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cbd stent mri safety

Results: We identified 88 patients with pancreatic cancer who received a CSEMS. Forty patients were deemed resectable and underwent surgery. Pancreaticoduodenectomy was performed in 34 of 40 patients. The CSEMS was easily removed at the time of surgical resection without any complications. The 44 unresected patients with covered SEMS were followed for a mean of 4.2 months (range, 1 to 13). The patency rate for stents was 97% at 12 months. Immediate procedural complications included post-endoscopic retrograde cholangiopancreatography pancreatitis (n=9) and duodenal perforation (n=2). Four patients (5%) had migration and 3 (3%) had stent occlusion. There were no cases of cholecystitis during the follow-up. The patients who presented with stent migration or occlusion underwent stent revision.

Patients and methods: Between March, 2009 and March, 2010, all patients with obstructive jaundice secondary to pancreatic cancer underwent placement of a CSEMS, regardless of resectability. A CSEMS was placed across the malignant stricture. These patients were then staged for their cancer by computed tomography, magnetic resonance imaging, and/or endoscopic ultrasound-guided fine-needle aspiration. Patient found to have resectable cancer were offered a pancreaticoduodenectomy.

Aim: We report a retrospective analysis of patients with malignant biliary obstruction in whom a newly released fully silicon-covered, WallFlex, self-expandable metal stent (CSEMS) was placed for biliary decompression.

Conclusions: Placement of the newly available CSEMS can be used to effectively and safely treat biliary obstructions from pancreatic carcinoma. We recommend that the CSEMS be used as an initial intervention to relieve malignant biliary obstruction, even in patients whose surgical resectability status is uncertain.

Cbd stent mri safety

All MR imaging studies were performed using a closed 1.5-T high-field MR imaging system (Vision; Siemens, Erlangen, Germany).

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There are many reasons why MR cholangiography is not used more frequently in patients with biliary stents. The image quality of MR cholangiography is often severely compromised by susceptibility artifacts associated with the stent. In addition, aside from the composition of the stent alloy, other factors, such as the magnetic field strength B0, the orientation of the stent in relation to the magnetic field, and the individual sequence parameters of sequence type and echo time, must be taken into consideration [10,11,12,13]. In addition, the internal stent mesh structure may cause signal deflection from the interior lumen (Melzer et al., presented at the International Meeting of the Society of Magnetic Resonance in Medicine, April 2000). Furthermore, particularly in patients with indwelling metallic stents, there are certain safety issues to consider, such as the potential movement or dislodging of the stent by magnetic field interactions and the heating of the endoprosthesis by radiofrequency power deposition [14]. However, because stents are increasingly manufactured with MR-compatible materials, even MR imaging—guided percutaneous or endoscopic stent implantation is increasingly possible. Wacker et al. [15] performed percutaneous transhepatic cholangiography without complication in an animal model using a 0.2-T low-field MR imaging system for guidance; Wacker et al. then confirmed these positive findings in three patients (presented at the third international meeting of the Society for Magnetic Resonance in Medicine, April 2000). Also, MR-compatible, custom-made endoscopes have recently become available [16].

Hepatobiliary Imaging

Because of the lesser extent of the associated susceptibility artifact, evaluation of the interior lumen of the nitinol-based Smart Stent should theoretically be possible. However, this was not confirmed in four of the five patients we examined; demarcation of the stent itself was only partially possible because the extent of artifact was not sufficiently large (Figs. 3A , 3B and 4A , 4B , 4C ).