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MR imaging increasingly has been adopted for follow-up imaging post-liver transplantation and for diagnosis of its complications. These include vascular and biliary complications as well as post-transplant malignancies. Interpretation of postoperative MR imaging should take into account the surgical technique and expected post-transplant changes. Contrast-enhanced MR imaging has high sensitivity for identification of vascular complications. MR cholangiopancreatography on the other hand is the most accurate noninvasive method for evaluation of biliary complications.

The purpose of this study was to compare the proposed rapid NT-MRCP protocol and the conventional NT-MRCP protocol with respect to image quality as well as the acquisition time.Between January 2019 and May 2019, a total number of 67 consecutive patients with suspected pancreaticobiliary diseases were included in this prospective study and underwent 3D rapid MRCP and 3D conventional MRCP sequences. Both acquisition protocols were set from the same navigator-triggered 3D SPACE sequence. The acquisition time was recorded. Two blinded radiologists performed qualitative analyses with respect to overall image quality, motion artifacts, and CBD visibility using a four-point scale. Quantitative evaluation included the contrast, signal-noise ratio (SNR), and contrast-noise ratio (CNR) between the common bile duct (CBD) and periductal tissues. A paired t test was used to assess differences in the qualitative and quantitative evaluations between the two acquisition methods.All MRCP studies were completed successfully. The mean acquisition time of rapid NT-MRCP (96.64 ± 30.55 s) was significantly lower than that of the conventional NT-MRCP (271.42 ± 61.63 s; p 0.001).The contrast ratio, SNR, and CNR of the CBD were significantly higher for conventional NT-MRCP than with rapid NT-MRCP images (0.95 ± 0.02 vs. 0.93 ± 0.03, p 0.001; 10.36 ± 4.63 vs. 8.90 ± 4.71, p = 0.011; 14.01 ± 6.02 vs. 12.22 ± 6.36, p = 0.020, respectively). The rapid MRCP depicted the overall image quality, artifacts, CBD visibility, right and left hepatic duct, segment 2 branch, main pancreatic duct, and cystic duct significantly better compared with conventional MRCP (p 0.05). There were no statistically significant differences between the two methods regarding visibility of anterior, posterior, and segment 3 branches (p 0.05).In conclusion, the proposed rapid MRCP protocol yielded significantly higher overall image quality and better visualization of the pancreaticobiliary tree with a significantly reduced imaging time without deterioration of image quality compared with the conventional MRCP at 3T.

To evaluate the image quality of an accelerated compressed-sensing single-breath-hold 3D magnetic resonance cholangiopancreatography (BH-CS-MRCP) prototype sequence compared to the standard 3D sequence with respiratory triggering (STD-MRCP) at 1.5 T and 3 T. To assess the individual factors that can affect image quality.This is a retrospective analysis. Both sequences (BH-CS-MRCP and STD-MRCP) were performed in 200 patients at 1.5 T and 200 patients at 3 T. Overall image quality and the visualization of the bilio-pancreatic ducts were rated on a 5-point scale. Image sharpness and background suppression were rated on a 4-point scale. A double reading was performed in 50 patients to assess the inter-observer reproducibility. Individual characteristics studied were gender, age, BMI, ascites, abdominal surface and breath-hold quality.At 1.5 T, BH-CS-MRCP was inferior to STD-MRCP in terms of overall quality (p = 0.0046), background suppression (p 0.0001), visualization of the cystic duct (p 0.0001), the right bile duct (p = 0.0008), the left bile duct (p = 0.0152), and the main pancreatic duct (p 0.0001). However, BH-CS-MRCP was sharper than STD-MRCP (p = 0.028). At 3 T, BH-CS-MRCP was superior to STD-MRCP for overall quality (p 0.0001), sharpness (p 0.0001), and visualization of the bilio-pancreatic ducts (p 0.0001). Background signal was conversely better suppressed in STD-MRCP (p 0.0001). At 1.5 T, the volume of ascites was inversely correlated with image quality for BH-CS-MRCP while BMI was inversely correlated with image quality for STD-MRCP. Breath-hold quality was correlated with image quality for BH-CS-MRCP at 1.5 T and 3 T.BH-CS-MRCP is feasible in clinical routine at 1.5 and 3 T, yielding significantly better perceived image quality at 3 T but not at 1.5 T. BH-CS-MRCP appears to be influenced by ascites whereas STD-MRCP is influenced by BMI at 1.5 T. This study was approved by the Ethics Review Board for Research in Medical Imaging (IRB: CRM-2003-065).

Magnetic resonance (MR) with cholangiopancreatography imaging has evolved considerably in the last decades. Improving in spatial resolution and speed of acquisition, MR provides comprehensive information to evaluate the full range of biliary and pancreatic diseases in a single session, without using any ionizing radiation. Furthermore, MR cholangiopancreatography (MRCP) has an accepted main role in the study of many biliary and pancreatic disorders, becoming a noninvasive diagnostic alternative to endoscopic retrograde cholangiopancreatography (ERCP).

