• Biliary
• Liver
• Multidisciplinary

• Humans
• Diagnosis, Differential
• Gallbladder Diseases/diagnostic imaging
• Gallbladder Diseases/pathology
• Biliary Tract Diseases/diagnostic imaging
• Biliary Tract Diseases/pathology

• diagnosis
• imaging technology
• junction variation
• pancreaticobiliary duodenal junction
• three-dimensional visualization technology
• tumorigenesis

• bile
• biomarker
• cholangiocarcinoma
• microrna
• pancreatic ductal adenocarcinoma

• Humans
• MicroRNAs/analysis
• MicroRNAs/genetics
• Female
• Male
• Middle Aged
• Aged
• Pancreatic Neoplasms/diagnosis
• Pancreatic Neoplasms/genetics
• Biomarkers, Tumor/genetics
• Biomarkers, Tumor/analysis
• Biomarkers, Tumor/metabolism
• Bile/metabolism
• Bile/chemistry
• Cohort Studies
• Cholangiocarcinoma/diagnosis
• Cholangiocarcinoma/genetics
• Cholangiocarcinoma/metabolism
• Bile Duct Neoplasms/diagnosis
• Bile Duct Neoplasms/genetics
• Prospective Studies
• Carcinoma, Pancreatic Ductal/diagnosis
• Carcinoma, Pancreatic Ductal/genetics

• Bismuth-Corlette classification
• Hepatectomy
• Hilar cholangiocarcinoma
• Memorial Sloan Kettering Cancer Centre Staging
• Portal vein embolisation
• Preoperative biliary drainage
• Surgical resection

• Humans
• Klatskin Tumor/therapy
• Klatskin Tumor/surgery
• Treatment Outcome
• Hepatectomy/methods
• Bile Duct Neoplasms/diagnosis
• Bile Duct Neoplasms/therapy
• Bile Duct Neoplasms/pathology
• Cholangiocarcinoma/diagnosis
• Cholangiocarcinoma/therapy
• Bile Ducts, Intrahepatic/pathology
• Cholangiopancreatography, Endoscopic Retrograde
• Drainage

• bile duct cancer
• bile ducts

• Abscess
• Case report
• Extrapulmonary tuberculosis
• Ilium wing
• Psoas

• Adult
• Antitubercular Agents/therapeutic use
• Female
• Humans
• Isoniazid/therapeutic use
• Psoas Abscess/diagnostic imaging
• Pyrazinamide/therapeutic use
• Rifampin/therapeutic use
• Tuberculosis/drug therapy

This article aims to give an overview of some of the common conditions seen in emergency general surgery and the recommended choice of imaging. For junior doctors, choosing the correct imaging modality can be difficult so we aim to provide a summary of the evidence behind radiology for emergency general surgery. Four of the most important acute surgical conditions were chosen, alongside abdominal aortic aneurysm. A literature search was carried out to review the most up-to-date evidence regarding imaging choices. Cases were chosen from everyday practice to put the imaging into context. This article gives an overview of the most common imaging modalities used in emergency general surgery. It can be used by medical students and junior doctors to help understand the reasoning behind imaging choices on the acute surgical take.

Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive method to detect pancreaticobiliary strictures. In this study, we aimed to evaluate the diagnostic performance of MRCP and detect sensitive and specific radiologic features in distinguishing malignant and benign pathologies.

In this study, 50 patients with biliary obstruction and a confirmed diagnosis using histopathology were included. The pathologies were evaluated using MRCP which were categorized into malignant and benign strictures. The etiology of strictures was detected using histopathology and endoscopic retrograde cholangiopancreatography. The diagnostic performance of MRCP was calculated using SPSS software. P < 0.05 was considered statistically significant.

Of 50 patients, 23 patients (46%) had malignant strictures based on MRCP and histopathology. The sensitivity and specificity of MRCP to detect malignancy were 95.7% and 96.3%, respectively. The most sensitive MRCP features to detect malignancy were upstream biliary duct dilation, abrupt tapering, and the presence of a solid mass with sensitivity 100%, 95.7%, and 78.2%, respectively. The malignancy rate was significantly higher in the strictures with length >11.5 mm or wall thickness >2.75 mm (P < 0.05).

MRCP is a sensitive method to differentiate malignant lesions from benign pathologies. A long and thick stricture with the presence of a solid mass, upstream biliary duct dilation, and abrupt tapering is highly suggestive of malignancy.

