Search

Background: This study aimed to assess the feasibility and performance of 5.0 T MRI in MR Cholangiopancreatography (MRCP) imaging compared to 3.0 T, focusing on detail visualization, signal-to-noise ratio (SNR), and image artifacts. Methods: A prospective study from May to October 2023 involved 20 healthy subjects and 19 with biliary dilation. Both groups underwent MRCP using 3.0 T and 5.0 T scanners. The detail visualization capability of the biliary tree and the SNR of the images were quantitatively evaluated. Two experienced MRI diagnostic physicians assessed the image artifacts qualitatively on a scale of 1 to 5. The t-test or Wilcoxon signed-rank test compared the quantitative results of biliary visualization and SNR between 3.0 T and 5.0 T scanners, while the Wilcoxon signed-rank test was used for comparing the level of image artifacts between the two scanners. The inter reader consistency was tested using Kappa test. Results: In both healthy subjects and those with biliary dilation, the 5.0 T group exhibited significantly higher numbers of biliary tree branches, along with greater total and maximum branch lengths, compared to the 3.0 T group (P<0.05). Although the maximum branch length was higher in the 5.0 T group among healthy subjects, this difference was not statistically significant (P = 0.053). No notable differences were observed in SNR and image artifact levels between the two groups across both field strengths (P>0.05). Conclusions: MRCP at 5.0 T offers superior biliary tree visualization compared to 3.0 T. The performance regarding SNR and image artifacts between the two is relatively comparable. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to assess the feasibility and performance of 5.0 T MRI in MR Cholangiopancreatography (MRCP) imaging compared to 3.0 T, focusing on detail visualization, signal-to-noise ratio (SNR), and image artifacts. Methods A prospective study from May to October 2023 involved 20 healthy subjects and 19 with biliary dilation. Both groups underwent MRCP using 3.0 T and 5.0 T scanners. The detail visualization capability of the biliary tree and the SNR of the images were quantitatively evaluated. Two experienced MRI diagnostic physicians assessed the image artifacts qualitatively on a scale of 1 to 5. The t-test or Wilcoxon signed-rank test compared the quantitative results of biliary visualization and SNR between 3.0 T and 5.0 T scanners, while the Wilcoxon signed-rank test was used for comparing the level of image artifacts between the two scanners. The inter reader consistency was tested using Kappa test. Results In both healthy subjects and those with biliary dilation, the 5.0 T group exhibited significantly higher numbers of biliary tree branches, along with greater total and maximum branch lengths, compared to the 3.0 T group (P0.05). Conclusions MRCP at 5.0 T offers superior biliary tree visualization compared to 3.0 T. The performance regarding SNR and image artifacts between the two is relatively comparable.

Background: The diagnosis of abdominal pathologies is a challenge and radiology is a very important tool in diagnosis. Various methods are often used for the diagnosis of such conditions. We in the present study tried to compare the efficacy of magnetic resonance cholangiopancreatography and ultrasonography in evaluating biliary duct diseases. Methods: The present study was conducted in the Department of Radiodiagnosis, Prathima Institute of Medical Sciences, Naganur, Karimnagar. All patients presenting with recurrent pancreatitis, hypochondriac pain, jaundice presenting to the radiology department are included in the present study. Patients with metallic implants, claustrophobia are excluded from the present study. Ultrasonography was performed using a Philips HD 15 and Philips affinity 70 machine. Both curvilinear and linear probes were used in the study. Images of the biliary tree were recorded for later review. MRI-MRCP was performed on Philips ACHIEVA 1.5 Tesla MRI Scanner. Results : In this study, n=13 subjects were clinically suspected to have cholelithiasis (n=7), choledocholithiasis (n=2), and both Cholelithiasis with choledocholithiasis (n=4). Ultrasonography was able to diagnose Cholelithiasis correctly in n=5 cases, choledocholithiasis in n=1 case, Cholelithiasis with choledocholithiasis in n=4 cases and rule out Cholelithiasis in n=2 cases, but failed to identify distal CBD calculus in n=1 case (choledocholithiasis) hence having a diagnostic accuracy of 92.31% for the cholelithiasis-choledocholithiasis group. Conclusion: MR Cholangiopancreatography is very accurate in demonstrating calculi at the distal end of CBD as an area of the signal void, also in demonstrating strictures as the cause of dilatation of biliary radicals. It showed the length of the stricture segment very well and differentiated stricture as malignant and benign

Purpose: To assess the effect of gadobenate dimeglumine on magnetic resonance cholangiopancreatography (MRCP) and determine an appropriate time frame for performing MRCP sequences. Materials and methods: 2D MRCP sequences obtained after intravenous administration of gadobenate dimeglumine or gadobutrol over 14 months were reviewed retrospectively in randomized order by five abdominal radiologists, using a 3-point scale to rate biliary and pancreatic duct clarity (1 = no-, 2 = limited-, 3 = good visualization). Intraclass correlation coefficients were computed and mean scores were compared for both agents. For gadobenate dimeglumine exams, time delays between arterial phase and MRCP acquisition times were analyzed concerning duct clarity. For gadobutrol, only exams with delays ≥ 15 min were included. Results: 134 exams (107 gadobenate dimeglumine, 27 gadobutrol) were included. Moderate reliability for pancreatic duct visualization and excellent reliability for visualization of intrahepatic bile ducts and upper and lower extrahepatic bile ducts were noted. No difference in mean scores was noted for pancreatic duct visualization (p = 0.66). Bile duct segment scores were lower with gadobenate dimeglumine (mean: 2.1–2.6) compared with gadobutrol (mean: 2.8–2.9) (p ≤ 0.006). For gadobenate dimeglumine, visualization scores varied depending on the delay between the arterial phase and MRCP acquisition (p ≤ 0.047). Good visualization for all bile duct segments was noted with delays of 7.2–9.4 min (95% confidence interval; mean 8.3 min). Conclusion: Bile duct clarity degraded on MRCP images with an increasing delay following gadobenate dimeglumine injection. 2D MRCP, thus, should be performed within 7.2 min after obtaining the arterial phase sequence to ensure good visualization of the entire biliary system. [ABSTRACT FROM AUTHOR]