Objective: To analyze imaging findings of Fasciola (F.) gigantica infection on computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US). Method: Twenty-nine patients with F. gigantica were admitted to the Affiliated Hospital of Dali University (n = 18) and Dali Prefecture People's Hospital (n = 11) from November 2011 to April 2012. All patients were examined by routine CT scan and US, and 24 of them were detected by MRI and MR cholangiopancreatography (MRCP). Serologic methods using enzyme-linked immunosorbent assay (ELISA) in 27 patients, stool examination in all patients, and hepatic tissue biopsy in 3 patients were performed. CT and US as follow-up examination was carried out in most patients for 3 years. Results: Multiple and scattered hypodense lesions in liver were seen in all patients on CT. Four types of hepatic lesions were observed on MRI as follows: tunnel-like lesions, abscesses, enhancement lesions, and iso- or slightly hypointense areas on T1-weighted images or T2-weighted images. These hepatic lesions were hypoechoic on US. Pathological images showed coagulation necrosis of liver lesions. Multiple calcifications were disclosed in 19 patients at follow-up. Conclusion: The imaging findings of CT, MRI, and US are helpful for the diagnosis of acute and chronic stages of Fasciola gigantica in liver. Keywords: Fasciola gigantica, Magnetic resonance imaging, Computed tomography, Ultrasonography

To clarify the clinical usefulness of breath-hold compressed sensing three-dimensional magnetic resonance cholangiopancreatography (BH-MRCP) added to conventional respiratory-gating MRCP (RG-MRCP), we prospectively evaluated the image quality of BH-MRCP and compared it with that of RG-MRCP. We also evaluated to what extent the overall image quality was improved by adding BH-MRCP to RG-MRCP.A total of 113 patients who underwent RG-MRCP and BH-MRCP at a 3-T MR unit were enrolled. We set a scan time of approximately 180 s for RG-MRCP and 20 s for BH-MRCP before examination, and measured actual scan time and assessed image quality using a 5-point scale (5, good; 1, poor). Image quality scores of 1, 2 and 3 were considered clinically inadequate. Image quality scores of RG-MRCP and BH-MRCP were compared. In addition, we compared "RG-MRCP alone" and "hybrid MRCP" (the best-scoring image was picked from RG-MRCP and BH-MRCP when the RG-MRCP score was clinically inadequate).The mean actual scan time of RG-MRCP/BH-MRCP was 191/20 s. The mean scores of RG-MRCP, BH-MRCP and hybrid MRCP were 3.67, 3.35 and 3.92, respectively. The score of hybrid MRCP was significantly better than that of RG-MRCP (P 0.05). The image quality of RG-MRCP was clinically inadequate in 43/113 (38 %) cases and the inadequate image quality was improved to be clinically adequate in 13/43 (30 %) cases by adding BH-MRCP.BH-MRCP brings added value to RG-MRCP because an additional examination of BH-MRCP could compensate for the image deterioration of RG-MRCP caused by motion artifacts.

Objective: Assessing the clinical application value of Ferric Citrate Effervescent granules (FAC) in magnetic resonance cholangio-pancreatography (MRCP) inspection. Methods: We invited 10 patients who were diagnosed with diseases of the pancreas system and bile duct system and undergoing magnetic resonance cholangio-pancreatography and use Ferric Citrate Effervescent granules in the MRCP process. The time of their MRCP is from May 2018 to February 2020. In addition, we collected the information from the participants, that the information included Sequence and scanning parameters of Mr Cholangiopancreatography, Image quality score before and after MRCP administration, contrast to noise ratio (CNR) score and comparison score of different parts in MRCP images before and after drug administration. Result: In scanning parameters, the data is standard in research, that the TR and TE of 2d MRCP and 3D MRCP are similar, that are > 6000 and > 500. But Layer thickness/Layer spacing between the objects had big gap in data, that are 50/0 and 1.8/0. Additionally, FOV had little different length, which is 40 vs 36. In NEX, they are same. In image quality score, it has higher score after taking the FAC. The CNR score research is similar, that FAC affect the CNR outcome. Conclusion: the FAC provide the improvement to the outcome of patient in MRCP process, that it improves image quality of MRCP.

Multiple biliary hamartomas (MBHs) are a rare source of cystic lesions of the liver that radiologic detection is difficult, because of its tiny size. We report the case of a 64-year-old woman, with recurrent abdominal pain. The ultrasonographic configuration in this patient showed multiple cystic hepatic lesions. However, the diagnosis of MBH was made by magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP). A regular follow-up of patient presenting this benign disease is recommended because of its potential for malignant conversion.

