Reoperation ; Sphincterotomy, Endoscopic

OBJECTIVE: We wanted to evaluate the therapeutic efficacy of the percutaneous balloon dilatation and large profile catheter maintenance method for the management of patients with anastomotic biliary strictures following liver transplant. MATERIALS AND METHODS: From May 1999 to June 2003, 12 patients with symptomatic benign biliary stricture complicated by liver transplantation were treated with the percutaneous balloon dilatation and large profile catheter maintenance method (1-6 months). The patients were eight males and four females, and their ages ranged from 20 to 62 years (mean age: 44 years). Ten patients underwent living donor liver transplantation and two underwent cadaveric liver transplantation. Postoperative biliary strictures occurred from two to 21 months (mean age: 18 months) after liver transplantation. RESULTS: The initial technical success rate was 92%. Patency of the bile duct was preserved for eight to 40 months (mean period: 19 months) in 10 of 12 (84%) patients. When reviewing two patients (17%), secondary balloon dilatations were needed for treating the delayed recurrence of biliary stricture. In one patient, no recurrent stenosis was seen during the further 10 months follow-up after secondary balloon dilatation. Another patient did not response to secondary balloon dilatation, and he was treated by surgery. Eleven of 12 patients (92%) showed good biliary patency for 8-40 months (mean period: 19 months) of follow-up. CONCLUSION: The percutaneous balloon dilatation and large profile catheter maintenance method is an effective therapeutic alternative for the treatment of most biliary strictures that complicate liver transplantation. It has a high success rate and it should be considered before surgery.
Treatment Outcome ; Middle Aged ; Male ; Liver Transplantation/*adverse effects ; Humans ; Hepatic Artery/ultrasonography ; Female ; Constriction, Pathologic/etiology/therapy ; Cholangiography ; Bile Duct Diseases/etiology/*therapy ; Balloon Dilatation/*methods ; Adult

OBJECTIVETo investigate the feasibility of multi-slice spiral CT (MSCT) for cholangiopancreatography without cholangio-contrast.

METHODSTen patients without any digestion system diseases and 24 patients with suspected pancreatic malignancy received the 16-slice spiral CT multi-phased contrast-enhanced scanning. The images of patients without any digestion system diseases and cancer-suffered patients were curved reformatted (CR) technique to perform the structure of pancreatic duct, common bile duct, and ampulla. The cholangiopancreatical systems of the cancer suffered patient were reconstructed through volume rendering technique (VRT), minimum intensity projection (MinIP), and indirect minimum intensity projection (IMinIP). The results of patients without any digestion system diseases in curved multiplanar reconstruction were analyzed; meanwhile display rates of the pancreatic duct, common bile duct, and ampulla were evaluated.

RESULTSof the four different cholangiopancreatographies were compared.

RESULTSThe display rate of pancreatic duct in the CR images was 90.0 (9/10) with an average diameter of (2.63 +/- 0.51) mm. Sub-pancreatic duct could be seen in 88.9% (8/9) of them. The display rate of common bile duct in the CR images was 100% (10/10) with an average diameter of (7.45 +/- 1.12) mm. The display rate of ampulla was 60.0 (6/10), which was affected by the filling status of duodenum. The cholangiopancreatography using CR, VRT, MinIP, and IMinIP for patients with pancreatic cancer reveal the whole pancreatic and common bile duct, and the modality of distal obstructed bile duct. The result showed that IminIP got the best outcome (98.6%), while VRT got the worst (68.1%).

CONCLUSIONThe negative CT cholangiopancreatography is a simple and non-invasive examination. It reflects both the 3-dimensional cholangio-pancreatic anatomical structure and its adjacent condition. It has curtain clinical application values, especially for patients with obstructed duct system.

Adult ; Aged ; Aged, 80 and over ; Cholangiography ; methods ; Female ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Pancreatic Ducts ; diagnostic imaging ; Pancreatic Neoplasms ; diagnostic imaging ; Tomography, Spiral Computed