Introduction: Magnetic resonance cholangiopancreatography (MRCP) is an imaging technique that has advanced over the past few years. It still plays a crucial role in the study of numerous pancreaticobiliary diseases. This study aimed to evaluate the effects of hematinic syrup, date syrup, and pineapple juice on MRCP image quality., Methodology: This study involved a total of 90 participants, distributed evenly among three groups, with each group comprising 30 patients. Negative oral contrast solutions containing paramagnetic substances like Mn+2 and Fe+3, such as pineapple juice, date syrup, and hematinic syrup were imaged by 1.5 Tesla (T) magnetic resonance imaging (MRI) with T2-weighted (T2W) and MRCP sequences. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were computed. Ninety patients underwent MRCP 20-30 min after ingestion of 100 mL of date syrup, 30 ml of hematinic syrup diluted to 200 ml of water, and 200 mL of pineapple juice. MRCP images were taken to visualize various pancreaticobiliary structures (bile duct, stomach, and duodenum)., Results: The in vitro evaluation of the solutions showed that date syrup and hematinic syrup were hypointense in T2W sequences. The images obtained showed no significant difference in the CNR between the three solutions. However, the SNR was significantly higher for pineapple juice compared to date syrup and hematinic syrup in T2W and MRCP sequences. Images acquired post-administration of the oral contrast agents significantly improved the gastrointestinal tract signal suppression and increased visibility of the pancreaticobiliary structures (bile duct, stomach, and duodenum). No adverse events were observed among the participants., Conclusion: Pineapple juice was the best contrast agent. However, date syrup and hematinic syrup can also be used to improve the imaging quality., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, R K et al.)

Background: Gallstone disease is a common disease responsible for considerable morbidity in the society. Surgery is the definitive treatment and laparoscopic cholecystectomy has largely replaced conventional surgery. However, laparoscopic cholecystectomy carries a higher risk of injury to biliary tree than conventional surgery. Significant number of these injuries is caused by variations in the biliary tree anatomy. By precisely delineating the biliary tree anatomy, magnetic resonance imaging and magnetic resonance cholangiopancreatography can assist the surgeons in predicting difficult surgery. Objective: The present study attempts to determine the role of magnetic resonance imaging and magnetic resonance cholangiopancreatography prior to laparoscopic cholecystectomy in gallstone disease. Method: In the present study, 100 patients with gallstone disease, referred for magnetic resonance imaging and magnetic resonance cholangiopancreatography were evaluated Result: The most common age group to be involved was 4th and 5th decade. Females were almost twice commonly affected than males. The sensitivity of MRI was 95 -100%, specificity 97 – 100% and accuracy 96 - 98% for detecting gallstones. Similar sensitivity and specificity was found for CBD calculi.3. The sensitivity and specificity for delineation of biliary tree anatomy was 100% each. Type A IHBR pattern was seen in 42 %, Type B in 22%, Type C in 26%, Type D in 6% and Type E in 2%. The cystic duct anatomy was delineated with 100% sensitivity and specificity. Anomalous cystic duct insertion patterns were seen in 11%. The incidence of CBD calculus was 7%. The mean diameter of CBD was 5.73±2.65 mm. The gall bladder volume had no statistically significant correlation with difficult surgery. The patterns of IHBR did not have any impact of difficult surgery. However, the pattern of cystic duct insertion had a statistically significant correlation with difficult surgery with anomalous insertions leading to difficult surgery with a p value of 0.025. It was significant on multivariate analysis too with a p value of 0.034. The CBD diameter also had a statistically significant correlation with difficult surgery with a p value of 0.011 on Univariate analysis and 0.021 on multivariate analysis. There were no bile duct injuries or forced conversion to open surgery. The mean operation time was 54.13±33.73 min. Conclusion: MRI and MRCP can accurately detect gallstones and delineate biliary tree anatomy. They can also detect anomalous biliary tree and can predict difficult surgery thus helping the surgeon to be prepared for the eventualities during surgery.

