title: Carbon dioxide-enhanced virtual MDCT cholangiopancreatography.
abstract: OBJECTIVE
  We investigated the feasibility of new carbon dioxide-enhanced virtual multidetector computed tomography (MDCT) cholangiopancreatography (CMCP) for intraluminal exploration in 73 patients with hepatobiliary and pancreatic disease.
  
  
  METHODS
  CMCP was performed via a percutaneous or transpapillary drainage tube, and, synchronously, intravenous contrast material was employed for virtual angiography; three-dimensional (3D) virtual reality was incorporated using OsiriX and Fovia applications. The capability of carbon dioxide to delineate the biliary and pancreatic system was evaluated.
  
  
  RESULTS
  All CMCPs showed complete technical success; complications including pancreatitis or pain never occurred. The incidences of visible third- and fourth-order biliary branches were 100 and 86.0%. The capability of carbon dioxide to pass an obstruction through an occluded hilar bile duct malignancy was 80.0%; it provided feasible information on additional bile duct segments. The full extent of the gallbladder was depicted in 72.7% of the studies. Minimum 2-mm lesions of biliary stones or gallbladder polyps were clearly detected. The main or second-order pancreatic ducts were visible in 100 and 83.3% of the studies, respectively. Carbon dioxide enabled the replacement of mucin and pancreatic juice and facilitated the detection of cystic lesions of intraductal papillary-mucinous neoplasm (IPMN) in 75.0% of the studies. We succeeded in achieving 3D spatial recognition of vascular structures in the cholangiopancreatic region, through the fusion of CMCP and 3DCT arteriography and venography in a single image scanning, and radiation time was decreased. This combined modality proved to be feasible for planning operations and for image-guided navigated surgery in the resection of a malignancy.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report to demonstrate the diagnostic accuracy of carbon dioxide MDCT cholangiopancreatography and the use of this modality for depicting biliary, pancreatic, and fusion blood vessels simultaneously. Carbon dioxide possesses many advantages over conventional iodinated contrast agents, and it might replace more invasive diagnostic measures in the near future.
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, Japan. sgmt@med.kobe-u.ac.jp
authors.forename: Maki
authors.initials: M
authors.lastname: Sugimoto
authors.forename: Hideki
authors.initials: H
authors.lastname: Yasuda
authors.forename: Keiji
authors.initials: K
authors.lastname: Koda
authors.forename: Masato
authors.initials: M
authors.lastname: Suzuki
authors.forename: Masato
authors.initials: M
authors.lastname: Yamazaki
authors.forename: Tohru
authors.initials: T
authors.lastname: Tezuka
authors.forename: Chihiro
authors.initials: C
authors.lastname: Kosugi
authors.forename: Ryota
authors.initials: R
authors.lastname: Higuchi
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Watayo
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Yagawa
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Uemura
authors.forename: Hironori
authors.initials: H
authors.lastname: Tsuchiya
authors.forename: Takeshi
authors.initials: T
authors.lastname: Azuma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D002245:Carbon Dioxide / Q000008:administration & dosage; D002758:Cholangiography / Q000379:methods*; D002763:Cholecystectomy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D011029:Pneumoradiography / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D002245:Carbon Dioxide