To compare the image quality of navigator-triggered (NT) 3D MR cholangiopancreatography (MRCP) with and without a patient-adapted respiratory training, in clinical patients with painful pancreatobiliary disorders.With institutional review board approval, hospitalized patients with painful pancreatobiliary disorders who were scheduled for MRCP study were prospectively enrolled. The numerical rating scale (NRS) of abdominal pain during the examination was recorded. Special patient-adapted respiratory training was conducted before the examination. A control group of patients was enrolled with the same criteria, who received ordinary instructions only (n=60 for each group). A subgroup of patients (n=10) underwent MRCP studies with ordinary instructions first and with patient-adapted training later. Acquisition time was recorded. General image quality, degree of artifacts and visualization of 12 segments of the pancreatobiliary tree were rated on a five-point scale and compared between the groups.Both groups had similar NRS of pain. There was a significant improvement in image quality (p0.01) as well as visualization of right posterior hepatic duct (p=0.045), left lateral hepatic duct (p=0.037), and pancreatic duct (p0.01 for head, body and tail segments) in patients receiving respiratory training. The other segments showed no significant differences. The percentage of patients with severe and extensive imaging artifacts decreased from 18.3%(11/60) to 8.3%(5/60). The acquisition time was shorter (175±54s vs 249±67s, p0.01) in patients with respiratory training.Patient-adapted respiratory training improves the image quality of NT-MRCP in patients with painful pancreatobiliary disorders.

Purpose To analyze the cost-effectiveness of the American Society for Gastrointestinal Endoscopy (ASGE) risk stratification guidelines versus magnetic resonance (MR) cholangiopancreatography-based treatment of patients with possible choledocholithiasis. Materials and Methods A decision-analytic model was constructed to compare cost and effectiveness of three diagnostic strategies for gallstone disease with possible choledocholithiasis: noncontrast MR cholangiopancreatography, contrast material-enhanced MR imaging/MR cholangiopancreatography, and ASGE risk stratification guidelines for diagnostic evaluation recommending endoscopy (high risk), MR cholangiopancreatography (intermediate risk), or no test (low risk). Analysis was performed from a U.S. health system perspective over 1-year and lifetime horizons. The model accounted for benign and malignant causes of biliary obstruction and procedural complications. Cost information was based on Medicare reimbursements. Sensitivity analysis assessed the impact of parameter variability on model results. Results Noncontrast MR cholangiopancreatography was most cost-effective in 45-55-year-old patients (less than $100 000 per quality-adjusted life-year [QALY] gained), while contrast-enhanced MR imaging was favored in younger adults. Risk-stratified testing was less costly than MR cholangiopancreatography, with long-term savings of $1870 and $2068 versus noncontrast and contrast-enhanced MR cholangiopancreatography, respectively, but was also less effective (-0.1814, -0.1831 QALY, respectively). The lifetime incremental cost per QALY for noncontrast MR cholangiopancreatography was $10 311. Contrast-enhanced MR imaging was favored with pretest probabilities of biliary stricture or malignancy 0%-73% for patients aged 20-44 years. For patients older than 55 years, ASGE guidelines maximized QALYs at the lowest cost. Conclusion Although adults older than 55 years of age are optimally evaluated by using ASGE guidelines, younger patients suspected of having acute biliary obstruction likely benefit from MR cholangiopancreatography rather than risk-stratified diagnostic imaging because of improved detection of choledocholithiasis and alternative causes of biliary obstruction. © RSNA, 2017 Online supplemental material is available for this article.

The purpose of this study was to compare CT with negative-contrast CT cholangiopancreatography (nCTCP) using subvolume minimum intensity projection (MinIP) versus MRI with MRCP in differentiating noncalculous periampullary obstruction. Sixty-four patients with clinically proven noncalculous periampullary obstructions who had undergone both MDCT and MR examinations before operation were reviewed retrospectively. Two reviewers independently interpreted the two image sets (the CT with nCTCP set [CT set] vs. the MRI with MRCP set [MRI set]) in differentiating both benign from malignant obstruction and pancreatic head carcinoma (PHC) from non-PHC, and the results were compared to the final clinical records. In this study, no statistically significant differences were observed in the accuracy of differentiating benign from malignant periampullary obstruction (p = 0.754 for reviewer 1 and p = 0.508 for reviewer 2) on the two image sets. The accuracy of differentiating PHC from non-PHC was also statistically insignificant (p = 0.125 for reviewer 1 and p = 1.000 for reviewer 2) on the two image sets. The CT set provides a comparable performance to that of the MRI set in differentiating noncalculous periampullary obstruction. • nCTCP with subvolume MinIP is a practical tool in evaluating biliary obstruction • Two image sets have a comparable performance in differentiating noncalculous periampullary obstruction • MDCT could serve as an alternative in patients not eligible for MRI