Purpose: To use MRCP to investigate age-related changes and gender differences of the pancreas and to correlate pancreatic gland size and duct diameter.Methods: In this institutional review, board-approved, HIPAA-compliant study, 280 patients (age 20-88 years) without a history of pancreatic or liver disease who had undergone MRI/MRCP from 2004 to 2015 were identified. The anteroposterior size and main duct diameter of the pancreatic head, body, and tail were measured. The pancreatic gland and duct sizes were compared between genders, and among seven age subgroups (20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80-89).Results: The pancreatic head and body were significantly larger in males than females (head, p < 0.01; body, p = 0.03), while the tail and the duct diameters of the pancreatic head, body, and tail showed no gender difference. As the age of male participants increased, there was an associated increase in size of the pancreatic gland initially (largest at age 50-59 (body) and 60-69 (head)), followed by subsequent decline in size thereafter. Additionally, the pancreatic duct diameter was found to increase gradually. In females, the size of the pancreatic gland decreased, while the diameter of the pancreatic duct increased with age. Moderate positive correlation for gland size and strong positive correlation for duct diameter among different pancreatic regions were found. Weak negative correlation was found between gland size and duct diameter.Conclusions: There are gender differences in the gland size of the pancreatic head and body. The pancreatic gland size increases until the sixth decade in males, with a more continuous decrease in gland size with age in females. Both males and females demonstrate a marked decrease in gland size after the eighth decade. The duct diameter increases with age in both males and females. [ABSTRACT FROM AUTHOR]

Purpose: Our study was aimed to assess the diagnostic value of MR cholangiopancreatography (MRCP) and MR imaging at 3 T device when evaluating biliary adverse events after liver transplantation.Materials and Methods: A series of 384 MR examinations in 232 liver transplant subjects with suspected biliary complications (impaired liver function tests and/or biliary abnormalities on ultrasound) were performed at 3 T device (GE-DISCOVERY MR750; GE Healthcare). After the acquisition of axial 3D dual-echo T1-weighted images and T2-weighted sequences (propeller and SS-FSE), MRCP was performed through coronal thin-slab 3D-FRFSE and coronal oblique thick-slab SSFSE T2w sequences. DW-MRI of the liver was performed using an axial spin-echo echo-planar sequence with multiple b values (150, 500, 1000, 1500 s/mm2) in all diffusion directions. Contrast-enhanced MRCP was performed in 25/232 patients. All MR images were blindly evaluated by two experienced abdominal radiologists in consensus to determine the presence of biliary complications, whose final diagnosis was based on direct cholangiography, surgery and integrating clinical follow-up with ultrasound and/or MRI findings.Results: In 113 patients no biliary abnormality was observed. The remaining 119 subjects were affected by one or more of the following complications: non-anastomotic strictures including typical ischemic-type biliary lesions (n = 67), anastomotic strictures (n = 34), ampullary dysfunction (n = 4), anastomotic leakage (n = 4), stones, sludge and casts (n = 65), vanishing bile duct (n = 1). The sensitivity, specificity, PPV, NPV and diagnostic accuracy of the reviewers for the detection of all types of biliary complications were 99%, 96%, 95%, 99% and 97%, respectively.Conclusion: MR cholangiopancreatography and MR imaging at 3 T device are extremely reliable for detecting biliary complications after liver transplantation. [ABSTRACT FROM AUTHOR]

Objective To select the best concentration， volume and checking time of Gd-DTPA dilution as an oral negative gastrointestinal contrast agent by in vitro /in vivo experiments. Methods (1) In vitro experiments : we used 0.05， 0.10， 0.15 and 0.20 mL intravenous injections of Gd-DTPA， which were diluted into concentrations of 0.25， 0.50， 0.75， 1.00 mmol/L， then we examined and made a contrastive analysis about the signal intensity and attenuation rate of 2D-MRCP with different concentration contrast agent. (2) In vivo experiments: we used the optimum concentration of Gd-DTPA dilution with 50 and 100 mL， made 2D-MRCP scanning on 20 cases in two groups in 4-6 minutes and 9-11 minutes respectively after oral administration of Gd-DTPA dilution， and observed the restraint of the high signal liquid in stomach and duodenum，and whether the patients had adverse reactions. Results (1) It showed that the high signal liquid in stomach and duodenum of some patients with oral administration of 100ml dilution with 1.00 mmol/L concentration could be fully restrained in 9-11 minutes. (2) The allocation of oral Gd-DTPA dilution is simple， the effect of restraining the high signal liquid in stomach and duodenumis well after oral administration of little dilution， and the patients have no adverse reactions，so it is a good oral gastrointestinal contrast agent．Conclusions 2D-MRCP scanning in suitable time after oral administration of Gd-DTPA dilution with proper concentration and volume can effectively restrain the high signal liquid in stomach and duodenum. [ABSTRACT FROM AUTHOR]

