Intra-operative ultrasound assessment of the biliary tree during robotic cholecystectomy.

Image-guided assessment of bile ducts and associated anatomy during laparoscopic cholecystectomy can be achieved with intra-operative cholangiography (IOC) or laparoscopic ultrasound (LUS). Rates of robotically assisted cholecystectomy (RC) are increasing and herein we describe the technique of intra-corporeal biliary ultrasound during RC using the Da Vinci system. For intraoperative evaluation of the biliary tree during RC, in cases of suspected choledocholithiasis, the L51K Ultrasound Probe (Hitachi, Tokyo, Japan) is used. The extrahepatic biliary tree is scanned along its length, capitalising on the benefits of the full range of motion offered by the articulated robotic instruments and integrated ultrasonic image display using TileProTM software. Additionally, this technique avoids the additional time and efforts required to undock and re-dock the robot that would otherwise be required for selective IOC or LUS. The average time taken to perform a comprehensive evaluation of the biliary tree, from the hepatic ducts to the ampulla of Vater, is 164.1 s. This assessment is supplemented by Doppler ultrasound, which is used to fully delineate anatomy of the porta hepatis, and accurate measurements of the biliary tree and any ductal stones can be taken, allowing for contemporaneous decision making and management of ductal pathologies. Biliary tract ultrasound has been shown to be equal to IOC in its ability to diagnose choledocholithiasis, but with the additional benefits of being quicker and having higher completion rates. We have described our practice of using biliary ultrasound during robotically assisted cholecystectomy, which is ergonomically superior to LUS, accurate and reproducible.

High-resolution three-dimensional T1-weighted hepatobiliary MR cholangiography using Gd-EOB-DTPA for assessment of biliary tree anatomy: Parallel imaging versus compressed sensing.

PURPOSE: To compare the quality of images obtained by T1-weighted hepatobiliary MR cholangiography using Gd-EOB-DTPA with 1-mm isovoxel acquisition and compressed sensing (T1-MRCCS) or parallel imaging (T1-MRCPI) for assessment of biliary tree anatomy. METHOD: We prospectively reviewed T1-MRCCS, T1-MRCPI, and respiratory-triggered 3D T2-weighted MR cholangiography (T2-MRC) images in 58 patients. Two radiologists independently assessed the three sets of images and scored the biliary tree visualization and overall image quality in all cases using a 5-point Likert scale. The resulting scores were compared among T1-MRCCS, T1-MRCPI, and T2-MRC images using a Friedman test followed by a Scheffe test. The inter-reader agreement in scoring was assessed using κ statistics. RESULTS: The image quality scores for the gallbladder on both T1-MRCCS and T1-MRCPI were significantly lower than those on T2-MRC (p < 0.01) for both readers. Meanwhile, the image quality scores for the right and left hepatic ducts and the anterior and posterior branches of the right hepatic duct on both T1-MRCCS and T1-MRCPI were significantly higher than those on T2-MRC (p < 0.05) for both readers. For Reader 2, the overall image quality scores on T1-MRCCS and T1-MRCPI were both significantly higher than those on T2-MRC (p < 0.05). There were no significant differences between the image quality scores on T1-MRCCS and T1-MRCPI for visualization of each bile duct (p < 0.05). CONCLUSIONS: There may be no significant difference in quality between T1-MRCCS images and T1-MRCPI images for assessment of biliary tree anatomy, and both types of images may be better than T2-MRC images, although clinical indication is limited compared with T2-MRC.

Radiological assessment of secondary biliary tree lesions: an update.

OBJECTIVE: To conduct a systematic literature review of imaging techniques and findings in patients with peribiliary liver metastasis. METHODS: Several electronic datasets were searched from January 1990 to June 2017 to identify studies assessing the use of different imaging techniques for the detection and staging of peribiliary metastases. RESULTS: The search identified 44 studies, of which six met the inclusion criteria and were included in the systematic review. Multidetector computed tomography (MDCT) is the technique of choice in the preoperative setting and during the follow-up of patients with liver tumors. However, the diagnostic performance of MDCT for the assessment of biliary tree neoplasms was low compared with magnetic resonance imaging (MRI). Ultrasound (US), without and with contrast enhancement (CEUS), is commonly employed as a first-line tool for evaluating focal liver lesions; however, the sensitivity and specificity of US and CEUS for both the detection and characterization are related to operator expertise and patient suitability. MRI has thus become the gold standard technique because of its ability to provide morphologic and functional data. MRI showed the best diagnostic performance for the detection of peribiliary metastases. CONCLUSIONS: MRI should be considered the gold standard technique for the radiological assessment of secondary biliary tree lesions.

