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To prospectively evaluate the clinical feasibility of the magnetic resonance cholangiopancreatography (MRCP) protocol using both contact-free physiological monitoring (CFPM) and compressed sensing (CS) (CS-CFPM-MRCP) and to compare its performance with that of the standard navigator-triggered (NT) CS-NT-MRCP and NT-MRCP.A total of 63 patients (36 males, 27 females, age range: 18-83 years, mean age: 52.30 ± 15.70 years) suspected with duct-related pathologies were prospectively enrolled and performed the three MRCP protocols randomly. The acquisition time was compared. The pancreaticobiliary system was divided into 12 segments and evaluated based on a five-point Likert scale and compared by the Friedman test with a post hoc test. The diagnostic performance of the 3 MRCP was evaluated by the AUC value and compared by Delong's test. The interobserver agreement was evaluated by Kendall's W test.Compared to NT-MRCP, the acquisition time of CS-NT-MRCP and CS-CFPM-MRCP was significantly decreased (both p0.001). There is no significant difference in the overall imaging quality (p0.05) between the NT-MRCP and CS-CFPM-MRCP protocols. CS-CFPM-MRCP depicted pancreatic duct and intrahepatic ducts better than CS-NT-MRCP (all p0.05) and was comparable with that of the NT-MRCP (all p0.05). For identification of abnormalities and diseases associated with MPD anatomy, the mean AUC value for NT-MRCP and CS-CFPM-MRCP were 0.896 (95%CI: 0.834, 0.958) and 0.905 (95%CI: 0.846, 0.964), which were significantly higher when compared to that for CS-NT-MRCP (0.713 [95%CI:0.622, 0.805]) (p = 0.001 and0.001). All evaluations showed good to excellent agreement (0.619-0.897).The combination of CS and CFPM is considered feasible for shortening the scan time of 3D free breath MRCP without impairing the imaging quality and CS-CFPM-MRCP is considered feasible for patients suspected with pancreaticobiliary diseases.

Purpose To show the feasibility of motion-sensitized driven-equilibrium-balanced magnetic resonance cholangiopancreatography and to determine the optimal velocity encoding (VENC) value. Materials and methods Sixteen healthy volunteers underwent MRI study using a 1.5-T clinical unit and a 32-channel body array coil. For each volunteer, images were obtained using the following seven respiratory-triggered sequences: (1) balanced magnetic resonance cholangiopancreatography without motion-sensitized driven-equilibrium, and (2)–(7) balanced magnetic resonance cholangiopancreatography with motion-sensitized driven-equilibrium, with VENC = 1, 3, 5, 7, 9 and ∞ cm/s for the x-, y-, and z-directions, respectively. Quantitative evaluation was obtained by measuring the maximum signal intensity of the common hepatic duct, portal vein, liver tissue including visible peripheral vessels, and liver tissue excluding visible peripheral vessels that were evaluated. We compared the contrast ratios of portal vein/common hepatic duct, liver tissue including visible peripheral vessels/common hepatic duct and liver tissue excluding visible peripheral vessels/common hepatic duct among the five finite sequences (VENC = 1, 3, 5, 7, and 9 cm/s). Statistical comparisons were performed using the t-test for paired data with the Bonferroni correction. Results Suppression of blood vessel signals was achieved with motion-sensitized driven-equilibrium sequences. We found the optimal VENC values to be either 3 or 5 cm/s with the best suppression of relative vessel signals to bile ducts. At a lower VENC value (1 cm/s), the bile duct signal was reduced, presumably due to minimal biliary flow. Conclusion The feasibility of motion-sensitized driven-equilibrium-balanced magnetic resonance cholangiopancreatography was suggested. The optimal VENC value was considered to be either 3 or 5 cm/s. The clinical usefulness of this new magnetic resonance cholangiopancreatography sequence needs to be verified by further studies.