Purpose To evaluate the effect of parallel imaging (PI) with different acceleration factors on the image quality and duct visibility of breathhold two-dimensional (2D) thick-slab single-shot turbo spin-echo (SSTSE) MR cholangiopancreatography (MRCP) images. Materials and Methods Breathhold 2D thick-slab SSTSE MRCP was performed three times, i.e., without PI, with PI factor 2, and with PI factor 3, at 1.5 Tesla (T) for each of 85 patients. Two, independent readers evaluated the image quality and the visibility of five duct segments and ranked their preference of the three MRCP sequences. The data were analyzed using the repeated-measures analysis of variance test, the Friedman test, and the linear-by-linear chi-square test. Results MRCP sequences with PI factor 2 or 3 generated better image quality (P 0.05). Among the three sequences, both readers most often preferred the MRCP with PI factor 3, followed by the MRCP with PI factor 2 (P

In this review, a brief discussion of the important events of pancreatic embryology is followed by presentation of congenital anomalies and normal variants. For each variant, the appearance at different radiologic modalities including computed tomography, magnetic resonance (MR) imaging, endoscopic retrograde cholangiopancreatography, MR cholangiopancreatography, and fluoroscopy will be demonstrated.

Purpose: To investigate whether Caerulein-induced acute pancreatitis (AP) in rats could be noninvasively studied by clinical magnetic resonance imaging (MRI) techniques and validated by enzymatic biochemistry and histomorphology. Materials and Methods: The study was approved by the institutional animal ethical committee. The AP was induced in 26 rats by intraperitoneal injections of Caerulein, as compared to 6 normal rats. T2-weighted 3D MRI, T2 relaxation measurement and contrast enhanced T1-weighted MRI were performed at 3 Tesla. Pancreatic volume and contrast ratio of pancreas against surrounding tissues were measured by MRI. Animals were scarified at 3, 8, 24 and 48-hr respectively for analyses of serum lipase and amylase levels, and biliopancreatic perfusion-assisted histomorphology. Results: The AP could be observed on MRI 3-hr onwards after Caerulein-administration. T2 relaxation within the pancreas was prolonged due to high water content or edema. Increase of vascular permeability was indicated by T1 contrast enhancement. Both edema and vascular permeability gradually recovered afterwards (p

Background: Contrast enhanced magnetic resonance cholangiography is a novel technique and promising method in demonstrating biliary tree anatomy and evaluating biliary disorders. However, to date, there are a limited number of studies that have focused on the impact of this technique. Aims: We aimed to evaluate the additional role of contrast enhanced MR cholangiography (MRC) and compare contrast enhanced MRC with T2-weighted (w) magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of biliary disorders. Study Design: Diagnostic accuracy study. Methods: The T2w-MRCP and contrast enhanced MRC sequences of 31 patients whose gold standard test results were available were scored visually for the existence of pathological findings with regard to any of the biliary diseases. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) was used as the contrast agent. The correlation values were determined according to the statistical analysis made from those scores and the sensitivity, specificity and accuracy values of each sequence were detected as well. Results: We detected that the correlation values with gold standard methods of contrast enhanced MRC sequences were significantly higher than the ones of T2w-MRCP sequences. The correlation ratios of T2w-MRCP sequences were between 26 and 34%, while those for contrast enhanced MRC sequences were between 81 and 83% for the first reader and the correlation ratios of T2w-MRCP sequences were between 10 and 61%, whereas those of contrast enhanced MRC were between 79 and 81% for the second reader The mean sensitivity, specificity and accuracy values of T2w-MRCP sequences were 14.3-42.5%, 85-89.2% and 59.3-72.5%, respectively, while the mean sensitivity, specificity and accuracy values of contrast enhanced MRC sequences were 100%, 86.7% and 93.2-93.3%, respectively. Conclusion: We suggest that obtaining of contrast enhanced MRC sequences in addition to the T2w-MRCP can be useful in the diagnosis of many diseases in relation with biliary tree.

Our study shows that adding nonenhanced T1-weighted images to MR cholangiopancreatography significantly improves the diagnostic accuracy of MR imaging in the detection of biliary cast syndrome in liver transplant recipients.

Here we describe three cases of choledochal cyst involving the cystic duct or isolated dilatation of the cystic duct. All cases were visualised on MR cholangiopancreatography (MRCP) imaging. We report findings of ultrasonography, CT and MRCP. These cases are extremely rare; nine cases have been reported in the English-language literature. This anomaly was not included in Todani's classifications of choledochal cysts, a system that is accepted worldwide. We think that this variant anomaly will be included in this classification system in the near future.