Quantitative assessment of liver function using hepatobiliary scintigraphy: the effect of microcirculatory alterations after portal vein embolization.

OBJECTIVES: Hepatobiliary scintigraphy using technetium-99m mebrofenin has been validated as a quantitative liver function test. Preoperative portal vein embolization (PVE) is performed in patients to increase future remnant liver function and volume. Changes in hepatic microcirculation after PVE remain largely unknown and may influence the uptake of mebrofenin. The aim was to evaluate microcirculatory changes after PVE to examine differences in perfusion that might influence the uptake of mebrofenin, and consequently, assessment of function. PATIENTS AND METHODS: Patients undergoing liver resection with or without preoperative PVE were included. Future remnant liver volume and function were measured before and after PVE. Hepatic microcirculation was measured in the embolized and the nonembolized lobes during resection. Microcirculatory flow index, perfused vessel density, sinusoidal diameter and red blood cell velocity were assessed. RESULTS: A total of 16 patients, eight with preoperative PVE and eight control patients without PVE, were included. After PVE, both function and volume of the nonembolized lobe were significantly increased, and the functional increase exceeded the increase in volume. Perfused vessel density and sinusoidal diameter were significantly higher in the nonembolized liver lobe (P<0.002 and <0.04). No significant differences between both lobes were found concerning microcirculatory flow index or red blood cell velocity. CONCLUSION: After PVE, the nonembolized lobe had a significantly higher (functional) microvascular density compared with the embolized lobe, without differences in microvascular flow. These findings indicate that the measured functional increase using hepatobiliary scintigraphy, which exceeded the volumetric increase, was not the consequence of an increase in hepatic perfusion, therefore, providing adequate representation of the liver function.

Practical guidelines for the use of technetium-99m mebrofenin hepatobiliary scintigraphy in the quantitative assessment of liver function.

Surgical resection remains the most important curative treatment for liver tumors; however, it harbors the risk of developing posthepatectomy liver failure. The principal risk is associated with the quality and quantity of the future remnant liver. Therefore, preoperative assessment of the future remnant liver is essential in patients scheduled for major liver resection. Technetium-99m mebrofenin hepatobiliary scintigraphy (HBS) in combination with single-photon emission computed tomography/computed tomography is increasingly applied for the quantitative assessment of liver function before major liver surgery. This dynamic quantitative liver function test allows assessment of both total and regional liver function, represented by the hepatic mebrofenin uptake rate, thereby assisting in adequate patient selection. Since routine implementation, it has shown to reduce the risk of posthepatectomy liver failure and has proven to be more valuable than volumetric assessment. To ensure optimal and reproducible results that can be compared across different centers, it is crucial to standardize the methodology and ensure practical applicability of this technique, thereby facilitating external validation and multicenter trials. This article provides an overview of the HBS methodology used at some of the largest HBS centers and covers practical details in the application of HBS for the quantitative scintigraphic assessment of liver function.

Validation of hepatobiliary transport PET imaging in liver function assessment: Evaluation of 3ß-[18F]FCA in mouse models of liver disease.