A novel 3D breath-held Dixon fat–water separated balanced steady state free precession (b-SSFP) sequence for MR cholangiopancreatography (MRCP) is described and its potential clinical utility assessed in a series of patients. The main motivation is to develop a robust breath-held alternative to the respiratory gated 3D Fast Spin Echo (FSE) sequence, the current clinical sequence of choice for MRCP. Respiratory gated acquisitions are susceptible to motion artifacts and blurring in patients with significant diaphragmatic drift, erratic respiratory rhythms or sleep apnea. A two point Dixon fat–water separation scheme was developed which eliminates signal loss arising from B0 inhomogeneity effects and minimizes artifacts from perturbation of the b-SSFP steady state. Preliminary results from qualitative analysis of 49 patients demonstrate robust performance of the 3D Dixon b-SSFP sequence with diagnostic image quality acquired in a 20–24 s breath-hold.

Objective To highlight the diagnostic features of PSC on MRCP studies in patients with biochemical cholestasis. Conclusion MRCP enables accurate detection and localization of PSC and in defining the extent of disease.

Objective To investigate value of magnetic resonance cholangiopancreatography (MRCP) using oral diluted gadolinium (Gd)-diethylenetriamine penta-acetic acid (DTPA) as negative contrast materials in diagnosis of juxtapapillary duodenal diverticulum with atypical imaging features. Methods Nineteen patients with juxtapapillary duodenal diverticula of which imaging findings were atypical underwent MRCP using oral diluted Gd-DTPA as negative contrast materials after conventional MRCP without any oral contrast materials. Results Twenty diverticula were revealed in the 19 patients. At conventional MRCP, the diverticula appeared as rounded lesion with high signal intensity. After oral administration of diluted Gd-DTPA, they disappeared at MRCP. These entities were diagnosed as duodenal diverticula for they communicate with duodenal lumen. Conclusion MRCP using oral Gd-DTPA as negative contrast materials can be helpful in obtaining definitive diagnosis of those juxtapapillary duodenal diverticula without typical imaging features.

Purpose To investigate the imaging features of portal biliopathy with emphasis on MR cholangiopancreatography (MRCP). The ancillary vascular findings of portal biliopathy were also evaluated by accompanying MR portography, dynamic contrast-enhanced (CE) CT, and dynamic CE MRI studies. Materials and methods Sixteen patients with portal cavernoma were included in the study. Patients had undergone MRCP (n = 16) studies accompanied by MR portography (n = 13), dynamic CE CT (n = 3) or dynamic CE MRI (n = 2) of the liver. Two patients had undergone both dynamic CE CT and dynamic CE MRI. Two radiologists evaluated all the examinations together, retrospectively. MRCP images were analyzed for the presence of biliary stenosis, upstream (prestenotic) dilatation, wavy appearance of the bile ducts, angulation of the common bile duct (CBD), and choledocholithiasis. MR portography, dynamic CE CT and dynamic CE MRI studies were evaluated for the existence of portal cavernomas, and the presence of gall bladder/choledochal varices. Results All patients had signs of portal biliopathy on MRCP. Frequencies of the biliary findings on MRCP were as follows: biliary stenosis, 93.7%; upstream dilatation, 68.7%; wavy appearance of the biliary tree, 87.5%; angulation of the CBD, 75%. None of the patients had choledocholithiasis. Frequencies of the ancillary vascular findings detected on CE studies were as follows: gall bladder varices, 100%, choledochal varices, 93.7%. Conclusion MRCP features of portal biliopathy in order to their frequencies were as follows: biliary stenosis, wavy appearance of the bile ducts, angulation of the CBD, and upstream dilatation of the bile ducts.

El carcinoma de pancreas es una neoplasia de mal pronostico que se diagnostica en fases avanzadas de la enfermedad en la mayoria de los pacientes. Dado que la reseccion quirurgica es la unica terapeutica po-tencialmente curativa de la enfermedad, resulta de maximo interes seleccionar adecuadamente el grupo de pacientes con tumor pancreatico en fase inicial, no extendida, y por ello resecable. Son varias las tecnicas de imagen de que disponemos para llevar a cabo este proposito: ul-trasonografia (US), tomografia computarizada (TC), resonancia magnetica (RM), mas recientemente se ha incorporado la ultrasonografia endoscopica (USE) y por ultimo la tomografia por emision de positrones (PET). Otras tecnicas como la laparoscopia asistida o no mediante ecografia, tambien intervienen en el proceso diagnostico y de estadificacion de estos pacientes. El continuo desarrollo tecnologico de cada una de las tecnicas mencionadas hace que esten siendo evaluadas de forma reiterada en la literatura cientifica a lo largo de las dos ultimas decadas. La presente revision tiene por objetivo evaluar cada una de las tecnicas y presentar algunos algoritmos de diagnostico reflejados en la literatura con el proposito de obtener la mayor precision diagnostica y de extension de la enfermedad para evitar asi una cirugia innecesaria en casos no susceptibles de ser resecados.

