Magnetic Resonance Cholangiopancreatography Images Research Articles

Surveillance MRI is associated with improved survival in patients with primary sclerosing cholangitis.

The benefits of regular surveillance imaging for cholangiocarcinoma in patients with primary sclerosing cholangitis (PSC) are unclear. Hence, we aimed to evaluate the impact of regular magnetic resonance cholangiopancreatography (MRCP) on outcomes of patients with PSC in Australia, where the practice of MRCP surveillance is variable. The relationship between MRCP surveillance and survival outcomes was assessed in a multicenter, retrospective cohort of patients with PSC from 9 tertiary liver centers in Australia. An inverse probability of treatment weighting approach was used to balance groups across potentially confounding covariates. A total of 298 patients with PSC with 2117 person-years of follow-up were included. Two hundred and twenty patients (73.8%) had undergone MRCP surveillance. Regular surveillance was associated with a 71% reduced risk of death on multivariate weighted Cox analysis (HR: 0.29, 95% CI: 0.14-0.59, p < 0.001) and increased likelihood of having earlier endoscopic retrograde cholangiopancreatography from the date of PSC diagnosis in patients with a dominant stricture (p < 0.001). However, survival posthepatobiliary cancer diagnosis was not significantly different between both groups (p = 0.74). Patients who had surveillance of less than 1 scan a year (n = 41) had comparable survival (HR: 0.46, 95% CI 0.16-1.35, p = 0.16) compared to patients who had surveillance at least yearly (n = 172). In this multicenter cohort study that employed inverse probability of treatment weighting to minimize selection bias, regular MRCP was associated with improved overall survival in patients with PSC; however, there was no difference in survival after hepatobiliary cancer diagnosis. Further prospective studies are needed to confirm the benefits of regular MRCP and optimal imaging interval in patients with PSC.

A Study to Assess the Role of Date Syrup, Pineapple Juice, and Hematinic Syrup as Magnetic Resonance Oral Contrast Agents in Improving the Image Quality of Magnetic Resonance Cholangiopancreatography.

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. 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 andFe+3, such aspineapple 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 datesyrup, 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). 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. Pineapple juice was the best contrast agent. However, date syrup and hematinic syrup can also be used to improve the imaging quality.

DPDS Demystified: Imaging Insights and Minimally Invasive Management

Abstract Aim This article retrospectively evaluates the radiological imaging features in establishing the diagnosis of pancreatic duct disconnection along with outlining the effective management protocols. Materials and Methods Sixty-three patients with radiological or clinical suspicion of pancreatic duct disconnection were identified. Their computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) images, clinical data, and laboratory parameters from medical records were retrieved and analyzed. Endoscopic retrograde cholangiopancreatography (ERCP) findings or raised amylase values in the necrotic collection higher than three times the reference range were considered as proven cases of disconnected pancreatic duct syndrome (DPDS) for the study. Multiple parameters were assessed on imaging to establish the diagnosis of DPDS. SPSS software was used for statistical analysis and radiological imaging features of pancreatic duct disconnection were evaluated. Laboratory parameters of serum amylase/lipase and amylase/lipase values from the collection were also studied along with the mode of clinical management and outcome on follow-up. Results The radiological imaging features of pancreatic duct disconnection were assessed in 63 patients in which it was seen that magnetic resonance imaging had a significantly higher accuracy rate in diagnosing DPDS as opposed to CT. Minimally invasive procedures such as endoscopic cystogastrostomy was the preferred management in most cases with ERCP stenting being the next favored management of choice. Resolution or reduction of symptoms was mostly seen on follow-up with 12.69% of patients developing complications. Conclusion This study highlighted the imaging features of DPDS apart from ascertaining the parameters that could be assessed to aid in early diagnosis of DPDS. MRCP has a higher accuracy rate compared with CT in diagnosing DPDS. A combination of two or more parameters on MRCP was more accurate in the identification of DPDS rather than a single parameter. Minimally invasive treatment options such as endoscopic transluminal drainage with or without stenting are currently preferred in the treatment of DPDS over surgical management. Early diagnosis and prompt management of DPDS is essential to reduce the onset of serious complications apart from improving the quality of life of these patients posttreatment.