Recently, our research group reported on the development of 3ß-[18F]Fluorocholic acid (3ß-[18F]FCA), a 18F labeled bile acid to detect drug interference with the bile acid transporters (drug-induced cholestasis). It was hypothesized that 3ß-[18F]FCA could also be used as a non-invasive tool to monitor (regional) liver function in vivo in different liver diseases through altered expression of bile acid transporters. METHODS: Hepatobiliary transport of 3ß-[18F]FCA was evaluated in four murine liver disease models. Acute liver injury was induced by oral gavage of an acetaminophen (APAP) overdose (300 mg/kg). Chronic cholangiopathy and non-alcoholic steatohepatitis (NASH) were induced by feeding mice 3,5-diethoxycarbonyl- 1,4-dihydrocollidine (DDC) diet or methionine and choline deficient (MCD) diet, respectively. Hepatocellular carcinoma (HCC) was evoked by intraperitoneal injection of 35 mg/kg diethylnitrosamine (DEN) once a week for 23 weeks. Gene expression of the murine bile acid transporters was determined by RT-qPCR. RESULTS: Hepatobiliary transport of 3ß-[18F]FCA was not significantly altered after an APAP overdose. Mice fed the DDC or MCD diet showed impaired transport of 3ß-[18F]FCA compared to baseline, which was associated with altered expression of the bile acid transporters ntcp, oatp4 and mrp2. After recovery from DDC- and MCD-induced liver injury, 3ß-[18F]FCA parameters returned to baseline. Global hepatobiliary transport of 3ß-[18F]FCA in HCC bearing mice was not significantly different compared to control mice. However, HCC lesions showed reduced hepatic uptake of the tracer (tumor-to-background: 0.45 ±â€¯0.13), which was in line with decreased in expression of basolateral bile acid uptake transporters nctp and oatp4 in tumor tissue. CONCLUSION: 3ß-[18F]FCA is a useful tool to assess and longitudinally follow-up liver function in several mouse models for liver diseases that are associated with altered expression of the bile acid transporters. These results point towards the (pre)clinical utility of 3ß-[18F]FCA as a PET tracer to monitor altered liver functionality in patients with chronic liver diseases.

Ultrasound Assessment of Hepatobiliary and Splenic Changes in Patients With Dengue and Warning Signs During the Acute and Recovery Phases.

OBJECTIVES: To evaluate whether abdominal ultrasound (US) with a gallbladder (GB) contractility study or motor function test can be used as a diagnostic tool in patients with dengue and warning signs in acute and recovery phases. METHODS: Fifty-one individuals in the acute phase of dengue presenting with warning signs (dengue group) and 49 healthy individuals without a history of dengue or hepatobiliary disease (control group) were studied with abdominal US and a GB contractility study. RESULTS: Statistical differences in US measurements of the liver (right lobe, P = .012; left lobe, P = .001) and spleen (P = .008) dimensions, GB wall thickness (P < .001), and the GB emptying fraction (P < .001) were observed in dengue during the acute phase compared with the control group. After 60 days, abdominal US of the dengue group showed a statistical difference in liver (right lobe, P < .001; left lobe, P = .078) and spleen (P < .001) dimensions, GB wall thickness, and the GB emptying fraction (P < .001) compared with the results obtained during the acute phase. Furthermore, a statistical difference in the spleen volume and GB emptying fraction (P < .001) was observed when comparing dengue after clinical recovery and the control group. Abdominal pain in patients with dengue was positively associated with hepatomegaly (P = .031), splenomegaly (P = .008), increased GB wall thickness (P = .016), and a reduced GB emptying fraction (P = .038) during the acute phase and with splenomegaly (P = .001) and a reduced GB emptying fraction (P = .003) after clinical recovery. CONCLUSIONS: Abdominal US with a GB motor function test can be used as a diagnostic tool in patients with dengue during acute and recovery phases.

Feasibility of gadoxetate disodium enhanced 3D T1 MR cholangiography (MRC) with a specific inversion recovery prepulse for the assessment of the hepatobiliary system.

