Ectopic opening of common bile duct into the duodenal bulb: magnetic resonance cholangiopancreatography findings

PURPOSEWe aimed to evaluate the spectrum of magnetic resonance cholangiopancreatography (MRCP) findings in patients with ectopic opening of the common bile duct (CBD) into the duodenal bulb and to determine the effectiveness of the MRCP technique in diagnosis.METHODSMorphologic and morphometric MRCP/MRI features in 16 patients and 36 controls were retrospectively analyzed by 2 radiologists. The frequency of MRCP findings was determined. The significance of the difference between the MRCP observations in patients and controls was evaluated statistically and the diagnostic effectiveness of MRCP was investigated.RESULTSHook-shaped ending of CBD and bulbar deformity were the most frequent morphologic findings seen on MRCP in the ectopic bulbar opening. Mean pylorus-papilla distance and mean CBD length were significantly shorter and the median diameter of CBD was significantly larger than the control group (patients: 28.6 ± 15.3 mm, 33.7 ± 12.8 mm, 8.6 (2-16) mm; controls: 66.7 ± 11.7 mm, 50.3 ± 14.4 mm, 3.2 (1.5-10) mm, P < .001, respectively). Receiver operating curve analysis showed sensitivity and specificity of MRCP in the diagnosis to be 87.5% and 100%, respectively, if any 3 of the 4 signs (hook-shaped ending of CBD, bulbar deformity, large, and short CBD) were present in a patient whose pylorus-papilla distance was <50 mm.CONCLUSIONAt MRCP, the presence of short and large CBD with a hook-shaped ending in the deformed duodenal bulb may support the diagnosis of ectopic biliary drainage

Quantitative liver magnetic resonance imaging: correlation between conventional magnetic resonance imaging, laboratory values, and prognostic indices in Budd–Chiari syndrome

PURPOSEIn Budd–Chiari syndrome (BCS), unevenly distributed parenchymal changes and perfusion abnormalities occur due to hepatic venous outflow obstruction. This study aimed to evaluate the changes in the liver parenchyma in BCS using the quantitative magnetic resonance (MR) techniques of MR elastography, T1 and T2 mapping, and diffusion imaging and correlate the quantitative MR parameters through biochemical results and prognostic indices.METHODSFourteen patients with BCS (seven men and seven women) were examined retrospectively. Liver stiffness (kPa), T1 relaxation times (ms) were achieved using the modified Look–Locker inversion recovery (MOLLI) 3(2)3(2)5 sequence and B1-corrected variable flip angle methods, T2 relaxation times (ms), and apparent diffusion coefficient (ADC) values (mm2/s) were measured using regions of interest placed in the same region in all quantitative methods. Measurements were repeated at the precontrast and postcontrast hepatobiliary phases. The reduction rate (RR; %) and adjusted postcontrast T1 (%) were calculated. The values obtained from different liver parenchyma areas (whole liver, caudate lobe, pathological T2 hyperintense tissue, and relatively preserved normal-appearing tissue) were compared using the Wilcoxon signed-rank test. Spearman’s correlation coefficient was used to investigate the correlation between quantitative MR parameters and biochemical parameters/ prognostic scores (Child–Pugh score, Clichy score, and Rotterdam index).RESULTSThe parenchymal stiffness and precontrast T1 values of the caudate lobe were significantly lower than those of the remainder of the parenchyma, whereas the adjusted postcontrast T1 percentages (MOLLI) were significantly higher (P ≤ 0.027). The parenchymal stiffness value, T1 and T2 values, percentages of RR (MOLLI), and adjusted postcontrast T1 values for the pathological tissue and relatively normal tissue were significantly different (P < 0.028). No significant difference was found in terms of ADC values between any of the distinct regions of the liver.A strong correlation was detected between the Child–Pugh score, Clichy score, and precontrast T1 values obtained through the MOLLI sequence (r = 0.867, P = 0.012, r = 0.821, P = 0.023, respectively). No correlation was found between the whole liver stiffness values and the laboratory parameters, fibrosis markers, prognostic indices, or MR parameters. A significant correlation was identified between creatinine levels and several T1 parameters and the T2 relaxation time (r ≥ 0.661, P ≤ 0.052).CONCLUSIONTissue stiffness and T1 relaxation values are high in the areas identified as fibrosis compared with those in the relatively preserved parenchyma. The T1 relaxation time can offer quantitative information for assessing segmental functional changes and prognosis in BCS.ion for assessing segmental functional changes and prognosis in BCS

Magnetic resonance elastography: basic principles, technique, and clinical applications in the liver

Magnetic resonance elastography (MRE) is a constantly advancing technique for assessment of stiffness of tissues with newer technology and sequences. It is being increasingly used for the assessment of liver fibrosis. In this article, we discuss the advantages of MRE over biopsy and noninvasive methods such as US elastography in the assessment of liver fibrosis. Image acquisition and interpretation of liver MRE is also discussed

MRI quantification techniques in fatty liver: the diagnostic performance of hepatic T1, T2, and stiffness measurements in relation to the proton density fat fraction

