Abstract
Purpose: Magnetic resonance cholangiopancreatography (MRCP) is an established technique for the evaluation of intra- and extrahepatic bile ducts in patients with known or suspected hepatobiliary disease. However, the ideal acquisition and reconstruction plane for optimal bile duct evaluation with 3D technique has not been evaluated.The purpose of our study was to compare different acquisition and reconstruction planes of 3D MRCP for bile duct assessment. Methods: 51 consecutive adult patients suspected to have pancreatico-biliary disease were examined with 3 Tesla (Philips 3 T Ingenia) system both a multi thin slice (3D) and a breath-hold (Single Shot) MRCP technique were performed. In the multi thin slice technique both source images and maximum intensity projections were examined. Two radiologists blinded to clinical information viewed both MRCP techniques independantly. Measure of correlation between each of the techniques and the inter observer agreement were computed. Coronal and axial MIP were reconstructed based on each dataset (resulting in two coronal and two axial MIP, respectively) and assessed the MIP, regarding visualization of bile ducts and image quality.Results were compared (Wilcoxon test). Intra- and interobserver variability were calculated (kappa-statistic). Results: In case of coronal data acquisition, visualization of bile duct segments was significantly better on coronal reconstructed MIP images as compared to axial reconstructed MIP (p 0.05). Image quality of coronal and axial datasets did not differ significantly. Obstruction due to tumor was shown in 30% of patients, and calculi in the common bile duct were shown also in 30% of patients employing the 3D MRCP technique. Obstruction due to tumor and calculi were shown in 30% and 21% of patients, respectively, using the SS 2D MRCP technique. Sensitivity and specificity in distinguishing calculi in the common bile duct by 3D MRCP and SS MRCP were 100%, 100%, 70% and 100% respectively. Conclusions: Although the 3D MRCP multislice technique is more time consuming than the SS MRCP breathhold technique at a 3 Tesla (Philips 3 T Ingenia) system it is advisable to use thin slice 3D MRCP in order not to misdiagnose calculi in the common bile duct.The results of our study suggest that for visualization and evaluation of intra- and extrahepatic bile duct segments reconstructed images in coronal orientation are
Highlights
MAGNETIC resonance cholangiopancreatography (MRCP) is an established technique for the evaluation of intra- and extra-hepatic bile ducts in patients with known or suspected hepatobiliary disease [1]
Most current MRCP techniques are based on heavily T2-weighted fast spin echo (FSE) pulse sequences, which yield a luminal image of the bile ducts that is based on the inherent signal of slowflowing or stationary bile
Single-shot projections are preferred in individuals who are unable to hold their breath, such as severely sick patients or small children [7]. 3D-imaging techniques provide better image quality compared to 2D-sequences [1,8,9], even though the combination of different MRCP sequences has proven to be valuable in the assessment of bile duct anatomy and pathology [10]. 3D FSE sequences are usually acquired with the slab in coronal orientation
Summary
MAGNETIC resonance cholangiopancreatography (MRCP) is an established technique for the evaluation of intra- and extra-hepatic bile ducts in patients with known or suspected hepatobiliary disease [1]. Most current MRCP techniques are based on heavily T2-weighted fast spin echo (FSE) pulse sequences, which yield a luminal image of the bile ducts that is based on the inherent signal of slowflowing or stationary bile. Both single-shot projections and multislice techniques are available [5], with the latter being distinguished into 2D- [6] and 3D-techniques [7]. Single-shot projections are preferred in individuals who are unable to hold their breath, such as severely sick patients or small children [7]. 3D-imaging techniques provide better image quality compared to 2D-sequences [1,8,9], even though the combination of different MRCP sequences has proven to be valuable in the assessment of bile duct anatomy and pathology [10]. 3D FSE sequences are usually acquired with the slab in coronal orientation
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