AIM: To compare the potential of a gadoxetate disodium enhanced navigator-triggered 3D T1 magnetic-resonance cholangiography (MRC) sequence with a specific inversion recovery prepulse to T2-weighted MRCP for assessment of the hepatobiliary system. MATERIALS AND METHODS: 30 patients (12 male, 18 female) prospectively underwent conventional navigator-triggered 3D turbo spin-echo T2-weighted MRCP and 3D T1 MRC with a specific inversion pulse to minimise signal from the liver 30 minutes after administration of gadoxetate disodium on a 1.5 T MRI system. For qualitative evaluation, biliary duct depiction was assessed segmentally following a 5-point Likert scale. Visualisation of hilar structures as well as image quality was recorded. Additionally, the extrahepatic bile ducts were assessed quantitatively by calculation of signal-to-noise ratios (SNR). RESULTS: The advantages of T1 3D MRC include reduced affection of image quality by bowel movement and robust depiction of the relative position of the extrahepatic bile ducts in relation to the portal vein and the duodenum compared to T2 MRCP. However, overall T1 3D MRC did not significantly (p > 0.05) improve the biliary duct depiction compared to T2 MRCP in all segments: Common bile duct 4.1 vs. 4.4, right hepatic duct 3.6 vs. 4.2, left hepatic duct 3.5 vs. 4.1. Image quality did not differ significantly (p > 0.05) between both sequences (3.6 vs. 3.5). SNR measurements for the hepatobiliary system did not differ significantly (p > 0.05) between navigator-triggered T1 3D MRC and T2 MRCP. CONCLUSIONS: This preliminary study demonstrates that T1 3D MRC of a specific inversion recovery prepulse has potential to complement T2 MRCP, especially for the evaluation of liver structures close to the hilum in the diagnostic work-up of the biliary system in patients receiving gadoxetate disodium.

Epidemiology, determinants, and management of AIDS cholangiopathy: A review.

Diseases of the liver and biliary tree have been described with significant frequency among patients with human immunodeficiency virus (HIV), and its advanced state, acquired immunodeficiency syndrome (AIDS). Through a variety of mechanisms, HIV/AIDS has been shown to affect the hepatic parenchyma and biliary tree, leading to liver inflammation and biliary strictures. One of the potential hepatobiliary complications of this viral infection is AIDS cholangiopathy, a syndrome of biliary obstruction and liver damage due to infection-related strictures of the biliary tract. AIDS cholangiopathy is highly associated with opportunistic infections and advanced immunosuppression in AIDS patients, and due to the increased availability of highly active antiretroviral therapy, is now primarily seen in instances of poor access to anti-retroviral therapy and medication non-compliance. While current published literature describes well the clinical, biochemical, and endoscopic management of AIDS-related cholangiopathy, information on its epidemiology, natural history, and pathology are not as well defined. The objective of this review is to summarize the available literature on AIDS cholangiopathy, emphasizing its epidemiology, course of disease, and determinants, while also revealing an updated approach for its evaluation and management.

[Incidental findings of liver, biliary system, pancreas and spleen in asymptomatic patients : Assessment and management recommendations]. / Zufallsbefunde von Leber, Gallensystem, Pankreas und Milz bei asymptomatischen Patienten : Bewertung und Managementempfehlung.

CLINICAL ISSUE: The increased use of highly developed imaging procedures, such as multidetector-row computed tomography and magnetic resonance imaging has led to a substantial increase of asymptomatic and unexpected findings. STANDARD RADIOLOGICAL METHODS: Abdominal CT investigations are particularly affected with a large number of incidental findings. This valuable diagnostic procedure also entails the risk of complex and cost-intensive subsequent investigations with partly invasive procedures. ACHIEVEMENTS: For this reason radiologists are more often confronted with the difficult task of correctly assessing these lesions, to decide on the need for additional investigations and to inform the patient in detail about the clinical relevance. PRACTICAL RECOMMENDATIONS: The aims of this article are to describe the most common abdominal incidentalomas, to assist with the interpretation and differential diagnosis and to give recommendations for further management.

Ultrasonography assessment of hepatobiliary abnormalities in 3359 subjects with Opisthorchis viverrini infection in endemic areas of Thailand.

A cross sectional study on hepatobiliary abnormalities in opisthorchiasis was performed in 8936 males and females aged from 20 to 60 years from 90 villages of Khon Kaen province, Northeast Thailand. All were stool-examined for Opisthorchis viverrini infection by standard quantitative formalin/ethyl acetate concentration technique. Of these, 3359 participants with stool egg positive underwent ultrasonography of the upper abdomen. The hepatobiliary abnormalities detected by ultrasound are described here. This study found a significantly higher frequency of advanced periductal fibrosis in persons with chronic opisthorchiasis (23.6%), particularly in males. Risks of the fibrosis included intensity of infection, and age younger than 30 years. Height of left lobe of the liver, cross-section of the gallbladder dimensions post fatty meal, sludge, and, interestingly, intrahepatic duct stones were significantly associated with the advanced periductal fibrosis. Eleven suspected cholangiocarcinoma (CCA) cases were observed. This study emphasizes the current status of high O. viverrini infection rate and the existence of hepatobiliary abnormalities including suspected CCA in opisthorchiasis endemic areas of Thailand.