Purpose: To develop, train, and validate a multiview deep convolutional neural network (DeePSC) for the automated diagnosis of primary sclerosing cholangitis (PSC) on two-dimensional MR cholangiopancreatography (MRCP) images., Materials and Methods: This retrospective study included two-dimensional MRCP datasets of 342 patients (45 years ± 14 [SD]; 207 male patients) with confirmed diagnosis of PSC and 264 controls (51 years ± 16; 150 male patients). MRCP images were separated into 3-T ( n = 361) and 1.5-T ( n = 398) datasets, of which 39 samples each were randomly chosen as unseen test sets. Additionally, 37 MRCP images obtained with a 3-T MRI scanner from a different manufacturer were included for external testing. A multiview convolutional neural network was developed, specialized in simultaneously processing the seven images taken at different rotational angles per MRCP examination. The final model, DeePSC, derived its classification per patient from the instance expressing the highest confidence in an ensemble of 20 individually trained multiview convolutional neural networks. Predictive performance on both test sets was compared with that of four licensed radiologists using the Welch t test., Results: DeePSC achieved an accuracy of 80.5% ± 1.3 (sensitivity, 80.0% ± 1.9; specificity, 81.1% ± 2.7) on the 3-T and 82.6% ± 3.0 (sensitivity, 83.6% ± 1.8; specificity, 80.0% ± 8.9) on the 1.5-T test set and scored even higher on the external test set (accuracy, 92.4% ± 1.1; sensitivity, 100.0% ± 0.0; specificity, 83.5% ± 2.4). DeePSC outperformed radiologists in average prediction accuracy by 5.5 ( P = .34, 3 T) and 10.1 ( P = .13, 1.5 T) percentage points., Conclusion: Automated classification of PSC-compatible findings based on two-dimensional MRCP was achievable and demonstrated high accuracy on internal and external test sets. Keywords: Neural Networks, Deep Learning, Liver Disease, MRI, Primary Sclerosing Cholangitis, MR Cholangiopancreatography Supplemental material is available for this article. © RSNA, 2023., Competing Interests: Disclosures of conflicts of interest: H.R. No relevant relationships. F.W. M3I grant from University Hospital of Hamburg-Eppendorf made to the Institute of Medical Systems Biology for funding of salary. A.E. Support from the LFF-FV 78 and DFG-funded CRU 306 grants. J.Y. No relevant relationship. P.F. Support from the LFF-FV 78 and DFG-funded CRU 306 grants. M.Z. SFB 1192 B8 funding from the German Research Foundation to the Institute of Medical Systems Biology, University Medical Center Hamburg-Eppendorf. J.S. No relevant relationships. F.S. No relevant relationships. C.Ö. No relevant relationships. A.W. No relevant relationship. G.A. No relevant relationship. S.B. Funding from UKE R3 reduction of animal testing grant, LFF-FV 78 grant, and DFG-funded CRU 306 grant made to the Institute of Medical Systems Biology at the University Hospital of Hamburg-Eppendorf. C.S. Support from the YAEL Foundation, the Hannelore and Helmet Greve Foundation, and the LFF-FV 78 and DFG-funded CRU 306 grants., (© 2023 by the Radiological Society of North America, Inc.)

MR cholangiopancreatography (MRCP) is an imaging technique that has evolved over the past 2 decades and that continues to have a fundamental role in the non-invasive detection of morphologic features of the pancreatic ducts. In several studies, MRCP has shown a good correlation with endoscopic retrograde cholangiopancreatography in the evaluation of diseases and anatomic variants of the pancreatic ductal system. However, in physiologic conditions the pancreatic ducts are not always easily recognisable. More recently, secretin-enhanced MRCP protocols have been developed for a more complete assessment of pancreatic ducts and glandular function, including monitoring of pancreatic flow dynamics and duodenal filling after pancreatic hormonal stimulation with secretin. The injection of this hormone causes temporary dilation of the pancreatic ducts, principally by increasing pancreatic exocrine secretions, and thus improving MRCP detection of the ducts and characterisation of pancreatic disorders and allowing the assessment of the exocrine pancreatic reserve. The purpose of this pictorial review is to summarise the technical aspects of secretin-stimulated MRCP, to report the secretin-stimulated MRCP findings of pancreatic duct abnormalities and to review the diagnostic capabilities of secretin-stimulated MRCP in various pancreatic ductal system conditions. Main Messages : • MRCP has a fundamental role in the non-invasive detection of pancreatic ducts. • In physiologic conditions pancreatic ducts are not always well detected on MRCP. • Secretin injection causes temporary dilation of pancreatic ducts and thus improves MRCP detection. • Secretin-stimulated MRCP may allow the assessment of the exocrine pancreatic reserve. • Secretin increases the diagnostic capabilities of MRCP for evaluating pancreatic disorders. [ABSTRACT FROM AUTHOR]

Background: We report on a case of pancreatic arteriovenous malformation (PAVM) that obliterated shortly after diagnostic angiography (DSA). PAVM is a rare anomaly that presents with upper abdominal pain, signs of acute pancreatitis and massive gastrointestinal bleeding. The management of PAVM is rather complex, with complete treatment usually accomplished only by a total extirpation of the affected organ or at least its involved portion. DSA prior to treatment decisions is helpful for characterizing symptomatic PAVM, since it can clearly depict the related vascular networks. In addition, interventional therapy can be performed immediately after diagnosis. Case Presentation: A 39-old male was admitted due to recurring upper abdominal pain that lasted several weeks. Initial examination revealed the absence of fever or jaundice, and the laboratory tests, including that for pancreatic enzymes, were unremarkable. An abdominal ultrasound (US) showed morphological and Doppler anomalies in the pancreas that were consistent with a vascular formation. A subsequent DSA depicted a medium-sized nidus, receiving blood supply from multiple origins but with no dominant artery. Coil embolization was not possible due to the small caliber of the feeding vessels. In addition, sclerotherapy was not performed so as to avoid an unnecessary wash out to the non-targeted duodenum. Consequently, the patient received no specific treatment for his symptomatic PAVM. A large increase in pancreatic enzymes was noticed shortly after the DSA procedure. Imaging follow-up by means of CT and MRI showed small amounts of peripancreatic fluid along with a limited area of intra-parenchymal necrosis, indicating necrotizing pancreatitis. In the post-angiography follow-up the patient was hemodynamically stable the entire time and was treated conservatively. The symptoms of pancreatitis improved over a few days, and the laboratory findings returned to normal ranges. Long-term follow-up by way of a contrast-enhanced CT revealed no recanalization of the thrombosed PAVM. Conclusion: The factors associated with the obliteration of PAVM during or after DSA are poorly understood. In our case it may be attributed to the low flow dynamics of PAVM, as well as to the local administration of a contrast agent. Asymptomatic PAVM, as diagnosed with non-invasive imaging techniques, should not be evaluated with DSA due to the potential risk of severe complications, such as acute pancreatitis. [ABSTRACT FROM AUTHOR]