Follicular cholangitis: a rare cause of benign biliary stricture

Introduction: The differential diagnosis of focal biliary strictures comprises both malignant and benign conditions. We report a rare case of follicular cholangitis presenting with segmental stricture of the left hepatic duct. Case description: An asymptomatic 59-year-old male with no past medical history presented with dilation of the left intrahepatic bile ducts revealed as an incidental finding on an abdominal ultrasound. Blood examinations showed only a slightly elevated gamma- glutamyl transferase (gammaGT) value, while carbohydrate antigen 19-9 (Ca 19-9) and serum immunoglobulin G4 (IgG4) were within normal range. Abdominal computed tomography and magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) scans revealed a high grade focal intrahepatic stricture of the left hepatic duct (FIHS type III) with proximal dilatation. Given that a diagnosis of cholangiocarcinoma could not be ruled out, the patient was referred for a left hepatectomy with regional lymph node dissection. Histological analysis showed a lymphoplasmacytic infiltration of the left hepatic duct with fibrosis and follicle formations in the submucosa, findings consistent with follicular cholangitis. The postoperative course was uneventful and there is no evidence of recurrence 8 months after the surgery. Discussion: The clinical and imaging presentation of follicular cholangitis is very similar to cholangiocarcinoma, rendering it a challenging diagnosis preoperatively. Conclusion: The approach to these cases should be primarily surgical. Even though it is very rare -- our report is the 13th case reported worldwide -- follicular cholangitis should be included in the differential diagnosis of focal biliary strictures.

Using deep learning models in magnetic resonance cholangiopancreatography images to diagnose common bile duct stones

Backgrounds and aims Magnetic resonance cholangiopancreatography (MRCP) plays a significant role in diagnosing common bile duct stones (CBDS). Currently, there are no studies to detect CBDS by using the deep learning (DL) model in MRCP. This study aimed to use the DL model You Only Look Once version 5 (YOLOv5) to diagnose CBDS in MRCP images and verify its validity compared to the accuracy of radiologists. Methods By collecting the thick-slab MRCP images of patients diagnosed with CBDS, 4 submodels of YOLOv5 were used to train and validate the performance. Precision, recall rate, and mean average precision (mAP) were used to evaluate model performance. Analyze possible reasons that may affect detection accuracy by validating MRCP images in 63 CBDS patients and comparing them with radiologist detection accuracy. Calculate the correctness of YOLOv5 for detecting one CBDS and multiple CBDS separately. Results The precision of YOLOv5l (0.970) was higher than that of YOLOv5x (0.909), YOLOv5m (0.874), and YOLOv5s (0.939). The mAP did not differ significantly between the 4 submodels, with the following results: YOLOv5l (0.942), YOLOv5x (0.947), YOLO5s (0.927), and YOLOv5m (0.946). However, in terms of training time, YOLOv5s was the fastest (4.8 h), detecting CBDS in only 7.2 milliseconds per image. In 63 patients the YOLOv5l model detected CBDS with an accuracy of 90.5% compared to 92.1% for radiologists, analyzing the difference between the positive group successfully identified and the unidentified negative group not. The incorporated variables include common bile duct diameter > 1 cm (p = .560), combined gallbladder stones (p = .706), maximum stone diameter (p = .057), combined cholangitis (p = .846), and combined pancreatitis (p = .656), and the number of CBDS (p = .415). When only one CBDS was present, the accuracy rate reached 94%. When multiple CBDSs were present, the recognition rate dropped to 70%. Conclusion YOLOv5l is the model with the best results and is almost as accurate as the radiologist’s detection of CBDS and is also capable of detecting the number of CBDS. Although the accuracy of the test gradually decreases as the number of stones increases, it can still be useful for the clinician’s initial diagnosis.