Prospective, randomized comparison of mechanical and electronic radial endoscopic ultrasound systems: assessment of performance parameters and image quality.

OBJECTIVE: Implementation of electronic image technology in endoscopic ultrasonography (EUS) should improve image quality, but systematic data are scarce. The purpose of this study was to compare the image quality and performance of an electronic and a mechanical radial echoendoscope. MATERIAL AND METHODS: Eighty consecutive patients (42 M, mean age 56 years) in a tertiary referral center, without gross pathology (advanced tumors excluded), were prospectively randomized to EUS with the mechanical or electronic echoendoscope. Images from five standardized positions (pancreatobiliary and upper gastrointestinal (GI) tract) were taken by two examiners of differing experience. Time to acquire images was noted. Penetration depth was also measured. Image quality variables (overall quality, contrast, and structure discrimination) were assessed blindly on the basis of randomly shuffled images during three independent evaluations by the same experienced examiner (mean values were taken), using a visual analogue scale (VAS) from 1 (excellent) to 10 (inadequate). RESULTS: Time needed to achieve visualization of the distal common bile duct (CBD) was significantly shorter with the electronic scope (49.7+/-8.6 versus 97.4+/-8.5 s; p<0.001). Image quality with the electronic scope was rated significantly better for all variables assessed, whereas EUS penetration depth was similar in both groups. There were no differences in examiner experience. CONCLUSIONS: Electronic EUS provided better quality images according to the examiner's subjective assessment. An objective advantage was faster identification of the distal CBD.

Extracolonic findings in an asymptomatic screening population undergoing intravenous contrast-enhanced computed tomography colonography.

BACKGROUND AND AIM: The purpose of this study was to evaluate extracolonic findings that could be encountered with computed tomography colonography (CTC) using intravenous (IV) contrast material in an asymptomatic screening population. METHODS: Intravenous contrast medium-enhanced CTC was performed in 2230 asymptomatic adults (mean age, 57.5 years). Axial images were prospectively examined for extracolonic lesions. These findings were classified into three categories: potentially important findings, likely unimportant findings, and clinically unimportant findings. Potentially important extracolonic findings were defined as those which required immediate further diagnostic studies and treatment. Clinical and radiologic follow up, missed lesions and clinical outcomes were assessed using medical records (mean duration of follow up, 1.6 years). RESULTS: A total of 115 new potentially important findings in 5.2% of subjects (115/2230) were found. Subsequent medical or surgical intervention was performed in 2.0% (45/2230). New extracolonic cancer was detected in 0.5% (12/2230), and the majority of them (83.3%) were not metastasized. Computed tomography colonography missed eight potentially important extracolonic findings in eight subjects (0.4%, 8/2230): 0.8-cm early-stage prostatic cancer, six adrenal mass and one intraductal papillary mucinous tumor. There were no severe life-threatening complications related to contrast medium. CONCLUSION: Intravenous contrast-enhanced CTC could safely detect asymptomatic early-stage extracolonic malignant diseases without an unreasonable number of additional work-ups, thus reducing their morbidity or mortality.

Risk assessment of posthepatectomy liver failure using hepatobiliary scintigraphy and CT volumetry.