This study retrospectively determined magnetic resonance (MR), MR cholangiopancreatography (MRCP) and secretin-MRCP findings in patients with autoimmune pancreatitis (AIP). The MR examinations of 28 patients with histopathologically proven AIP were reviewed. In 14 cases, secretin-enhanced MRCP was performed. The observers evaluated pancreatic parenchymal enlargement, signal intensity abnormalities, enhancement, vascular involvement, bile-duct diameter and main pancreatic duct (MPD) narrowing (diffuse/focal/segmental). After secretin administration, the presence of the "duct-penetrating" sign was evaluated. MR imaging showed diffuse pancreatic enlargement in 8/28(29%) cases, focal pancreatic enlargement in 16/28 (57%) cases and no enlargement in 4/28 (14%) cases. The alteration of pancreatic signal intensity was diffuse in 8/28 (29%) cases (eight diffuse AIP) and focal in 20/28 (71%) cases (20 focal AIP). Delayed pancreatic enhancement was present in all AIP, with peripheral rim of enhancement in 8/28 (29%) AIP (1/8 diffuse, 7/20 focal); vascular encasement was present in 7/28 (25%) AIP (1/8 diffuse, 6/20 focal); distal common bile duct narrowing was present in 12/28(43%) AIP (5/8 diffuse, 7/20 focal). MRCP showed MPD narrowing in 17/28 (61%) AIP (4/8 diffuse, 15/20 focal), MPD dilation in 8/28(29%) AIP (3/8 diffuse, 5/20 focal) and normal MPD in1/8 diffuse AIP. Secretin-MRCP showed the duct-penetrating sign in 6/14(43%) AIP (one diffuse AIP with MPD segmental narrowing, five focal AIP with MPD focal narrowing), demonstrating integrity of the MPD. Delayed enhancement and MPD stenosis are suggestive for AIP on MR and MRCP imaging. Secretin-enhanced MRCP is a problem-solving tool in the differential diagnosis between focal AIP and ductal adenocarcinoma.

We describe here a case of intraductal tubular carcinoma of the main pancreatic duct. Gadolinium-enhanced pancreas magnetic resonance (MR) imaging showed an enhancing mass that was confined in the dilated main pancreatic duct of the pancreatic body, along with dilatation of the upstream main pancreatic duct and chronic pancreatitis that was due to obstruction. MR cholangiopancreatography and an endoscopic retrograde pancreatogram showed a filling defect that was due to an intraductal mass of the pancreatic body, along with dilatation of the upstream main pancreatic duct and no dilatation of the downstream main pancreatic duct. The pathological findings demonstrated an intraductal nodular appearance without papillary projection or mucin hypersecretion.

This paper describes the magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) pattern of multifocal intraductal papillary mucinous tumours (IPMT) of the pancreatic side branches and its evolution during followup.Twenty-six patients with multifocal IPMT of the side branches were included in this retrospective study. Inclusion criteria wereor =2 ectasic side branches, presence of communication with the main pancreatic duct, andor =2 MRI/MRCP examinations afteror = 6-12 months. Exclusion criteria were IPMT involving both the main pancreatic duct and its branch ducts, previous surgery and lack of follow-up MRI examinations. Median follow-up was 27 (range 6-59) months. Images were assessed qualitatively and quantitatively. Qualitative assessment considered: the number of cystic lesions of the branch ducts, morphology of the communication between the cystic lesion and the main duct (direct or neck), presence of intraluminal filling defects within the cystic lesions, presence of mural nodules and mural enhancement of the cystic lesion. quantitative assessment considered mean maximal diameter of the cystic lesions and mean length of the communication neck.At diagnosis, the mean number of cystic lesions of the side branches was 7.5. a communication neck was detected in 16/26 patients (60%). Intraluminal filling defects in the side branches were present in 6/26 patients (23%). Mural nodules were seen in 1/26 patients (4%). The mean diameter of the cystic lesions was 18.8 mm. The mean length of the communication neck was 6.9 mm. At follow-up, the mean number of cystic lesions of the side branches was 8.4. A communication neck was detected in 20/26 patients (77%). Intraluminal filling defects in the side branches were detected in 7/26 patients (27%); mural nodules were seen in 2/26 patients (8%). Mural enhancement of the branch duct was detected in 2/26 patients (8%). The mean diameter of the cystic lesions increased to 22.3 mm (p0.05), and the mean length of the communication neck was 8.6 mm.MultifocaL IPMT of the side branches shows a constant but very slow progression over time. In our series, only 2/26 patients showed mural nodules.

Objective To explore the efficiency, cost, and time for examination of one-stop-shop gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) in preoperative evaluation for parent donors by comparing with multidetector computer tomography combined with conventional MR cholangiopancreatography (MDCT-MRCP). Materials and methods Forty parent donors were evaluated with MDCT-MRCP, and the other 40 sex-, age-, and weight-matched donors with Gd-EOB-DTPA-enhanced MRI. Anatomical variations and graft volume determined by pre- and intra-operative findings, costs and time for imaging were recorded. Image quality was ranked on a 4-point scale and compared between both groups. Results Gd-EOB-DTPA-enhanced MRI provided better image quality than MDCT-MRCP for the depiction of portal veins and bile ducts by both reviewers (p < 0.05), hepatic veins by one reviewer (p < 0.05), rather hepatic arteries by both reviewers (p < 0.01). Sixty-nine living donors proceeded to liver donation with all anatomical findings accurately confirmed by intra-operative findings. The “in-room” time of Gd-EOB-DTPA-enhanced MRI was 12 min longer than MDCT-MRCP. Gd-EOB-DTPA-enhanced MRI was cheaper than MDCT-MRCP (US$519.72 vs. US$631.85). Conclusion One-stop-shop Gd-EOB-DTPA-enhanced MRI has similar diagnostic accuracy as MDCT-MRCP and can provide additional benefit in terms of costs and convenience in preoperative evaluation for parent donors.