Carcinoid tumors arising from the ampulla of Vater are rare, and their magnetic resonance (MR) imaging findings have not been reported in the literature to date. We report a case of carcinoid tumor of the ampulla of Vater and discuss the characteristic MR imaging findings. The tumor was isointense relative to the muscle on both the T1- and T2-weighted images with heterogeneous enhancement after gadolinium administration. Both the common bile and the pancreatic ducts were dilated on the MR cholangiopancreatography.

In the initial evaluation of common pancreatic disorders, MR cholangiopancreatography (MRCP) has replaced the use of diagnostic endoscopic retrograde cholangiopancreatography (ERCP) at many institutions. MRCP is a heavily T2-weighted MR sequence that depicts the fluid-containing pancreatic duct in a noninvasive manner, avoiding potential complications associated with ERCP. MRCP is useful in the setting of pancreatitis for the identification of aberrant ductal anatomy and complications, and is valuable for detecting and characterizing cystic pancreatic masses. Furthermore, with the addition of conventional T1-weighted, T2-weighted, and gadolinium-enhanced sequences to MRCP, pancreatic adenocarcinoma can also be detected and staged. This article reviews MRCP with regard to the evaluation of common pancreatic diseases, with emphasis on its use for guiding treatment options.

Aim To evaluate the 3 T MR cholangiopancreatography (MRCP) appearances of biliary ascariasis. Materials and methods Nine patients with a MRCP diagnosis of biliary ascariasis were reviewed. All patients had endoscopic retrograde cholangiopancreatography (ERCP) or surgical confirmation of the disease. Results On thin-slab MRCP imaging, Ascaris worms are clearly demarcated within the biliary tree. All the identified worms demonstrated a characteristic three-parallel-lines appearance. The middle high-signal intensity line is sandwiched between two low-signal intensity lines and they are in turn surrounded by high signal bile. On thick-slab MRCP the worms also show the three-line sign but with less clarity. However, thick-slab MRCP has the advantage of providing three-dimensional ERCP-like images of the pancreaticobiliary system. Conclusion The “three-line” sign appears to be a characteristic sign of biliary ascariasis on 3 T MRCP.

Objective: To compare axial and coronal fast Spin-Echo fat-suppressed T2-weighted sequences with three-dimensional (3D) maximum intensity projection (MIP) images in patients with suspected pancreaticobiliary obstruction. Material and methods: MR cholangiopancreatography (MRCP) was performed in 108 consecutive patients with a non-breath-hold, fat-suppressed, 2D, heavily T2-weighted fast spin-echo sequence in coronal plane. Axial T1- and T2-weighted images were previously obtained. In addition, 3D reconstructions of the coronal images were analysed separately by using a MIP algorithm. Both two-dimensional (2D) (axial and coronal) and 3D MIP images were separately evaluated by two readers in conference and their results were compared with that of endoscopic retrograde cholangiopancreatography, percutaneous trans-hepatic cholangiography, surgery and/or imaging follow-up. Statistical analysis of 2D and 3D MRCP images in diagnosing the level and probable cause of pancreaticobiliary obstruction were separately calculated. Results: 106/108 of MRCP examinations were judged diagnostic by the two reviewers for adequacy of visualisation of the biliary and pancreatic ducts. Sensitivity, specificity, positive predictive value, negative predictive value and global diagnostic accuracy of 2D (axial and coronal) and 3D MRCP images in diagnosing the pancreaticobiliary obstruction were 94 and 57%, 95 and 93%, 97 and 92%, 91 and 60%, 94 and 72%, respectively. Conclusion: Our results do indicate a higher global accuracy for axial and coronal fast Spin-Echo fat-suppressed T2-weighted sequences versus 3D MIP images in diagnosis of the level and probable cause of pancreaticobiliary obstruction and stress the limitations of 3D images in depiction of small intraductal pathology such as calculi and biliary neoplastic lesions.