UNLABELLED: A major part of morbidity and mortality after liver resections is caused by inadequate remnant liver function leading to liver failure. It is therefore important to develop accurate diagnostic tools that can predict the risk of liver resection-related morbidity and mortality. In this study, preoperative hepatobiliary scintigraphy of the future remnant liver and CT volumetric measurement of the future remnant liver were performed on patients who were to undergo liver resection. The accuracy of risk assessment for postoperative morbidity, liver failure, and mortality was evaluated. METHODS: Forty-six patients who were scheduled for liver resection because of hepatobiliary tumors, including 17 patients with parenchymal disease (37%) and 13 patients with hilar cholangiocarcinoma (28%), were assessed preoperatively. Hepatobiliary scintigraphy was performed by drawing regions of interest around the future remnant to calculate (99m)Tc-mebrofenin uptake in it. CT volumetry was used to measure the volume of the total liver, the tumors, and the future remnant. Receiver-operating-characteristic analysis was performed to assess cutoff values for risk assessment of morbidity, liver failure, and mortality. Furthermore, univariate and multivariate analyses were performed to determine factors related to morbidity and mortality. RESULTS: Morbidity and mortality rates were 61% and 11%, respectively. Liver failure occurred in 6 patients (13%). Significantly decreased uptake in the future remnant was found in patients in whom liver failure and liver failure-related mortality developed (P=0.003 and 0.02, respectively). The volume of the future remnant was not significantly associated with any of the outcome parameters. In receiver-operating-characteristic analysis, uptake cutoff values for liver failure and liver failure-related mortality were 2.5%/min/body surface area and 2.2%/min/body surface area, respectively. In multivariate analysis, uptake was the only significant factor associated with liver failure. CONCLUSION: Preoperative measurement of (99m)Tc-mebrofenin uptake in the future remnant liver on hepatobiliary scintigraphy proved more valuable than measurement of the volume of the future remnant on CT in assessing the risk of liver failure and liver failure-related mortality after partial liver resection.

Assessment of anomalous pancreaticobiliary ductal junction with high-resolution multiplanar reformatted images in MDCT.

OBJECTIVE: The objective of our study was to assess the capabilities of MDCT for the diagnosis of an anomalous pancreaticobiliary ductal junction using high-resolution multiplanar reformatted (multiplanar reconstruction) images. MATERIALS AND METHODS: This study included nine patients with and 54 without an anomalous pancreaticobiliary ductal junction confirmed on direct cholangiopancreatography. Multiplanar reconstruction images with 0.5-mm continuous slices were generated from isotropic or nearly isotropic pancreatic phase images. By mainly interpreting the multiplanar reconstruction images using the Scrolling mode, two blinded reviewers independently determined whether the confluence of the pancreatic and biliary ducts joined in the pancreatic parenchyma (in other words, outside the duodenal wall). The results were correlated with the findings of direct cholangiopancreatography. The diagnostic capabilities of CT for revealing associated pancreatobiliary diseases were assessed in patients with this anomaly. RESULTS: Interobserver agreement in the classification of the duct confluence was high (kappa = 0.804). The duct confluence was identified in all patients except four without an anomalous pancreaticobiliary ductal junction. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CT for diagnosing an anomalous pancreaticobiliary ductal junction were 100% (9 of 9 patients), 87% (47 of 54 patients), 89% (56 of 63 patients), 75% (9 of 12 patients), and 100% (47 of 47 patients) in the final decisions, respectively. CT showed all associated pancreatobiliary diseases except bile duct stones in two patients. CONCLUSION: MDCT enabled the diagnosis of an anomalous pancreaticobiliary ductal junction by showing whether the pancreatic and biliary ducts join within the pancreatic parenchyma on high-resolution multiplanar reconstruction images.

Assessment of early biliary complications after orthotopic liver transplantation and their relationship to the technique of biliary reconstruction.

INTRODUCTION: Biliary complications are known as the weak point of liver transplantation. Their occurrence can be related to the practice of drainage of the biliary anastomosis, the routine use of which was abandoned in June 2004. The aim of the study was to assess the incidence and type of biliary complications following orthotopic liver transplantation in relation to the technique of biliary anastomosis. MATERIAL AND METHODS: We compared the results of two groups of adult liver transplant recipients: group I, recent 50 transplantations with biliary drainage (25 women: 25 men of age range: 17 to 63 years), and group II, first 50 transplantations without drainage (19 women and 31 men of age range, 20 to 65 years). We examined the problem of biliary complications and their influence on the further management of the patients. In both groups the main indications for transplantation were various types of cirrhosis as well as cholestatic diseases. In the majority of cases (n = 86) an end-to-end common bile duct anastomosis was performed and in 14 cases, hepaticojejunal anastomosis. RESULTS: In group I, biliary complications requiring surgical or endoscopic intervention occurred in 10 (20%) recipients. In one case, biliary complications resulted in the need for retransplantation. In group II, biliary complications occurred in only four (8%) patients, none of which caused organ loss. CONCLUSION: Cessation of biliary anastomosis drainage has reduced the occurrence of early biliary complications following orthotopic liver transplantation.