PURPOSENonalcoholic fatty liver disease (NAFLD) can progress to liver cirrhosis and is predicted to become the most frequent indication for liver transplantation in the near future. Noninvasive assessment of NAFLD is important for diagnosis and patient management. This study aims to prospectively determine the liver stiffness and T1 and T2 values in patients with NAFLD and to compare the diagnostic performance of magnetic resonance elastography (MRE) and mapping techniques in relation to the proton density fat fraction (PDFF).METHODSEighty-three patients with NAFLD and 26 participants with normal livers were imaged with a 1.5 T scanner. PDFF measurements obtained from the multiecho Dixon technique were used to quantify the liver fat. MRE, native T1 mapping (modified Look-Locker inversion recovery [MOLLI] schemes 5(3)3, 3(3)3(3)5, and 3(2)3(2)5 and the B1-corrected variable flip angle [VFA] method), and T2 mapping values were correlated with PDFF. The diagnostic performance of MRE and the mapping techniques were analyzed and compared.RESULTST1 values measured with the MOLLI schemes and the B1-corrected VFA (P < 0.001), and the stiffness values from MRE (P = 0.047) were significantly higher in the NAFLD group. No significant difference was found between the groups in terms of T2 values (P = 0.127). In differentiation of the NAFLD and control groups, the B1-corrected VFA technique had slightly higher accuracy and area under the curve (AUC) than the MOLLI schemes. In the NAFLD group, there was a good correlation between the PDFF, MOLLI 3(3)3(3)5 and 3(2)3(2)5, and VFA T1 measurements (r=0.732; r=0.735; r=0.716, P < 0.001, respectively).CONCLUSIONLiver T1 mapping techniques have the potential to distinguish steatotic from nonsteatotic livers, and T1 values seem to have a strong correlation with the liver fat content

The Effects of a 'Transient Ischemic Attack Unit' on the Early Diagnosis and Treatment of Stroke and Other Vascular Events

Objective: Identifying the etiology and early treatment following a transient ischemic attack (TIA) or minor stroke may prevent patients from having a disabling ischemic stroke. The primary aim of this study was to increase awareness of the symptoms of TIA and minor ischemic stroke and provide early intervention via a TIA unit. In addition, the benefits provided by the TIA unit were analyzed in terms of prognosis and length of hospital stay. Materials and Methods: Before beginning the study, brochures and posters containing information about the symptoms of a TIA and minor ischemic stroke, along with the mobile phone number of a research fellow, were distributed in the clinics and hung on the main boards of the Ankara University Faculty of Medicine Hospitals. A presentation on the TIA unit was also given to the healthcare professionals of the hospitals. Afterward, 69 patients consecutively admitted with symptoms of a TIA or minor ischemic stroke [with a National Institutes of Health Stroke Scale (NIHSS) score of ≤5] between September 16, 2019, and September 15, 2020, were prospectively included in the study group. The hospital charts of 90 consecutive patients admitted with a TIA or minor ischemic stroke (with an NIHSS score of ≤5) were retrospectively evaluated as the control group from September 16, 2018, to September 15, 2019. The timing of the etiological diagnoses and treatments, the length of the hospital stay, and the prognoses of these two groups of patients, one comprising patients admitted before and the other comprising patients admitted after the TIA unit was established, were compared. Results: The two groups had no significant difference in vascular events and mortality. However, in the logistic regression analysis, the length of the hospital stay was significantly shorter in the study group (P = 0.015). Conclusion: A TIA and a minor stroke should be recognized quickly, and diagnostic tests should be performed as soon as possible to shorten the period of the hospital stay and reduce the costs and complications related to longer hospitalization

Evaluation of abdominal computed tomography findings in patients with COVID-19: a multicenter study

PURPOSE To evaluate the frequency of abdominal computed tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19) and interrogate the relationship between abdominal CT findings and patient demographic features, clinical findings, and laboratory test results as well as the CT atherosclerosis score in the abdominal aorta. METHODS This study was designed as a multicenter retrospective study. The abdominal CT findings of 1.181 patients with positive abdominal symptoms from 26 tertiary medical centers with a positive polymerase chain-reaction test for severe acute respiratory syndrome coronavirus 2 were reviewed. The frequency of ischemic and non-ischemic CT findings as well as the association between CT findings, clinical features, and abdominal aortic calcific atherosclerosis score (AA-CAS) were recorded. RESULTS Ischemic and non-ischemic abdominal CT findings were detected in 240 (20.3%) and 328 (27.7%) patients, respectively. In 147 patients (12.4%), intra-abdominal malignancy was present. The most frequent ischemic abdominal CT findings were bowel wall thickening (n = 120; 10.2%) and perivascular infiltration (n = 40; 3.4%). As for non-ischemic findings, colitis (n = 91; 7.7%) and small bowel inflammation (n = 73; 6.2%) constituted the most frequent disease processes. The duration of hospital stay was found to be higher in patients with abdominal CT findings than in patients without any positive findings (13.8 ± 13 vs. 10.4 ± 12.8 days, P < 0.001). The frequency of abdominal CT findings was significantly higher in patients who did not survive the infection than in patients who were discharged after recovery (41.7% vs. 27.4%, P < 0.001). Increased AA-CAS was found to be associated with a higher risk of ischemic conditions in abdominal CT examinations. CONCLUSION Abdominal symptoms in patients with COVID-19 are usually associated with positive CT findings. The presence of ischemic findings on CT correlates with poor COVID-19 outcomes. A high AA-CAS is associated with abdominal ischemic findings in patients with COVID-19