Evaluation of intraductal papillary mucinous neoplasms detected incidentally with magnetic resonance cholangiopancreatography

Objectives: The aim of this study was to estimate the prevalence of coincidentally found intraductal papillary mucinous neoplasms (IPMNs) and assess their features with magnetic resonance cholangiopancreatography (MRCP) imaging. Methods: The prevalence of incidentally detected IPMN was evaluated in 951 patients who underwent MRCP examination for various indications. MRCP images were assessed to analyze the number, size, location, and internal structure of lesions in patients with IPMN. Furthermore, the association between IPMN prevalence and age and gender was evaluated. Results: IPMN was detected in 102 (10.7%) of 951 patients. Solitary IPMNs were located in different parts of the pancreas: in the uncinate process in 8 (7.8%), in the head and neck in 19 (18.6%), in the corpus in 10 (9.8%), and in the tail in 7 (6.9%) patients. IPMN was multiple in 58 (56.9%) patients. IPMN was identified in 41 (6.18%) patients under 65 years and 61 (21.18%) patients over 65 years, and the variance was statistically substantial (p &amp;lt; 0.001). IPMN diameter was 7.22 ± 4.3 mm in patients under 65 years and 9.21 ± 4.74 mm in those over 65 years, which was statistically significant (p = 0.048). Patients who were older were more likely to have multiple IPMNs (p = 0.010). Conclusions: IPMNs increase in frequency, quantity, and size with age. MRCP is the most essential sequence for determining main pancreatic duct (MPD) involvement or communication, a critical finding for diagnosis. Since MRCP is capable of screening patients at very short intervals, it may be utilized for follow-up imaging in IPMN patients.

Feasibility of Magnetic Resonance Cholangiopancreatography in Dogs-A Post-Mortem Study.

Magnetic resonance cholangiopancreatography (MRCP) is commonly used in humans and is also feasible in cats. The aim of this post-mortem study was to investigate the feasibility of MRCP in eight adult dogs by comparing the visibility and measured diameters of the biliary tract and pancreatic ducts in MRCP with those of fluoroscopic retrograde cholangiopancreatography (FRCP) and corrosion casting. In autopsy, six dogs had no evidence of hepatobiliary disorders, one had pancreatic pathology, and one had biliary pathology. The gallbladder (GB), cystic duct, and common bile duct (CBD) were visible in the MRCP images of all eight dogs. However, the extrahepatic ducts and pancreatic ducts were only variably visible. There was statistical agreement between MRCP and FRCP in measuring the diameters of the GB (fundus and body) and CBD (at papilla and extrahepatic ducts' junction). The diameter measurements correlated between MRCP and corrosion casting. Our study showed that MRCP is feasible in dogs and allowed for proper visualization of the biliary tract. However, ducts with diameters of <1 mm were difficult to visualize using a 1.5 Tesla MRI machine. Further studies are warranted to apply MRCP in the diagnostic imaging of live dogs.

Morphometric examination of the hepatobiliary duct system in healthy individuals and patients with cholelithiasis: A radio-anatomic magnetic resonance cholangiopancreatography study

Purpose: Cholelithiasis is a common gallbladder disease with high morbidity and treatment cost. Although the disease has many formation factors such as bile duct obstruction, congenital anomalies, genetic and metabolic diseases, the main cause is gallstones. The aim of this study is to examine the radio-anatomic and demographic characteristics of the bile ducts of patients who have cholelithiasis due to gallstones by using magnetic resonance cholangiopancreatography (MRCP) and to compare with healthy individuals. &#x0D; Materials and Methods: The study was carried out by retrospectively scanning the MRCP images of 113 patients diagnosed with cholelithiasis and 87 healthy individuals who were referred to the hospital for various indications and had no gallbladder pathology. &#x0D; Results: According to the Spearman rho correlation test performed by ignoring gender, a significant correlation was found between right hepatic duct diameter (RHD-D) and right hepatic duct – cystic duct angle (RHDCD-A), and between left hepatic duct diameter (LHD-D) and common bile duct diameter (CBD-D). In the correlation analysis performed only among males, a significant correlation was found between RHDCD-A and right hepatic duct – left hepatic duct angle (RLHD-A), RHDCD-A and common hepatic duct diameter (CHD-D) parameters. In the correlation analysis performed only among women, a significant relationship was found between age and RHD-D, LHD-D, CHD-D, CBD-D, between RHDCD-A and cystic duct – gallbladder angle (CDG-A), RHD-D, and between CHD-D and cystic duct diameter (CD-D). &#x0D; Conclusion: This study will contribute to literature by revealing the morphometric characteristics and radio- anatomic information of the hepatobiliary systems of both patients with cholelithiasis and healthy individuals.