[Hepatobiliogastroscintigraphy in assessment of the hepatobiliary system in primary cancer of the liver]. / Gepatobiligastrostsintigrafiia v otsenke sostoianiia gepatobiliarnoi sistemy pri pervichnom rake pecheni.

Primary cancer of the liver is characterized not only by laboratory evidence for cytolytic (87.5% cases), cholestatic (100% cases) syndromes, high levels of oncomarkers (CA-19-9, 50%; CEA, 68.75%; alpha FP, 43.75%) and activation of hemostasis system but, as shown at hepatobiligastroscintigraphy with 99m-Tc-brommeside, by at least 2-fold decline in absorptive and excretory function of hepatic polygonal cells (in 75% cases), at least a 5-fold decline in secretory function of the gallbladder (in 100% cases), cholestasis (in 100% cases) manifesting as a 3.8-fold reduction, on the average, of the ratio of secretory function of the gallbladder to that of the intrahepatic bile ducts, dilation of the latter (in 50% cases), Oddi's sphincter hypotonicity (in 50% cases). None of the patients showed duodenogastric reflux.

Assessment of the biliary tract by ultrasonography and cholangiography during laparoscopic cholecystectomy: a prospective study.

OBJECTIVE: The introduction of laparoscopic cholecystectomy (Lap-chol) has induced routine cholangiography to map the biliary tree and identify common bile duct (CBD) stones. However, the use of more selective criteria for performing intraoperative cholangiography (IOC), drawbacks of IOC and experience with laparoscopic ultrasonography (LU) re-introduced intraoperative ultrasonography for the CBD. The purpose of this study was to compare the accuracy of LU and IOC to identify the anatomy of the CBD and the presence of stones. METHODS: A total of 50 unselected patients undergoing elective laparoscopic cholecystectomy were evaluated by LU and IOC. Stones were found in three patients by IOC and could be confirmed by ultrasonography and CBD exploration in two. RESULTS: Anatomic definition of the biliary tract and success of the procedure was better for LU (90 and 98%) than IOC (86 and 72%). CONCLUSION: For Surgical groups with experience in LU this technique appears to become the standard technique to identify the anatomy of the CBD and assessment of CBD stones.

Magnetic resonance cholangiopancreatography: non-invasive imaging for the biliary tree and pancreatic duct.

Producing images similar to those acquired by the invasive procedures of endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography, magnetic resonance cholangiopancreatography (MRCP) is indicated in patients who are unable to undergo ERCP or have had previously unsuccessful ERCP. It is used increasingly in non-invasive evaluation of the pancreaticobiliary tree in cases where the need for intervention during ERCP is expected to be low. MRCP may help in identifying anomalous biliary anatomy or choledocholithiasis before laparoscopic cholecystectomy, and in deciding between percutaneous or endoscopic treatment for patients with obstructive jaundice to decrease the rate of failed ERCP procedures.

[Hepatobiliary functions in primary biliary cirrhosis--assessment with 99mTc-PMT hepatobiliary scintigraphy].

To define a relationship between the changes of hepatic and gallbladder functions and the pathological progression in patients with primary biliary cirrhosis, we studied 15 patients at various pathologic stages with 99mTc-N-pyridoxyl-5-methyl-tryptophan (PMT) hepatobiliary scintigraphy. In stage I both the hepatic uptake rates and hepatic excretion rates of 99mTc-PMT were not reduced compared with the normal subjects. According to the progress of the pathologic stage, the hepatic uptake rates of 99mTc-PMT were decreased. The hepatic excretion rates were reduced in stages II, III and IV, but they were not related to the progression of the pathologic stage. The hepatic uptake rate is considered to be useful in evaluating the pathological progression in patients with primary biliary cirrhosis. The mean gallbladder ejection fraction in patients with primary biliary cirrhosis (32 +/- 18%) was significantly lower than that of the normal subjects (72 +/- 13%) (p < 0.005). The reduction of the gallbladder ejection fraction was not related to the progress of the pathologic stage. Sluggish emptying of gallbladder may suggest the gallbladder wall lesion in this disease.