Malignant lesions of the biliary tract are a frequent occurrence, typically presenting with clinical findings of obstructive jaundice. The authors discuss the role of MR cholangiopancreatography (MRCP) as a second level diagnostic technique, which can provide information regarding not only the location, but also the cause of the obstruction. This can be obtained if MRCP is considered as part of a complete study of the upper abdomen, with acquisition of T1- and T2-weighted images. The "all-in-one" approach may provide the identification, characterization, and staging of the lesion, giving the clinician all the information necessary for the planning of adequate treatment. Typical MR features of cholangiocarcinoma are provided, as well as conventional MR and MRCP findings in pancreatic carcinoma, periampullary carcinoma, and biliary obstruction secondary to hilar lymphadenopathy and metastatic lesions.

AIM: The aim of this pictorial review is to describe applications of cholangiopancreatography (MRCP) using half-Fourier (HASTE) MR sequences. MATERIALS AND METHODS: 350 patients were imaged over a four-year period with a 1.54 Tesla Siemens Vision scanner and a phased array body coil. The HASTE MR sequence was applied in multiple planes with an acquisition time of 13 seconds allowing breath hold techniques. In addition, a single-shot technique provided single slice acquisitions with a thickness of 20 mm. A chemical fat suppression algorithm reduced intra-abdominal MR high signal. RESULTS: HASTE MRCP accurately determines the presence of level of biliary obstruction in up to 97% of patients. Common bile duct stones are detected with a sensitivity of 93%. Acute cholecystitis is depicted on HASTE MR as pericholecystic high signal in 41 45 (91%) patients and gall stones are detected with a 93% sensitivity. CONCLUSION: HASTE MRCP offers a non-invasive, rapid imaging method to evaluate the gallbladder, common bile duct and pancreas. Its multi-planar, fluid sensitive capabilities are of particular value in detecting common bile duct stones and acute cholecystitis.

Cross-sectional imaging has become the cornerstone for primary and initial evaluation of most patients with suspected pancreatic disease. Significant advances in pancreatic imaging have occurred, including the development of helical computed tomography (CT), magnetic resonance (MR) imaging and MR cholangiopancreatography (MRCP), endoscopic and intraductal pancreatic sonography, and radionuclide scintigraphy with indium 111 ( 111 In) octreotide and positron-emission tomography (PET). This article discusses the techniques and applications of these new modalities.

There have been limited reports about the choledocholithiasis formed around nonabsorbable suture material in patients who underwent biliary surgery. We report an unusual case of choledocholithiasis in the common hepatic duct formed around the nidus of suture material, which mimics a pedunculated round tumor on MR cholangiopancreatography (MRCP) images. The diagnosis has been confirmed by surgery.

We report two cases of a choledochal cyst associated with dilatation of the cystic duct. This unusual variant of choledochal cyst was explored by ultrasonography and MR cholangiopancreatography.

s / Pancreatology 15 (2015) S1eS141 S53 remains a challenge to assess the accurate indications for ERCP in patients with suspected choledocholithiasis and to select high risk PEP patients for appropriate prevention. Aims: The aim was to evaluate PEP prevalence and analyse patient's predictive factors of PEP in suspected choledocholithiasis prior ERCP. Patients & methods: 270 patients undergone ERCP due to suspected choledocholithiasis from 2012-2014y. Mean age was 65y (range 21-96y), 66% were females. The PEP prevalence were analysed. Patients were grouped using American Society of Gastrointestinal Endoscopy (ASGE,2010) outlined predictive factors, risk groups of choledocholithiasis prior ERCP. Univariate, multivariate analysis of choledocholithiasis and PEP risk factors were made. Results: Overall 16 patient's(6%) had PEP, 2(0,7%) hyperamylasemia. 2 cases were severe PEP with one lethal outcome. Choledocholithiasis was confirmed in 139(51%) patients, 10 occured PEP. All patients were in high risk group of PEP (according to ESGE,2014). 195(72%) patients had high risk, 75 intermediate risk of choledocholithiasis according to ASGE guidelines. PEP occured in 13 cases of high(p1⁄40,067), 3 intermediate group(p1⁄40,04). No risk factor significantly increased risk of PEP by univariate analysis. Abnormal liver biochemical test other than bilirubin (OR 0,857, p1⁄40,0001) and age>55y (OR 0,664, p1⁄40,020) increased risk by multivariate analysis. PEP was in 19% of age 18-45y, 17% 46-65y, 25% 66-85y. Choledocholithiasis mostly was in age 66-85y(28%). Conclusion: Patients with high risk of choledocholithiasis have higher risk of PEP comparing to intermediated risk. Patient's age >55y in suspected choledocholithiasis is additional predictive factor of PEP.