Objective: To determine reliable MRI features of autoimmune pancreatitis (AIP) in the proximal pancreas that could allow its differentiation from pancreatic ductal adenocarcinoma (PDAC). Methods: Twenty-three patients with AIP and 61 patients with PDAC in the proximal pancreas underwent MRI. Two observers analyzed MRI for lesion morphology, hypointensity degree on T1-weighted images, enhancement pattern during dynamic phases, capsule-like rim, presence of cysts and duct penetrating sign, morphology of bile duct, and icicle appearance and tortuosity of the upstream pancreatic duct. Sensitivity and specificity for the diagnosis of AIP were calculated for each category or combined. Results: When isointensity on the portal and late phase of MRI and/or the icicle sign of pancreatic duct are applied, 100 % sensitivity for the diagnosis of AIP in the proximal pancreas was achieved. Applying both mild T1 hypointensity similar to the spleen and the icicle sign enabled 100 % specificity for the diagnosis of AIP by differentiating it from PDAC. Conclusion: The combination of the icicle sign in the upstream pancreatic duct and mild T1 hypointensity or isointensity on portal and late phase of dynamic MRI could be reliable MR features for the diagnosis of AIP in the proximal pancreas by allowing its differentiation from PDAC. Key Points: • The icicle sign of the pancreatic duct is useful for diagnosing AIP. • Mild T1 hypointensity similar to the spleen is useful for diagnosing AIP. • Isointensity on portal and late phases MRI is useful for diagnosing AIP. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the added value of diffusion-weighted imaging (DWI) to magnetic resonance cholangiopancreatography (MRCP) with unenhanced MR imaging for predicting the malignancy or invasiveness of intraductal papillary mucinous neoplasms (IPMNs). Materials and Methods: Following Institutional Review Board (IRB) approval, this retrospective study included 52 patients with surgically resected IPMNs and who underwent MRCP, unenhanced MRI, and DWI. Three blinded radiologists evaluated the two image sets, ie, MRCP with unenhanced MR images vs. the combined set with MRCP, unenhanced MR images, and DWI, and scored their confidence for malignancy or for invasiveness of IPMNs. The mean apparent diffusion coefficient (ADC) values of benign IPMNs and of intraductal mucinous carcinomas (IPMCs) were compared. The diagnostic accuracy was calculated using receiver operating characteristic (ROC) curve analysis. esults: The mean ADC of malignant IPMNs (2.05 ± 0.66 × 10−3mm2/sec) was significantly lower than that of benign IPMNs (2.95 ± 0.32 × 10−3mm2/sec, P < 0.0001). Invasive IPMCs (1.51 ± 0.32 × 10−3mm2/sec) showed significantly lower ADC than that of noninvasive IPMCs (2.67 ± 0.23 × 10−3mm2/sec, P = 0.0003). The area of diffusion restriction was more frequently seen in malignant IPMNs than in benign IPMNs ( P < 0.00001). The addition of DWI to MRCP with unenhanced MRI did not show a significant improvement for predicting malignant IPMN ( P> 0.05), but resulted in a tendency to improve the diagnostic accuracy for the prediction of invasive IPMN in two observers ( P = 0.072, P = 0.085). Conclusion: The addition of DWI to MRCP with unenhanced MRI may improve the diagnosis of malignant IPMN and further increase the prediction of invasive IPMC. J. Magn. Reson. Imaging 2013;38:555-563. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