To identify magnetic resonance (MR)/MR cholangiopancreatography (MRCP) imaging signs helpful in the differential diagnosis between serous cystadenomas (SCAs) and mucinous cystic neoplasms (MCNs), arising from the body/tail of the pancreas.This retrospective study had institutional review board approval and informed consent was waived. Fifty-three patients with non-communicating cystic pancreatic neoplasm of the body/tail, undergoing MR/MRCP, were included. Qualitative image analysis assessed the macroscopic pattern, number of cysts, presence of central scar, contrast enhancement of peripheral wall, and mural nodules. Quantitative analysis assessed the maximum diameter of the neoplasm, thickness of the peripheral wall, and calibre of the upstream main pancreatic duct.Histopathology results revealed that 27/53 (51 %) were SCAs, 26/53 (49 %) were MCNs. Microcystic pattern was observed in 88.2 % of SCAs and 11.8 % of MCNs; macrocystic pattern was observed in 90.5 % of MCNs and 9.5 % of SCAs (p 0.0001). Central scar was detected in 29.6 % of SCAs and no MCNs (p = 0.003). Contrast enhancement of the peripheral wall was evident in 99.5 % of MCNs and 11.5 % of SCAs (p 0.0001); mural nodules were depicted in 94.1 % of MCNs and 5.9 % of SCAs (p 0.0001). Median maximum diameter was 54 mm for MCNs, 32 mm for SCAs (p = 0.001); median wall thickness was 4 mm for MCNs, 2 mm for SCAs (p 0.0001).Macrocystic pattern, enhancement of a peripheral wall and mural nodules are suggestive of MCNs; whereas microcystic pattern, lack of peripheral wall and central scar are suggestive of SCAs.• MCNs have macrocystic patterns, contrast enhancement of the peripheral wall and mural nodules • Microcystic pattern and central scar are suggestive of SCA • Mural nodules detected in MCNs correlate with epithelial dysplasia • Chronic obstructive pancreatitis is equally depicted in patients with MCNs and SCAs.

The recent technical advances in fast MR imaging have greatly enhanced the clinical value of MR imaging of the body. Advances in T(1)-weighted images have enabled the acquisition of dynamic contrast-enhanced MR imaging, which is currently central to hepatic MR imaging for detection and characterization of liver tumors and is also useful for the evaluation of myometrial invasion in uterine cor-pus cancer. Advances in rapid T(2)-weighted MR imaging with single-shot fast spin-echo images have enabled MR cholangiopancreatography and MR urography. Application of respiratory triggering can also provide T(2)-weighted images of high quality. Cine MR imaging utilizing ultrafast MR sequences enables the assessment of the respiratory motion of the lung for evaluating thoracic wall invasion by tumors. Diffusion-weighted images can provide excellent tissue contrast based on molecular diffusion and have the potential to demonstrate malignant tumors. Quantitative measurement of apparent diffusion coefficient values may also be valuable in distinguishing malignancies from benign lesions.

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.

OBJECTIVE. We sought to evaluate MR cholangiopancreatography (MRCP) as the only imaging procedure used in the diagnosis and management of biliary complications after orthotopic liver transplantation (OLT).CONCLUSION. MRCP is a useful imaging procedure in the assessment of biliary complications after OLT.

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.

The current imaging technique and clinical application of MR cholangiopancreatography (MRCP) is reviewed. MRCP has evolved into a feasible method of non-invasively evaluating the pancreaticobiliary system and has considerable clinical utility. If endoscopic retrograde cholangiopancreatography (ERCP) is incomplete or has failed, or in patients with biliary and gastrointestinal surgical procedures, MRCP is a useful alternative modality. In the near future, MRCP may supplant diagnostic ERCP such that ERCP is reserved primarily for therapeutic interventions. Furthermore, when MRCP is performed in conjunction with abdominal MR and MR angiography, the 'all-in-one' examination can evaluate the solid organs and vessels of the abdomen as well as the ductal systems.

Magnetic resonance (MR) cholangiopancreatography has proved a robust and noninvasive imaging modality for evaluating the biliary and pancreatic ducts without the use of ionizing radiation. Although MR cholangiopancreatography reliably depicts the main extrahepatic and intrahepatic bile ducts, it does not depict the segmental intrahepatic ducts unless they are dilated. The segmental ducts are difficult to visualize with MR cholangiopancreatography because of their small caliber and the limited spatial resolution and signal-to-noise ratio achievable with standard MR pulse sequences. However, visualization of the normal (ie, nondistended) biliary system is necessary for the evaluation of donor candidates for living related liver transplantation. Because of the prevalence of variant biliary anatomy, MR cholangiopancreatography is often used for preoperative evaluation of prospective liver donors. Intravenous morphine administered prior to MR cholangiopancreatography can improve image quality by causing the sphincter of Oddi to contract, which increases pressure in and distention of the biliary and pancreatic ducts. Morphine administration may also be particularly helpful for the evaluation of patients with primary sclerosing cholangitis, malignant neoplasms such as cholangiocarcinoma, or cystic and non-organ-deforming benign pancreatic neoplasms.

