Diagnostic Value of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in the Evaluation of the Biliary Obstruction

Purpose. In this study, our purpose was to investigate the diagnostic efficacy of the dynamic contrast-enhanced magnetic resonance imaging (MRI) method in the patients with bile duct obstruction. Materials and Methods. 108 consecutive patients (53 men, 55 women, mean age; 55.77 ± 14.62, range 18–86 years) were included in this study. All the patients underwent conventional upper abdomen MRI using intravenous contrast material (Gd-DTPA) and MRCP in 1.5 Tesla MRI scanner. MRCP images were evaluated together with the T1 and T2w images, and both biliary ducts and surrounding tissues were examined for possible pathologies that may cause obstruction. Results. MRI/MRCP findings compared with final diagnoses, MRI/MRCP in the demonstration of bile duct obstruction sensitivity 96%, the specificity 100%, and accuracy 96.3%, in the detection of presence and level of obstruction, the sensitivity 96.7%, specificity 100%, and accuracy 97.2%, in the diagnosis of choledocholithiasis, the sensitivity 82.3%, specificity 96%, and accuracy 91.7%, and in the determination of the character of the stenosis, sensitivity 95.6%, specificity 91.3%, and accuracy 94.5% were found. Conclusion. The combination of dynamic contrast-enhanced MRI and MRCP techniques in patients with suspected biliary obstruction gives the detailed information about the presence of obstruction, location, and causes and is a highly specific and sensitive method

Omega-3 Fatty Acids and Vitamin D in Cardiology

Dietary modification and supplementation play an increasingly important role in the conservative treatment of cardiovascular disease. Current interest has focused on n-3 polyunsaturated fatty acids (PUFA) and vitamin D. Clinical trial results on this subject are contradictory in many aspects. Several studies indicate that n-3 PUFA consumption improves vascular and cardiac hemodynamics, triglycerides, and possibly endothelial function, autonomic control, inflammation, thrombosis, and arrhythmia. Experimental studies show effects on membrane structure and associated functions, ion channel properties, genetic regulation, and production of anti-inflammatory mediators. Clinical trials evaluating a possible reduction in cardiovascular disease by n-3 PUFA have shown different results. Supplementation of vitamin D is common regarding prevention and treatment of osteoporosis. But vitamin D also seems to have several effects on the cardiovascular system. Vitamin D deficiency appears to be related to an increase in parathyroid hormone levels and can predispose to essential hypertension and left ventricular hypertrophy, increased insulin resistance, and eventually to atherosclerosis and adverse cardiovascular events. Randomized prospective clinical trials are needed to determine whether vitamin D and omega-3 FA supplementation therapy should be recommended as a routine therapy for primary or secondary prevention of cardiovascular disease

MRI of Pancreas in Patients with Chronic Pancreatitis and Healthy Volunteers: Can Pancreatic Signal Intensity and Contrast Enhancement Patterns be Valuable Predictors of Early Chronic Pancreatitis?

WOS: 000415813000007Background: Chronic pancreatitis is a progressive inflammatory disease of the pancreatic parenchyma and ductal structures. Typical MR imaging features of chronic pancreatitis include dilatation of the main pancreatic duct and irregularities of branch pancreatic ducts that can be evaluated with MRCP, loss of the normal high signal intensity of the pancreatic parenchyma on T1-weighted images, and decreased enhancement on dynamic contrast-enhanced sequences. Objective: The aim was to evaluate the parenchymal MRI findings of the pancreas in conjunction with MRCP in patients with chronic pancreatitis and normal healthy subjects. Methods: MRI and MRCP findings of 90 consecutive patients with chronic pancreatitis and 26 healthy volunteers were evaluated in this study. Patients were divided into five groups according to Cambridge classification system considering ERCP, MRCP, CT, US and EUS findings. On MRI, signal intensity ratios of the pancreas and the spleen on unenhanced T1 weighted fat saturated spoiled gradient echo images (SIR P/S) along with the enhancement ratio between the arterial phase and the portal venous phase (SIR A/V) were calculated and their frequency in each Cambridge score were documented. MRI findings in normal subjects were compared to patients with chronic pancreatitis. Results: MRCP findings were normal and pancreatic signal intensity was higher than spleen (SIR P/S > 1) in 26 healthy control subjects. Mean pancreas signal in control group (SIR P/S; 1.48 +/- 0.13) was significantly higher (P < 0,001) than mean signal intensity in patients with chronic pancreatitis (SIR P/S; 1.18 +/- 0.24). In the control group, the highest contrast enhancement occurred in arterial phase (SIR A; 1.7 +/- 0.32) and this was significantly higher (P < 0,001) than portal venous phase (SIR V; 1.45 +/- 0.28). In chronic pancreatitis group, the highest contrast enhancement occurred in portal venous phase (SIR V; 1.56 +/- 0.18) but there was no statistically significant difference (P = 0.06) compared to arterial phase (SIR A; 1.51 +/- 0.21). Mean SIR A/V values of control group were 1.18 +/- 0.08, and SIR A/V values of patients with chronic pancreatitis were 0.97 +/- 0.12 respectively. Mean SIR A/V value in control group was statistically higher than patients with chronic pancreatitis (P < 0.05). Between the control group and patients with chronic pancreatitis in terms of SIR statistically significant differences were found SIR P/S (Spearman correlation coefficient (rs) = -0.76, P < 0.001), SIR A (rs = -0.28, P = 0.003), SIR V (rs = 0.43, P < 0.001), SIR LV (rs = 0.54, P < 0.001) and SIR A/V (rs = -0.68, P < 0.001). Conclusion: In our study, MRI findings were significantly different in subjects with chronic pancreatitis compared to the control group. MRI findings correlated well with the ductal changes according to Cambridge classification. However, MRI findings may occur prior to ductal changes

Failure of Femoral Access to Electrophysiological Evaluation Due to Aplasia of the Inferior Vena Cava

We report an interesting case of a man with a persistent left superior vena cava (PLSVC) with left azygos vein who underwent electrophysiological evaluation. Further evaluation revealed congenital dilated azygos vein, while a segment connecting the inferior vena cava (IVC) to the hepatic vein and right atrium was missing. The azygos vein drained into the superior vena cava, and the hepatic veins drained directly into the right atrium. The patient did not have congenital anomalies of the remaining thoracoabdominal vasculature