This article presents the MR protocols, imaging features, diagnostic criteria, and complications of commonly encountered emergencies in pancreaticobiliary imaging, which include pancreatic trauma, bile leak, acute cholecystitis, biliary obstruction, and pancreatitis. Various classifications and complications that can arise with these conditions, as well as artifacts that may mimic pathology, are also included. Finally, the emerging utility of abbreviated MR protocols is discussed., Competing Interests: Disclosure Conflicts of interest: Dr H. Chang: Nil. Dr D.D.B. Bates: Nil. Dr A. Gupta: Nil. Dr C.A. LeBedis: Nil., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: To determine the characteristic magnetic resonance imaging (MRI) features of mass-forming autoimmune pancreatitis (AIP), which allow its differentiation from pancreatic adenocarcinoma (PAC). Materials and Methods: MR images of 37 patients with either pathologically proven, mass-forming AIPs ( n = 9) or PACs ( n = 28) were retrospectively reviewed. The pancreatic MR protocol included unenhanced images, contrast-enhanced dynamic images, diffusion-weighted imaging (DWI), and MR-cholangiopancreatography (MRCP). Two reviewers analyzed the MR images regarding the number, location, morphologic features, and enhancement degree and pattern of the lesions as well as secondary changes of the pancreatic parenchyma, the biliary and pancreatic ducts. The size and apparent diffusion coefficient (ADC) values of the lesions were measured. Results: Although sensitivities were low (28.6%-44.4%), specificities of multiplicity, capsule-like rim enhancement, and skipped stricture of the biliary or pancreatic duct in mass-forming AIP were high (100%). Sensitivities and specificities of irregular or geographic shape, delayed enhancement, and a low ADC value <1.26 × 10−3 mm2/s in mass-forming AIP were favorable (71.4%-83.3% and 78.5%-89.3%). Conclusion: Although to differentiate mass-forming AIP from pancreatic cancer is difficult, the combination of MRI findings including contrast-enhanced dynamic images, MRCP, and DWI can be a help. J. Magn. Reson. Imaging 2012;36:188-197. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The purpose of our study was to compare three-dimensional (3D) negative-contrast CT cholangiopancreatography (3D-nCTCP) with 3D MR cholangiopancreatography (3D-MRCP) for the diagnosis of obstructive biliary diseases. Materials and methods: 3D-nCTCP and 3D-MRCP were performed on seventy clinically documented obstructive biliary diseases patients. The accuracy of each technique in determining the location and cause of biliary obstruction was evaluated compared with the final clinical diagnoses. Results: Both methods achieved 100% of accuracy in the diagnosis of the presence and location of biliary obstruction, and had a similar sensitivity, specificity, accuracy in differentiating benign from malignant biliary obstruction or calculous from noncalculous biliary obstruction (p >0.05). At 3D-nCTCP, six patients with stones were misinterpreted as cholangitis (N =2), papillitis (N =3), or bile duct adenocarcinoma (N =1); two metastases were mistaken as acute pancreatitis or pancreatic head carcinomas, and one intrahepatic cholangiocarcinoma was misled as bile duct adenoma. At 3D-MRCP, one small stone, one ampullary adenoma, and one intrahepatic cholangiocarcinoma were mistaken as cholangitis, ampullary stone, and intrahepatic bile duct stone, respectively, and three gallbladder carcinomas and another intrahepatic cholangiocarcinoma were misdiagnosed as hilar cholangiocarcinoma (N =3) or common hepatic duct stone (N =1); four metastases were mistaken as pancreatic head carcinomas (N =3) or distal cholangiocarcinoma (N =1). The overall accuracy in making specific diagnosis of the cause of biliary obstruction was 87.1% for 3D-nCTCP and 84.3% for 3D-MRCP, respectively, (p >0.05). Conclusion: 3D-nCTCP has the similar effects as 3D-MRCP for the diagnosis of biliary obstruction and, the location and the cause of biliary obstruction. In view of selected cases contraindications for MRI, 3D-nCTCP is a potential substitute. [Copyright &y& Elsevier]

Background: Biliary atresia (BA) is a progressive, obliterative cholangiopathy that occurs in neonates with hepatic portoenterostomy the treatment of choice, but early surgery is important for optimum outcomes. MRI, including MR cholangiopancreatography (MRCP) may be a diagnostically useful alternative to US, but the heavily T2-weighted sequences used include not only bile duct signals, but also other heterogeneously high signal intensities from surrounding structures. Objective: To evaluate the effects of gadolinium when used to decrease background signal intensity on T2-weighted MR cholangiopancreatography (MRCP) in infants and to evaluate the qualitative improvement of the depiction of the common bile duct (CBD) for evaluating neonatal cholestasis. Materials and methods: Our Institutional Review Board approved this prospective study. MRCP was performed with gadopentetate dimeglumine injection using a 1.5-T scanner. Pre- and postcontrast MRCP images were compared. Forty-nine infants (male:female = 21:28; age 0-12 months, mean 2.3) were included. The final diagnoses were biliary atresia (BA) in 28 cases and non-BA in 21. Quantitative analysis was conducted using region-of-interest measurements of mean signal intensities of the liver, pancreatic head and gallbladder (if defined). Qualitative analysis was performed by four radiologists who subjectively scored image confidence in the presence of CBD on a 4-point scale (0 for definitely absent, 1 for probably absent, 2 for probably present, and 3 for definitely present). Results: The signal-to-noise ratios were significantly decreased in the liver and pancreatic head after contrast medium enhancement (mean 5.7→4.0 in liver and mean 44.9→12.7 in the pancreatic head; P < 0.0001), and this finding was constant in both the BA and the non-BA group. The mean confidence score in the presence of CBD decreased in the BA group (0.9→0.5; P < 0.0001), but did not change significantly in the non-BA group (2.0→2.1; P = 0.459) after contrast medium enhancement. Both intra- and interobserver agreement was higher after contrast medium enhancement ( P = 0.046). Conclusion: Gadopentetate dimeglumine-enhanced MRCP increased the diagnostic confidence of absence of the CBD in cholestatic infants with increased intra- and interobserver agreement. [ABSTRACT FROM AUTHOR]

Abstract: 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. [Copyright &y& Elsevier]

Gallbladder duplications are uncommon anatomic variants that are sometimes mistaken for other entities on imaging. We present a surgically confirmed case of cholecystitis in a ductular-type duplicated gallbladder complicated by the formation of an inflammatory fistula to the adjacent duodenum. Both US and magnetic resonance cholangiopancreatography were performed preoperatively, in addition to intraoperative cholangiography, which confirmed the presence of a duplicated gallbladder. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The aim of this retrospective study is to evaluate the role of T2-weighted MR imaging (MRI) and MR cholangiopancreatography (MRCP) findings in the diagnosis of primary biliary cirrhosis (PBC). Materials and methods: The following T2-weighted MRI and MRCP findings: segmental hepatic atrophy/hypertrophy, irregular liver surface, parenchymal lace-like fibrosis, rounded low signal intensity lesions centering portal vein branches (periportal halo sign), periportal hyperintensity (cuffing), splenomegaly, ascites, lymphadenopathy, venous collaterals, and the configuration of intrahepatic biliary ducts were reviewed for their diagnostic significance by two observers in 13 female patients (mean age: 49 years) with PBC. Discordant readings of the observers were resolved at consensus. Results: When parenchymal lace-like fibrosis and periportal halo sign were seen together the sensitivity of T2-weighted MR images was 69%. In six cases periportal hyperintensity (cuffing) and periportal halo sign were seen together. Segmental hypertrophy was present in nine patients and hepatic surface irregularity due to regenerative nodules were present in 10 patients. Lymphadenopathy was seen in 10, splenomegaly was seen in 5, collateral vascular structures were seen in 2 and minimal perihepatic free fluid was seen in 2 patients. MRCP images revealed various mild irregularity in the intrahepatic bile ducts in 8 patients and focal narrowing at the common bile duct level in 1 patient. Conclusion: MRI and MRCP may support the clinical and laboratory findings of PBC even in the early stages of the disease. MRI can also be a choice of method for the recommended prolonged follow up. [Copyright &y& Elsevier]