Pancreatic imaging with multidetector CT allows multiphase acquisition of thin slices in a single breath-hold and is especially valuable in obtaining isotropic three-dimensional reformations that improves our ability to provide accurate pre-operative vascular mapping. Advanced MR technology allows faster imaging of pancreas, thus facilitating MR cholangiopancreatography. Use of tissue-specific MR contrast agents, endoscopic ultrasound and PET in pancreatic imaging has evolved considerably. This review article discusses the role of CT, MR, endoscopic ultrasound and PET imaging in pancreas.

To evaluate the demonstration of the pearl necklace sign at magnetic resonance (MR) cholangiopancreatography (MRCP) in patients with proven adenomyomatosis and carcinoma of the gallbladder.MRCP findings and those of a combination of unenhanced and arterial phase computed tomography (CT) and arterial phase MR imaging were retrospectively compared in 29 patients who were pathologically proven to have adenomyomatosis of the gallbladder and in 18 patients with pathologically proven gallbladder carcinoma. Receiver operating characteristic (ROC) analysis was used with a five-point confidence scale. The relative sensitivity, specificity, and accuracy of each imaging modality were also calculated. The pearl necklace sign was defined on MRCP images as small round foci, with the same markedly high signal intensity as bile, within the thickened wall of the gallbladder.The mean area under the ROC curve of MRCP alone and that of the combination of MRCP and arterial phase MR imaging was significantly higher than that of combined CT (unenhanced and arterial phase) and arterial phase MR imaging alone (P.01). The relative sensitivities in the diagnosis of adenomyomatosis of the gallbladder were 24% for the combined CT, 29% for arterial phase MR imaging, 62% for MRCP, and 57% for the combination of MRCP and arterial phase MR imaging. The mean relative sensitivity, specificity, and accuracy of the pearl necklace sign on MRCP images were 62%, 92%, and 74%, respectively. In eight (28%) of 29 patients with adenomyomatosis of the gallbladder, the pearl necklace sign was not identified by all three readers on the MRCP images.The pearl necklace sign, which indicates the presence of Rokitansky-Aschoff sinuses within the thickened gallbladder wall, was specifically detected at MRCP for adenomyomatosis of the gallbladder.

Our objective was to examine the influence of the shape of imaged structures and the velocity of flow on the appearance of flow artifacts seen on MR cholangiopancreatography (MRCP) in a phantom model.Three types of phantoms representing the biliary system were constructed. The first phantom type was a straight tube; the second, a single tube in which the inlet and outlet diameters varied by a ratio of as much as 1:6; and the third, a tube that simulated a stricture in the biliary system and a gallstone. All experiments were repeated three times.We did not observe any flow artifacts in the experiments we performed with the straight tubes. A higher rate of flow resulted in decreased signal intensity in tubes simulating bile ducts; the decreased signal was most likely to be observed on images in which the speed of flow exceeded 5 mm/sec. Flow artifacts were seen only if the ratio between the inlet and outlet diameters was 1:4 or greater. Simulations of bile duct abnormalities--such as a 50% stricture or the presence of a gallstone--did not produce any flow artifacts.In our experiments, a flow artifact could be seen on images in which the ratio between the inlet and the outlet diameters in the phantom was equal to or greater than 1:4. This finding indicates that a flow artifact could be observed in dilated bile ducts on MRCP under clinical conditions. Knowing that a pseudo-filling defect can be caused by a flow artifact should help to prevent misinterpretation of MRCP images.

Background/Aims: The diagnostic potential of magnetic resonance cholangiopancreaticography (MRCP) has improved as a result of evolving technique. MRCP has the advantage of negligible morbidity and mortality in contrast to endoscopic retrograde cholangiopancreatography (ERCP). This study was performed to evaluate MRCP as a replacement for diagnostic ERCP for the suspicion of common bile duct (CBD) stones. Methods: From 1998 to 2001, MRCP was performed in 202 patients with a suspicion of CBD stones based on medical history (MH), cholestatic liver function tests (CL), both MH and CL or other reasons. ERCP was performed in all patients where MRCP indicated the presence of CBD stones and in those patients with a persistent strong clinical suspicion for CBD stones despite a negative MRCP. Results: In 25 patients, MRCP suggested CBD stones which were proven with ERCP in 24 patients. Despite a negative MRCP, 27 patients had a subsequent ERCP. None of these patients appeared to have CBD stones. In this group, MRCP resulted in 100% sensitivity and 96% specificity in detecting CBD stones. Follow-up of all patients revealed 5 more patients with persistent clinical suspicion or cholestatic liver function values. Assuming CBD stones in these patients, MRCP had a sensitivity of 83 % and a specificity of 99% for this diagnosis. Conclusion: In the case of CBD stone suspicion, MRCP should be the diagnostic procedure of choice.