• Biliary tract
• Cholangiopancreatography
• Magnetic Resonance
• malignancy
• pancreas

Radiomics may provide more objective and accurate predictions for extrahepatic cholangiocarcinoma (ECC). In this study, we developed radiomics models based on magnetic resonance imaging (MRI) and machine learning to preoperatively predict differentiation degree (DD) and lymph node metastasis (LNM) of ECC.

A group of 100 patients diagnosed with ECC was included. The ECC status of all patients was confirmed by pathology. A total of 1200 radiomics features were extracted from axial T1 weighted imaging (T1WI), T2-weighted imaging (T2WI), diffusion weighted imaging (DWI), and apparent diffusion coefficient (ADC) images. A systematical framework considering combinations of five feature selection methods and ten machine learning classification algorithms (classifiers) was developed and investigated. The predictive capabilities for DD and LNM were evaluated in terms of area under precision recall curve (AUPRC), area under the receiver operating characteristic (ROC) curve (AUC), negative predictive value (NPV), accuracy (ACC), sensitivity, and specificity. The prediction performance among models was statistically compared using DeLong test.

For DD prediction, the feature selection method joint mutual information (JMI) and Bagging Classifier achieved the best performance (AUPRC = 0.65, AUC = 0.90 (95% CI 0.75–1.00), ACC = 0.85 (95% CI 0.69–1.00), sensitivity = 0.75 (95% CI 0.30–0.95), and specificity = 0.88 (95% CI 0.64–0.97)), and the radiomics signature was composed of 5 selected features. For LNM prediction, the feature selection method minimum redundancy maximum relevance and classifier eXtreme Gradient Boosting achieved the best performance (AUPRC = 0.95, AUC = 0.98 (95% CI 0.94–1.00), ACC = 0.90 (95% CI 0.77–1.00), sensitivity = 0.75 (95% CI 0.30–0.95), and specificity = 0.94 (95% CI 0.72–0.99)), and the radiomics signature was composed of 30 selected features. However, these two chosen models were not significantly different to other models of higher AUC values in DeLong test, though they were significantly different to most of all models.

MRI radiomics analysis based on machine learning demonstrated good predictive accuracies for DD and LNM of ECC. This shed new light on the noninvasive diagnosis of ECC.

• Cell differentiation
• Extrahepatic cholangiocarcinoma
• Lymphatic metastasis
• Machine learning
• Radiomics

Periampullary carcinoma refers to a malignant tumor within 2 cm of the duodenal ampulla. Primary ampullary carcinoma is very rare, accounting for only 0.2% of malignant gastrointestinal tumors. The small intestine accounts for 75% of the length of the gastrointestinal tract, and primary tumors in the small intestine account for only 2% of all gastrointestinal tumors. Here, we report the case of a duodenal ampullary tumor with malignant transformation of parapapillary polyps. The patient had both a primary ampullary tumor and high-grade intraepithelial neoplasia of juxtapapillary adenomatous duodenal polyps.

• Periampullary carcinoma
• adenomatous polyp
• duodenum
• high-grade neoplasia
• malignant transformation
• tubular adenoma

To determine whether contrast-enhanced computed tomography (CT) can promote the identification of malignant and benign distal biliary strictures (DBSs) compared to the use of magnetic resonance cholangiopancreatography (MRCP) alone and to identify imaging findings of malignant DBSs.

A total of 168 consecutive patients with confirmed DBSs were reviewed. MRCP alone and MRCP combined with CT images were blindly analyzed by two radiologists (e.g., stricture pattern, margins), and malignant or benign DBSs were identified based on surgical findings, endoscopy findings, or follow-up. The diagnostic accuracy of the two reviewers using MRCP alone and MRCP combined with CT were evaluated. MRCP and CT features of malignant and benign DBSs were compared using multiple logistic regression analysis to identify independent malignant risk factors.

MRCP combined with CT examination could improve the diagnostic accuracy, which increased from 70.2% to 81.5% in Doctor A and from 85.1% to 89.3% in Doctor B. The multiple logistic regression model revealed that stricture length [odds ratio (OR) 1.070, P=0.016], angle of the DBS (OR 1.061, P<0.001), double duct sign (OR 4.312, P=0.003) and low density in the arterial phase (OR 0.319, P=0.018) were associated with malignant DBS. A scoring model incorporating these four factors was established; at a threshold value of 1.75, and the sensitivity and specificity for the detection of malignant DBSs were 73.5 and 85.9%, respectively.

Compared to the use of MRCP alone, MRCP combined with contrast-enhanced CT can improve the accuracy of DBS diagnosis. The scoring model accurately predicts malignant DBSs and helps make treatment decisions.