The purpose of this study was to evaluate the accuracy of magnetic resonance (MR) in correctly locating and characterising biliary strictures in patients affected by extrahepatic cholangiocarcinoma, identify findings suggestive of the disease, identify lesions with similar MR features and possible criteria for differential diagnosis and establish prospective MR accuracy in diagnosis of malignant obstruction of extrahepatic bile ducts. We retrospectively reviewed the MR examinations of 39 patients affected by extrahepatic cholangiocarcinoma confirmed by histology or cytology. The studies were evaluated for the following parameters: site of obstruction (hilar, proximal or distal), presence of intra– or extrahepatic dilation of bile ducts, morphology of ductal stenosis (gradual tapering or abrupt ending), morphology of the lesion (mass like or circumferential), dimension, signal intensity before contrast medium administration and lesion enhancement after administration of contrast medium. Finally, we assessed the most useful sequence for the diagnosis. In order to evaluate MR accuracy in the diagnosis of malignant obstruction of extrahepatic bile ducts, we prospectively reviewed MR examinations of 74 patients affected by obstructive jaundice (55 malignant lesions and 19 inflammatory lesions). MR diagnosis was compared with histology or cytology considered as the gold standard. MR allowed identification and localisation of 41/41 extrahepatic cholangiocarcinomas. Fifty–four percent of the lesions showed gradual duct tapering; the remaining lesions showed an abrupt ending. Fifty–six percent of the lesions appeared as a circumferential thickening (infiltrative growth); the remaining lesions had a mass–like appearance (expansile growth). Most lesions were hypo– (49%) or isointense (49%) in T1–weighted sequences and hyper– (49%) or isointense (51%) in T2–weighted sequences. Ninety–five percent of the lesions did not enhance significantly in the arterial phase while 98% showed late enhancement (10 min). The most diagnostic sequence (in 76% of cases) was the late–phase gradient–echo (GRE) T1 fat–saturated sequence. MR had good sensitivity (91%) but poor specificity (47%) in characterising stenosis as malignant, given the large number (10/19) of benign lesions evaluated as neoplastic lesions. MR almost always identified the cause of stenosis and suggested its neoplastic nature if it exhibited a mass–like appearance (extraductal or growing into the choledochus). On the other hand, lesions with parietal thickening, particularly if smaller than 1 cm, require endoscopic cytology or histology because of the high risk of unnecessary procedures for benign lesions. [ABSTRACT FROM AUTHOR]

To evaluate the imaging findings of biliary hamartomas (von Meyenburg complexes, vMCs) and discuss their differential diagnosis from other related diseases, imaging findings of biliary hamartomas on ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), and hepatobiliary scintigraphy were prospectively analyzed in six patients. On ultrasound images, five of the six cases showed multiple small hyper- and hypoechoic lesions with comet-tail echoes, especially when magnified using the zoom function. In all six cases, multiple tiny hypodense lesions less than 10 mm in diameter were scattered throughout the liver with no enhancement on CT. These tiny lesions were demonstrated to be hyper- and hypointense on T2- and TI-weighted images, respectively, in three patients who underwent MRI examinations. MRCP was performed in two patients, and it clearly showed multiple tiny round and irregular-shaped hyperintense lesions. MRCP and hepatobiliary scintigraphy showed normal appearances of intra- and extrahepatic bile ducts in two and one patients, respectively. Imaging modalities are useful in the diagnosis and differential diagnosis of vMCs. A correct diagnosis might be obtained when typical imaging findings present even without histological confirmation. [ABSTRACT FROM AUTHOR]

The aim of this study was to quantify pancreatic exocrine function in normal subjects and in patients with chronic pancreatitis (CP) before and after pancreatic duct drainage procedures (PDDP) with dynamic secretin-enhanced magnetic resonance (MR) cholangiopancreatography (S-MRCP). Pancreatic exocrine secretions [quantified by pancreatic flow output (PFO) and total excreted volume (TEV)] were quantified twice in ten healthy volunteers and before and after treatment in 20 CP patients (18 classified as severe, one as moderate, and one as mild according to the Cambridge classification). PFO and TEV were derived from a linear regression between MR-calculated volumes and time. In all subjects, pancreatic exocrine fluid volume initially increased linearly with time during secretin stimulation. In controls, the mean PFO and TEV were 6.8 ml/min and 97 ml; intra-individual deviations were 0.8 ml/min and 16 ml. In 10/20 patients with impaired exocrine secretions before treatment, a significant increase of PFO and TEV was observed after treatment (P<0.05); 3/20 patients presented post-procedural acute pancreatitis and a reduced PFO. The S-MRCP quantification method used in the present study is reproducible and provides normal values for PFO and TEV in the range of those obtained from previous published intubation studies. The initial results in CP patients have demonstrated non-invasively a significant short-term improvement of PFO and TEV after PDDP. [ABSTRACT FROM AUTHOR]

