Abstract
AimCholangiocarcinoma is endemic in southeast Asia, generally developing from liver fluke infestation. However, diagnostic imaging of early-stage disease is challenging. The aim of this work is to investigate relaxometry (specifically, T2 mapping) as a method of exploiting the higher signal-to-noise ratio (SNR) of internal coils for improved reception of magnetic resonance signals, despite their non-uniform sensitivity.MethodsEx vivo T2 mapping was carried out at 3T on fixed resection specimens from Thai cholangiocarcinoma patients using an mGRASE sequence and an endoscope coil based on a thin-film magneto-inductive waveguide and designed ultimately for internal use.ResultsDisease-induced changes including granulomatous inflammation, intraepithelial neoplasia and intraductal tumours were correlated with histopathology, and relaxation data were compared with mono- and bi-exponential models of T2 relaxation. An approximately 10-fold local advantage in SNR compared to a 16-element torso coil was demonstrated using the endoscope coil, and improved tissue differentiation was obtained without contrast agents.ConclusionThe performance advantage above follows directly from the inverse relation between the component of the standard deviation of T2 due to thermal noise and the SNR, and offers an effective method of exploiting the SNR advantage of internal coils. No correction is required, avoiding the need for tracking, relaxing constraints on coil and slice orientation and providing rapid visualization.
Highlights
Cholangiocarcinoma (CCA) is an adenocarcinoma of the biliary ductal system.[1]
This study has shown by comparison with an external coil that improved tissue differentiation may be obtained in ex vivo T2 mapping of cholangiocarcinoma resection specimens using an endoscope coil designed for internal use
Raising signal-to-noise ratio (SNR) using an internal coil allows the performance of a clinical scanner to be raised closer to that of an NMR spectrometer, without the disadvantages of a larger slice thickness
Summary
Cholangiocarcinoma (CCA) is an adenocarcinoma of the biliary ductal system.[1] It is rare in the West ( incidence is rising2,3) but endemic in southeast Asian countries, where the cause is generally infestation with liver fluke following consumption of uncooked river fish.[4] Cysts hatch in the duodenum, migrate into the bile duct and mature in the extrahepatic bile ducts. Adult activity causes damage to the biliary epithelium. Toxic excretions cause chronic irritation and epithelial hyperplasia that can eventually lead to oxidative DNA damage and malignant transformation.[5] Despite education programs, an estimated 9.4% of the Thai population (around 6 million people) is affected with fluke. Khon Kaen University Hospital is the centre for treatment in Isaan province, where CCA is responsible for 25,000 deaths per year.[6]
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