• CT
• MRCP
• distal biliary strictures
• imaging findings
• risk factors

• benign biliary strictures
• biliary stent
• cholangioplasty
• interventional radiology
• percutaneous management

• Artificial intelligence
• Cholangiocarcinoma
• Imaging evaluation

Background

Challenges in the diagnosis of obstructive jaundice include locating the level of obstruction, knowing the cause of obstruction, and differentiating between benign and malignant causes. Imaging plays a significant role in detecting the causes of obstruction. Radiologists aim to diagnose biliary obstruction, its level, extent, and probable causes to determine the appropriate treatment for each case. 

Methods

Our study is a retrospective medical record review study. It included 150 patients who had ultrasound (US) diagnosis of biliary obstruction and underwent magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP) in King Fahad Specialist Hospital, Buraidah. The patients’ medical records have been reviewed to measure the sensitivity and specificity of US, MRCP, and ERCP. 

Results

Statistical analysis of the data showed that the sensitivity of US in detecting the most common cause of biliary obstruction, common bile duct (CBD) stone, was 26.6%, while the specificity was 100%. Comparing this sensitivity of US in detecting CBD stones to that of MRCP and ERCP, we obtained the following: US, 26.6%; MRCP, 62.9%; and ERCP, 62.4%. Although US was the least sensitive for detecting CBD stones, its specificity in this detection was 100%, while MRCP was 63.6%, and ERCP was 55.2%.

Conclusion 

US is the best initial step for the diagnosis of biliary obstruction. However, MRCP and ERCP are more sensitive in detecting CBD stones compared to US. Also, compared to US, they have shown higher percentages in all aspects of detection: level, cause, and extent of biliary obstruction.

• endoscopic retrograde cholangiopancreatography
• magnetic resonance cholangiopancreatography
• obstructive jaundice
• saudi arabia
• sclerosing cholangitis

• Cell-free DNA
• DNA methylation
• Differential biomarker
• MS-HRM
• Misdiagnosis

• Area Under Curve
• Bile Duct Diseases/diagnosis
• Bile Duct Diseases/genetics
• Bile Duct Neoplasms/diagnosis
• Bile Duct Neoplasms/genetics
• Biomarkers, Tumor/genetics
• Cell Adhesion Molecules/genetics
• Cell-Free Nucleic Acids
• Cholangiocarcinoma/diagnosis
• Cholangiocarcinoma/genetics
• DNA Methylation
• Diagnosis, Differential
• Female
• GPI-Linked Proteins/genetics
• Homeodomain Proteins/genetics
• Humans
• Male
• Neoplasm Proteins/genetics
• Sensitivity and Specificity

• benign biliary stricture
• chronic pancreatitis
• endoscopic retrograde cholangiopancreatography
• liver transplantation
• metal stent
• plastic stent
• primary sclerosing cholangitis
• stricture dilatation

Intrahepatic cholangiocarcinoma (ICC) is the second most common malignancy arising from the liver. ICC makes up about 10% of all cholangiocarcinomas. It arises from the peripheral bile ducts within the liver parenchyma, proximal to the secondary biliary radicals. Histologically, the majority of ICCs are adenocarcinomas. Only a minority of patients (15%) present with resectable disease, with a median survival of less than 3 years. Multidisciplinary management of ICC is complicated by large differences in disease course for individual patients both across and within tumor stages. Risk models and nomograms have been developed to more accurately predict survival of individual patients based on clinical parameters. Predictive risk factors are necessary to improve patient selection for systemic treatments. Molecular differences between tumors, such as in the epidermal growth factor receptor status, are promising, but their clinical applicability should be validated. For patients with locally advanced disease, several treatment strategies are being evaluated. Both hepatic arterial infusion chemotherapy with floxuridine and yttrium-90 embolization aim to downstage locally advanced ICC. Selected patients have resectable disease after downstaging, and other patients might benefit because of postponing widespread dissemination and biliary obstruction.

• developments
• diagnosis
• intrahepatic cholangiocarcinoma
• treatment

• biliary obstruction
• cancer
• interventional radiology
• percutaneous drainage

• benign stricture
• biliary strictures
• interventional radiology
• percutaneous biliary drainage
• percutaneous transhepatic cholangiogram

• Lowering Costs of Healthcare
• Value of Healthcare

• Diagnostic Tests, Routine/methods
• Diagnostic Tests, Routine/trends
• Gastroenterology/methods
• Gastroenterology/trends
• Gastrointestinal Diseases/diagnosis
• Humans

• R01 DK092179 NIDDK NIH HHS
• R56 DK067071 NIDDK NIH HHS