Improving the Quality of Magnetic Resonance Cholangiopancreatography Images

The purpose of this study was to address the variability in quality of magnetic resonance cholangiopancreatography (MRCP) images by examining differences in quality grades before and after modifying the MRCP protocol to include placement of physical bellows while scanning. This single institution quality improvement initiative included 727 MRCP examinations performed from July 2019 to December 2020 in patients 18 years and older. The Define, Measure, Analyze, Improve, and Control (DMAIC) strategy was utilized to explore factors related to MRCP image quality and identify solutions that could create effective change. Based on the results of this analysis, MRCP protocols were changed in December 2019 to include physical bellows. Examinations were grouped as occurring either pre- or postintervention as well as whether they occurred in an inpatient or outpatient setting. MRCP examinations were evaluated for quality and labeled either nondiagnostic or diagnostic. A logistic regression model was fit to compare the odds of a diagnostic QA grade between preintervention and postintervention groups and inpatient and outpatient settings. The preintervention group had 41.12% of MRCP studies of diagnostic quality, and the postintervention group had 60.57% of studies of diagnostic quality. The estimated odds of an image being of diagnostic quality in the postintervention group were 2.46 times the odds for the preintervention group across all departments and patient classes (P < 0.001). The estimated odds of an image being of diagnostic quality in the outpatient group were 2.01 times the odds for those in the inpatient group (P < 0.001). Utilizing a standardized quality improvement method can lead to sustained improvements in the diagnostic quality of MRCP studies.

Assessment of variations in intrahepatic bile duct by magnetic resonance cholangiopancreatography

For any biliary system or liver surgery, it is crucial to have a thorough understanding of the normal branching pattern of the intrahepatic bile duct and its deviations in order to prevent serious post-surgical problems and morbidity. Aim: This study's goal was to assess the variations in intrahepatic bile ducts appeared during Magnetic Resonance Cholangiopancreatography (MRCP) examinations. Place and Duration: In the Radiology department of Mian Gul Abdul Haq Jehanzeb Kidney Hospital Swat from January 2022 to June 2022. Methods: This cross-sectional, quantitative study was conducted among people who had been referred for MRCP examinations for a number of clinical reasons. A total of 70 patients done with MRCP examinations were selected by convenience sampling technique being used. The data of 1.5T Magnetom Amira Siemens MRI scanner was used for anlaysis. Using visual analysis, the 3D MRCP images were categorized into 7 Types using the Choi et al classification. Results: Among the 36(51.4%) patients in this analysis had Type 1/normal IHBD, 13(18.6%) had Type 2 IHBD, Type 3A was seen in 2(2.8%), and Type 3B was noticed in 5.7% of subjects.

Cholangiopancreatography in cats: a post-mortem comparison of MRI with fluoroscopy, corrosion casting and histopathology.

In human medicine, magnetic resonance cholangiopancreatography (MRCP) is a valuable diagnostic tool for hepatobiliary and pancreatic diseases. In veterinary medicine, however, data evaluating the diagnostic value of MRCP are limited. The primary objectives of this prospective, observational, analytical investigation were to assess whether MRCP reliably visualizes the biliary tract and pancreatic ducts in cats without and with related disorders, and whether MRCP images and measurements of the ducts agree with those of fluoroscopic retrograde cholangiopancreatography (FRCP), corrosion casting and histopathology. A secondary objective was to provide MRCP reference diameters for bile ducts, GB, and pancreatic ducts. Donated bodies of 12 euthanized adult cats underwent MRCP, FRCP, and autopsy with corrosion casting of the biliary tract and pancreatic ducts using vinyl polysiloxane. Diameters of the biliary ducts, gallbladder (GB), and pancreatic ducts were measured using MRCP, FRCP, corrosion casts and histopathologic slides. There was an agreement between MRCP and FRCP in measuring diameters of the GB body, GB neck, cystic duct, and common bile duct (CBD) at papilla. Strong positive correlations existed between MRCP and corrosion casting for measuring GB body and neck, cystic duct, and CBD at the extrahepatic ducts' junction. In contrast to the reference methods, post-mortem MRCP did not visualize right and left extrahepatic ducts, and pancreatic ducts in most cats. Based on this study, MRCP with 1.5 Tesla can be regarded as a contributory method to improve the assessment of feline biliary tract and pancreatic ducts when their diameter is>1mm.