The purpose of this study was to compare the efficacy of MR cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) for the diagnosis of intrahepatic stones.Of the 318 patients who underwent MRCP examinations at our institution during an 18-month period, we identified 49 patients who subsequently underwent surgery or cholangioscopic stone removal with proof of intrahepatic stones. Thirty-four of these patients also underwent ERCP; they made up our study population. All images were interpreted for the presence of bile duct stones: MRCP images were interpreted independently by two reviewers, and ERCP studies were interpreted by one reviewer who was unaware of the MRCP findings.The sensitivity and specificity of MRCP for detecting intrahepatic stones were 97% and 93%, respectively, whereas those of ERCP were 59% and 97%, respectively. MRCP showed a significantly higher sensitivity than ERCP in the diagnosis of intrahepatic stones (p0.001). We found no significant difference between MRCP and ERCP in sensitivity or specificity for detecting calculi in the common duct or gallbladder.MRCP is a more effective diagnostic method than ERCP for the evaluation of intrahepatic stones.

The purpose of this study was to evaluate the usefulness of kinematic MR cholangiopancreatographic (MRCP) images as an aid in predicting the need for intervention in patients with biliary dilatation.Fifty patients with suspected pancreaticobiliary disorders were separated into three groups. Group I patients had biliary dilatation with periampullary lesions (n = 16), group II patients had supraampullary obstructive lesions (n = 17), and group III patients had biliary dilatation without obstruction (n = 17). Twenty consecutive single thick-slice MRCP images were obtained in the 15 degrees or 30 degrees left anterior oblique coronal plane. Two radiologists jointly reviewed the images without knowledge of the final diagnosis. The numbers of images showing relaxation of the sphincteric segment and the configuration of the distal margin of the common bile duct for the three groups were compared.Relaxation of the sphincteric segment was observed on the images of only two patients (12%) in group I but on the images of all patients in groups II and III, although not on all images. Lack of visualization of sphincteric relaxation on the kinematic MRCP images had a sensitivity of 88% and a specificity of 100% for the diagnosis of periampullary lesions. Most patients whose images did not show sphincteric relaxation required biliary intervention at the sphincter level.Nonvisualization of sphincteric relaxation on kinematic MRCP indicates ampullary or periampullary lesions. Kinematic MRCP can be used to determine the necessity of biliary intervention in patients with biliary dilatation.

Our purpose was to investigate the effects of i.v. administration of gadolinium chelate on thick-section MR cholangiopancreatography performed with half-Fourier rapid acquisition with relaxation enhancement sequence.Unenhanced and enhanced MR cholangiopancreatograms obtained in 50 consecutive patients were quantitatively analyzed with region-of-interest measurements and were qualitatively evaluated by three independent radiologists unaware the patient information. A phantom study was performed to verify the effects.The mean contrast-to-noise ratios of the gallbladder, common bile duct, and main pancreatic duct significantly increased after gadolinium chelate administration (p0.005). The mean depiction score of the main pancreatic duct increased significantly with one radiologist (p0.05) and marginally with another (p0.06), and the mean depiction scores of the background structures and renal pelvis significantly decreased with all three radiologists (p0.001). The phantom study showed the results, indicating that T2- and T2(*)-shortening effects of gadolinium chelate caused the effects in vivo.i.v. administration of gadolinium chelate improves the depiction of pancreaticobiliary ducts in some selected patients, while decreasing the depiction in others with less frequency. There may be a value of enhanced MR cholangiopancreatography when unenhanced MR cholangiopancreatography is not sufficient.

Autoimmune pancreatitis, unlike alcoholic chronic pancreatitis, is a rare variant of pancreatitis. We describe the MR imaging findings in a 50-year-old man with multifocal autoimmune pancreatitis in the pancreatic head and tail. Our case demonstrates multifocal enlargement, diminished signal intensity on a T1-weighted image, and delayed enhancement with the capsule-like hypointense bands in a dynamic study. MR cholangiopancreatography is also found to be useful in evaluating the effectiveness of steroid therapy.

The authors reported a case of fundal-type adenomyomatosis in which mural stratification corresponding to histopathological findings was clearly demonstrated with MR imaging. Single-shot fast spin echo images for MR cholangiopancreatography clearly visualized Rokitansky-Aschoff sinuses (RAS), which are a diagnostic clue for this disease. However, mural stratification comprising RAS with muscular proliferation, massive fibrosis and subserosal fat deposition was more precisely demonstrated in T(2)-weighted images obtained with fast spin echo.