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Liver and biliary system, pancreas and spleen
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The pancreas is low to intermediate signal intensity on T2-weighted images, with pathological tissue presenting as isointense or hyperintense. On T1-weighted images with fat suppression the pancreas is the highest signal intensity of the abdominal organs. Adenocarcinoma and pancreatitis are lower signal than normal pancreas on T1 and there is greater signal on enhancement of normal pancreatic tissue with contrast than in cancerous or necrotic tissue. Pancreatic adenocarcinoma accounts for ≈90% of pancreatic tumours. MRI appearances of less common tumours on T2-weighted images and the pattern of contrast enhancement can help to characterise pancreatic tumours. In pancreatitis the formation of pseudocysts is a common finding. Pseudocysts result from fat necrosis and the formation of granulation tissue and a fibrous capsule enclosing pancreatic secretions and MRI is better than CT at demonstrating the complex internal structure of the pseudocyst [23]. MRI can establish the solid and fluid content of the inflammatory collection, which guides which lesions are amenable to percutaneous drainage. In addition, MRCP may be performed to identify choledocholithiasis as a cause of acute pancreatitis or for examination of the pancreatic duct [24].
Bioburden and transmission of pathogenic bacteria through elevator channel during endoscopic retrograde cholangiopancreatography: application of multiple-locus variable-number tandem-repeat analysis for characterization of clonal strains
Published in Expert Review of Medical Devices, 2019
Masoumeh Azimirad, Masoud Alebouyeh, Amir Sadeghi, Elham Khodamoradi, Hamid Asadzadeh Aghdaei, Amir Houshang Mohammad Alizadeh, Mohammad Reza Zali
Endoscopic retrograde cholangiopancreatography (ERCP) is used increasingly for diagnosis and treatment of pancreatobiliary diseases, including choledocholithiasis, gallstone pancreatitis, and bile duct or pancreatic duct stenosis [1]. Bacterial infection is the most morbid complications of ERCP, which can cause ERCP-related death through septic cholangitis, liver abscess, acute cholecystitis, and pancreatic pseudocyst [2]. During the procedure, bacteria can enter the biliary tract and colonize this tissue via contaminated device and its related instruments [3]. Difficulty in reprocessing, cleaning and disinfection of duodenoscopes, such as elevator mechanism, converted this medical device as a reservoir for life-threatening infections. The infection in this organ causes more frequently through enteric bacterial flora [4]. Several outbreaks were reported in association to used contaminated endoscopes during ERCP procedure in recent years [5–11]. Although these outbreaks were mainly related to Pseudomonas aeruginosa, Klebsiella spp., Enterococcus spp., Escherichia coli, and Staphylococci, sources of these bacteria and their transmission routes were not well characterized.