DeePSC: A Deep Learning Model for Automated Diagnosis of Primary Sclerosing Cholangitis at Two-dimensional MR Cholangiopancreatography.

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. 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. 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. 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.

Comparison of the cystocholedochal angle in patients with choledocholithiasis and only cholelithiasis.

This study aims to evaluate the relation between the cystocholedochal angle (SCA) and choledocholithiasis. The data of 3.350 patients were reviewed retrospectively and a total of 628 patients who met the criteria were included in the study. The patients included in the study were divided into three groups as patients with choledocholithiasis (Group I), patients with only cholelithiasis (Group II), and patients without gallstones as control group (Group III). Measurements of SCA, cystic, bile, and common hepatic ducts (CHDs) were made on magnetic resonance cholangiopancreatography (MRCP) images. Laboratory findings and demographic characteristics of the patients were also recorded. Of the patients included in the study 64.2% were female, 35.8% were male, and their age ranged from 18 to 93 (mean 53.37 ± 18.87 years). While the mean SCA values of all patient groups were 35.44° ± 10.44°, the mean length of cystic, bile and CHDs were 28.91 ± 9.30, 40.28 ± 12.91, 27.09 ± 9.68 mm respectively. All measurements were higher in Group I in comparison to other groups, whereas all measurements of Group II were higher than those of Group III (p< 0.001). Statistical analysis suggests that a SCA of 33.5° and above is an important criterion for diagnosis of choledocholithiasis. Increase of SCA raises the likelihood of choledocholithiasis, as it facilitates the passage of stones from gallbladder into the bile ducts. This is the first study to compare SCA in patients with choledocholithiasis and those with only cholelithiasis. Therefore, we think that this study is important and will be a guide for clinical evaluation.

Correlation between Pancreatic Duct Variation and Related Diseases: An Effective Method Observing the Dual-Energy CT with Low-keV Monoenergetic Images.

Pancreatic duct variation can affect the secretory function of the pancreas. We aimed to explore the pancreatic duct variation, observed using low-keV monoenergetic images [MEI (+)] of dual-energy CT (DECT), and its relationship with related diseases. We further sought to compare pancreatic duct imaging using low-keV MEI (+) of DECT and magnetic resonance cholangiopancreatography (MRCP). The DECT and MRCP images of 854 patients were evaluated retrospectively. The 808 patients' pancreatic duct types were classified according to the anatomy and the opening of the pancreatic ducts, and the correlation with related diseases was analyzed. The DECT and MRCP images of 852 patients were graded according to the sharpness of the pancreatic ducts for evaluation. A higher prevalence of acute pancreatitis (AP), chronic pancreatitis (CP), and duodenal papillary carcinoma (DPC) was observed in the variant group. Of the 27 AP cases in the variant group, 9 patients (33.3%) were Type 3c. Additionally, Type 4a was significantly correlated with AP and CP (p < 0.05). Low-keV MEI (+) of DECT outperformed the MRCP images in the sharpness of the pancreatic ducts in 852 patients. Pancreatic duct variation is associated with AP, CP, and DPC. Low-keV MEI (+) DECT is an effective method to observe the pancreatic duct system.

Risk Assessment and Cholangiocarcinoma: Diagnostic Management and Artificial Intelligence.

Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary liver tumor, with a median survival of only 13 months. Surgical resection remains the only curative therapy; however, at first detection, only one-third of patients are at an early enough stage for this approach to be effective, thus rendering early diagnosis as an efficient approach to improving survival. Therefore, the identification of higher-risk patients, whose risk is correlated with genetic and pre-cancerous conditions, and the employment of non-invasive-screening modalities would be appropriate. For several at-risk patients, such as those suffering from primary sclerosing cholangitis or fibropolycystic liver disease, the use of periodic (6-12 months) imaging of the liver by ultrasound (US), magnetic Resonance Imaging (MRI)/cholangiopancreatography (MRCP), or computed tomography (CT) in association with serum CA19-9 measurement has been proposed. For liver cirrhosis patients, it has been proposed that at-risk iCCA patients are monitored in a similar fashion to at-risk HCC patients. The possibility of using Artificial Intelligence models to evaluate higher-risk patients could favor the diagnosis of these entities, although more data are needed to support the practical utility of these applications in the field of screening. For these reasons, it would be appropriate to develop screening programs in the research protocols setting. In fact, the success of these programs reauires patient compliance and multidisciplinary cooperation.

Clinical characteristics, risk factors and diagnostic outcomes of patients presented with indeterminate biliary stricture: A multicenter study.

Indeterminate biliary stricture (IBS) is a frequently encountered clinical problem. In this study, we aimed to highlight the clinical characteristics, risk factors and diagnostic outcomes of patients presented with indeterminate biliary stricture. A Retrospective multicenter study included all patients diagnosed with IBS in the participating centers between 2017 and 2021. Data regarding IBS such as presentations, patient characteristics, diagnostic and therapeutic modalities were collected from the patients' records and then were analyzed. Data of 315 patients with IBS were retrospectively collected from 7 medical centers with mean age: 62.6 ± 11 years, females: 40.3% and smokers: 44.8%. For diagnosing stricture; Magnetic resonance imaging/Magnetic resonance cholangiopancreatography (MRI/MRCP) was the most frequently requested imaging modality in all patients, Contrast enhanced computerized tomography (CECT) in 85% and endoscopic ultrasound (EUS) in 23.8%. Tissue diagnosis of cholangiocarcinoma was achieved in 14% only. The used therapeutic modalities were endoscopic retrograde cholangiopancreatography (ERCP)/stenting in 70.5%, percutaneous trans-hepatic biliary drainage (PTD): 17.8%, EUS guided drainage: 0.3%, and surgical resection in 8%. The most frequent type of strictures was distal stricture in 181 patients, perihilar in 128 and intrahepatic in 6. Distal strictures had significant male predominance, with higher role for EUS for diagnosis and higher role for ERCP/stenting for drainage, while in the perihilar strictures, there was higher role for CECT and MRI/MRCP for diagnosis and more frequent use of PTD for drainage. Indeterminate biliary stricture is a challenging clinical problem with lack of tissue diagnosis in most of cases mandates an urgent consensus diagnostic and treatment guidelines.

The accuracy of magnetic resonance cholangiopancreatography in the diagnosis of biliary atresia in preterm infants with cholestasis.

Magnetic resonance cholangiopancreatography (MRCP) is a useful and non-invasive method to diagnose biliary atresia (BA) in term infants, however few studies have investigated its use in preterm infants. This study aimed to evaluate the accuracy of MRCP in the diagnosis of BA in preterm infants with cholestasis. Infants aged less than 6 months who received MRCP for cholestasis at a tertiary medical center were enrolled from 2011 to 2020. Demographic and laboratory data were retrospectively obtained. One pediatric radiologist reviewed the MRCP images. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MRCP to diagnose BA based on surgical proof or at least 6 months of follow-up were assessed. A total of 80 infants (36 preterm and 44 term) were analyzed. The mean post-chronological age was 1.8 months, and the female-to-male ratio was 0.78. Six (16.7%) preterm and 16 (36.4%) term infants were confirmed to have BA. BA was obscured by a choledochal cyst preoperatively in two term infants. In the preterm infants, the sensitivity, specificity, PPV, NPV, and accuracy of MRCP to diagnose BA were 100%, 77%, 46%, 100%, and 81%, respectively, compared to 81%, 86%, 76%, 89%, and 84% in the term infants. Using MRCP to differentiate BA from other cholestasis in the preterm infants had superior sensitivity (100% vs. 81%) and NPV (100% vs. 89%), and lower specificity (77% vs. 86%) and PPV (46% vs. 76%) than in the term infants. Negative MRCP findings can be used to exclude BA in preterm infants with cholestasis based on a favorable NPV.