This study aimed to assess the clinical usefulness of magnetic resonance cholangiopancreatography (MRCP) as a postoperative diagnostic tool in children with choledochal cysts. Magnetic resonance cholangiopancreatography was performed postoperatively in 19 patients and image quality was compared with that obtained by intravenous cholangiography spiral computed tomography (IVC-SCT). While the detectability by MRCP was inferior to that by IVC-SCT, MRCP highly (84.2%) depicted the anastomotic site together with the reconstructed bowel and intrahepatic bile ducts. Magnetic resonance cholangiopancreatography also clearly delineated the postoperative condition of pancreaticobiliary maljunction (PBM), residual distal common bile duct, common channel, and pancreatic duct. Since MRCP is noninvasive and requires neither radiation exposure nor a contrast agent, and is useful for detecting both anastomosis and pancreatico-biliary ducts around PBM, MRCP might be superior to IVC-SCT as an imaging technique for outpatient clinics performing long-term follow-up studies in children with choledochal cysts. [ABSTRACT FROM AUTHOR]

The aim of this study was to define the value of MRI of the pancreas for preoperative local staging of patients with a suspected pancreatic mass. Ninety-four patients (41 women, 53 men; age range 32-87 years) with a suspected pancreatic tumor underwent preoperative staging with MRI on a 1.5-T system. The MRI protocol included breath-hold MR cholangiopancreatography in turbo spin-echo technique, biphasic contrast-enhanced 3D MR angiography, and MRI of the upper abdomen with breath-hold T2-weighted half-Fourier acquired single-shot turbo spin-echo and T1-weighted fast-low-angle-shot (pre- and postcontrast) sequences. Data were collected prospectively and analyzed by two radiologists in agreement modality. Evaluation criteria were vascular involvement, resectability, and a characterization benign vs malignant. Results were compared to histopathology in 78 patients. Sixteen patients were followed-up. In 74 of 94 patients a solid tumor or an inflammation of the pancreas ( n=62) or the papilla ( n=12) was detected. In this group, MRI had a sensitivity of 98%, a specificity of 92%, and an accuracy of 96% in the characterization of malignant tumors. Regarding only the solid tumors, the positive predictive value of MRI was 87% with respect to resectability. Other pathologic findings included adenoma or inflammation of the duodenum ( n=5), carcinoma or benign stenosis of the choledochus duct ( n=7) and carcinoma of the gall bladder ( n=2). In 6 patients MRI did not depict any pathologic findings, and follow-up confirmed this interpretation. Magnetic resonance imaging allows a local preoperative staging in patients with suspected pancreatic tumor. Limitations, however, concern to the diagnostics of peritoneal and/or liver metastases. [ABSTRACT FROM AUTHOR]

Langerhans' cell histiocytosis (LCH) is a disorder of histiocytic proliferation that primarily affects infants. Imaging findings of a rare case of lung and liver involvement in an adult are presented. High-resolution computed tomography (HRCT) of the lungs showed confluent thin-walled cystic air spaces compatible with advanced LCH. Liver CT and MRI revealed unspecific signs of fatty infiltration. Irregular widening of peripheral bile ducts was displayed in breath-hold MR cholangiography. This pattern is considered characteristic for sclerosing cholangitis and should support the diagnosis of LCH in case of concomitant cystic pulmonary disease, even in adult patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare prospectively a breath-hold projection magnetic resonance cholangiopancreatography (MRCP) technique with diagnostic endoscopic retrograde cholangiopancreatography (ERCP). Seventy-six patients with suspected strictures or choledocholithiasis were referred for MRCP and subsequent ERCP examination, which were performed within 4 h of each other. The MRCP technique was performed using fat-suppressed rapid acquisition with relaxation enhancement (RARE) projection images obtained in standardised planes with additional targeted projections as required by the supervising radiologist. Two radiologists (in consensus) assessed the MRCP results prospectively and independently for the presence of bile duct calculi, strictures, non-specific biliary dilatation and pancreatic duct dilatation, and recorded a single primary diagnosis. The ERCP was assessed prospectively and independently by a single endoscopist and used as a gold standard for comparison with MRCP. Diagnostic agreement was assessed by the Kappa statistic. The MRCP technique failed in two patients and ERCP in five. In the remaining 69 referrals ERCP demonstrated normal findings in 23 cases, strictures in 19 cases, choledocholithiasis in 9 cases, non-specific biliary dilatation in 14 cases and chronic pancreatitis in 4 cases. The MRCP technique correctly demonstrated 22 of 23 normal cases, 19 strictures with one false positive (sensitivity 100 %, specificity 98 %), all 9 cases of choledocholithiasis with two false positives (sensitivity 100 %, specificity 97 %), 12 of 14 cases of non-specific biliary dilatation and only 1 of 4 cases of chronic pancreatitis. There was overall good agreement for diagnosis based on a kappa value of 0.88. Breath-hold projection MRCP can provide non-invasively comparable diagnostic information to diagnostic ERCP for suspected choledocholithiasis and biliary strictures and may allow more selective use of therapeutic ERCP. [ABSTRACT FROM AUTHOR]