BodyMR imaging applications continue to grow at a rapid pace. In our hospital, the number of examinations performed is limited primarily by the number of MR scanners available. Body MR imaging continues to be one of the largest areas of growth in terms of the percentage of examinations performed. Fellows applying for training in diagnostic imaging are highly interested in body MR imaging facilities at various hospitals and consider body MR imaging as a leading reason for selecting their fellowship programs. Traditional textbooks on the subject, however, have difficulty keeping pace with the rapidly changing nature of imaging in this field. It is for these reasons that this issue of the Radiologic Clinics of North America focuses on body MR imaging applications. Recently, outstanding advances in body MR methods have resulted in an increase in the use of MR for patients with a variety of suspected diseases. For example, new contrast agents are now available for use in hepatic imaging, and advanced clinical trials for intravascular contrast agents are taking place. Faster pulse sequences that result in improved image quality with higher resolution are available; these have helped to control problems of motion in the chest and abdomen. Entirely new applications that barely existed several years ago, such as MR cholangiopancreatography, adrenal, and breast MR imaging, are widely requested by referring physicians. Cardiac MR imaging is of great interest and is developing rapidly. The complexity of these newer applications remains a challenge for both radiologists and technologists, because comprehensive information is usually not readily available in the literature. Increasingly, referring physicians or patients themselves are requesting the latest MR methods and applications from radiologists. For these reasons, an issue devoted to body MR imaging should serve to update both the practicing clinician and academician on a wide range of established and novel methods. The authors chosen for these articles are experienced in their fields and have a broad range of expertise. This is a unique opportunity to present an up-to-date summary of the most widely applied applications in body MR imaging. I would like to thank all of the authors for their outstanding efforts to assemble this issue of the Radiologic Clinics of North America. In addition, I wish to thank Barton Dudlick for the support he provided to me as this issue was being planned and prepared. It is my hope that readers will find this issue a valuable resource in their current practice.

Purpose: Imaging quality of MR cholangiopancreatography (MRCP) has recently made a great advance, and MRCP plays an important part in the diagnosis of pancreticobiliary diseases. The goal of this study was to optimize the methodology of MRCP. Patients and Methods: Fifty patients underwent MRCP prior to endoscopic retrograde cholangiopancreatography (ERCP). MR imaging was performed with a superconducting imager at 1.5T (GE Medical Systems, Wis). MRCP images were obtained as maximum-intensity-projection reconstruction images (SS-MIP) and thick-slice (50-100mm) projection image (SS-P) by using single-shot fast spin-echo sequence with 128 echo train (4000 and 30000, respectively/1001msec [effectiveTR/effective TE]), and MIP reconstruction images by using respiratory-triggered fast spin-echo sequence (RT-MIP) (7500-15000/252msec [effective TR/effective TEl). A gastrointestinal radiologist graded the image quality from 1 to 5 and recorded the diagnosis in a blinded manner. ERCP images were used as standard of reference. Results: Grades of image quality of biliary tracts and pancreatic ducts were 2.8 -+ 0.9 (mean +-. SD) and 1.9 ± 0.8 for SS-MIP, 4.0 -+ 0.9 and 3.3 -+ 1.3 for SS-P, 3.8 +1.0 and 2.5 -+ 1.3 for RT-MIP, respectively. The quality of RT-MIP and SS-P images was significantly greater than the quality of SS-MIP images in biliary tracts (p