Magnetic Resonance Cholangiopancreatography (MRCP) Images after Black Tea Consumption

Aim: To evaluate black tea consumption as a negative contrast agent for better imaging of MRCP. Study design: Prospective study. Place and duration of study: Department of Radiology, JPMC Karachi from 1st January 2022 to 30th June 2022. Methodology: One hundred healthy individuals, who volunteered for this research, were provided an informed written consent to sign before their study enrolment. Tea bags from 3 different tea bag companies were used. The efficacy of improvement of MRCP image as a consequence of tea consumption was further noted by a standard procedure. The intensity of signals was measured by circular-ROI (1cm2). The intensity signal was based on noise and measured as signal void. The MRCP results were taken before tea intake after 5 minutes of tea intake and up to 15 minutes were performed. The results were observed through MRCP images. Results: Comparison of visibility in the distal part of the common bile duct by VAS and Likert method showed significant differences before and after the tea consumption and showed better image quality after tea consumption. Comparisons of duodenum and stomach according to VAS and Likert methods were statistically significant. Conclusion: Significant results were obtained after the consumption of black tea for better quality MRCP imaging. Keywords: MRCP; Tea consumption, Better quality imaging; Gastrointestinal system

Evaluation of Imaging Findings of Pancreatobiliary and Intestinal Type Periampullary Carcinomas with 3.0T MRI

The aim of this study was to differentiate pancreatobiliary and intestinal type periampullary carcinomas using dynamic contrast MRI and MRCP (Magnetic Resonance Cholangiopancreatography) with diffusion-weighted imaging (DWI) MATERIALS AND METHODS: MRI and MRCP images of 70 patients with pathologically proven periampullary adenocarcinoma were included. MRCP image features, extra-ampullary features, enhancement patterns, and apparent diffusion coefficient (ADC) values derived from b-values of 1000 s/mm² were evaluated by two radiologists independently. The interclass correlation coefficient (ICC) or Cohen's kappa statistic was used to evaluate the interobserver agreement. 51 patients were diagnosed with pancreatobiliary type carcinomas, and 19 with intestinal type. In the pancreatobiliary subtype, the distal wall of the common bile duct was usually irregular (p=0.047). Although the progressive enhancement pattern was evident in the pancreatobiliary type, an oval filling defect in the distal common bile duct was found to be more common in the intestinal type (p<0.001). The pancreatic duct cut-off sign (p<0.001), gastroduodenal artery involvement (p <0,001), and lymphadenopathy (p<0.05) were mostly observed in pancreatobiliary carcinomas. The ADCmin, ADCmean, and ADCmax values of the pancreatobiliary type carcinomas were all lower compared to the intestinal type carcinomas (p <0.05). The oval filling defect seen in MRI and MRCP examinations suggests intestinal type, whereas the progressive contrasting pattern of the masses with irregular narrowing in the distal margin of the common bile duct, the pancreatic duct cut-off sign, gastroduodenal artery involvement, lymphadenopathy, and low ADC values indicate pancreatobiliary type carcinomas.

Atypical Pattern of the Intrahepatic Biliary Duct on Magnetic Resonance Cholangiopancreatography in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

The liver possesses different patterns of intrahepatic duct confluences. Even though the typical pattern of the intrahepatic biliary duct is common, atypical variations are also frequently witnessed. The knowledge of the atypical intrahepatic biliary confluences is inevitable during hepato-biliary surgery to reduce post-operative complications. The aim of the study was to find out the prevalence of the atypical pattern of intrahepatic biliary duct pattern on magnetic resonanace cholangiopancreatography in a tertiary care centre. This descriptive cross-sectional study was done in a tertiary care centre after receiveing ethical approval from the Institutional Review Committee [Reference number: KUSMS/IRC (248/2021)]. The branching patterns of the atypical intrahepatic biliary pattern were observed in Magnetic resonance cholangiopancreatography images and were classified. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Among 199 magnetic resonance cholangiopancreatography images, the atypical intrahepatic biliary duct was observed in 48 (24.12%) (18.18-30.06, 95% Confidence Interval) of the images. The prevalence of the atypical intrahepatic biliary duct pattern is lower as compared to other studies done in similar settings. bile ducts; liver; magnetic resonance cholangiopancreatography.