Diagnostic pitfalls of MR cholangiopancreatography in the evaluation of the biliary tract and gallbladder.

Abstract

Magnetic resonance (MR) cholangiopancreatography is a noninvasive imaging technique that has proved accurate in the diagnosis of biliary obstruction. However, various diagnostic pitfalls have been reported with MR cholangiopancreatography that were not encountered previously at conventional biliary imaging. These pitfalls may simulate or mask various pathologic conditions of the extrahepatic bile duct or main pancreatic duct and may be caused by a variety of factors. Because of its postprocessing nature, maximum-intensity-projection reconstruction may mask a small gallstone if the stone is surrounded by hyperintense bile and may cause false ductal disconnection or duplication when a breath hold is not performed perfectly. Extraductal factors (e.g., metallic surgical clips, intravascular metallic coils, gas in the stomach or duodenum) can cause signal loss in the adjacent part of the extrahepatic bile duct, which may in turn lead to a false-positive diagnosis of ductal narrowing or obstruction. Normal vascular structures including the right hepatic and gastroduodenal arteries can cause pseudo-obstruction of the extrahepatic bile duct by pulsatile compression. Intraductal factors (e.g., gas, hemorrhage, debris, iodinated contrast material) reduce the signal intensity of the bile, which may result in pseudo-obstruction, false filling defects, or a nonvisualized gallbladder or bile duct. Knowledge of the existence and high prevalence of these diagnostic pitfalls should help prevent misinterpretation of MR cholangiopancreatograms.