Magnetic Resonance Cholangiopancreatography Images Research Articles

Three-Dimensional (3D) Breath-Hold Zoomed MR Cholangiopancreatography (MRCP): Evaluation of Additive Value to Conventional 3D Navigator Triggering MRCP in Patients With Branch Duct Intraductal Papillary Mucinous Neoplasms.

To resolve drawbacks of navigator triggering (NT) three-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP), several approaches were proposed to obtain 3D MRCP within a single breath-hold (BH). However, reduced field-of-view technique in the phase-encoding direction combined with two-dimensional spatially selective radiofrequency excitation pulses has not yet been applied to 3D BH MRCP. To investigate the feasibility and the complementary value of 3D BH zoomed MRCP to conventional 3D NT MRCP in patients with branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas. Retrospective. A total of 221 patients (116 male and 105 female, median age 73 years) with BD-IPMNs. 3.0 T/3D turbo spin echo ASSESSMENT: MR images were analyzed by three radiologists (R.M., H.O., M.T., with 1, 13, and 17 years of experience) to compare blurring and motion artifacts, background suppression, visualization of main pancreatic duct (MPD), conspicuity of BD-IPMN, and overall image quality. Wilcoxon-signed rank, Mann-Whitney U, chi-squared or Fisher's exact tests (P < 0.05). Image quality was significantly higher on 3D NT MRCP images than on 3D BH zoomed MRCP (median (interquartile range); background suppression, 4 (4-4) vs. 3 (3-4); visualization of MPD, 4 (3-4) vs. 4 (3-4), conspicuity of BD-IPMN, 4 (3-4) vs. 3 (3-4); and overall image quality, 3 (3-4) vs. 3 (3-3)). However, in 32 (14%) patients, 3D NT MRCP showed a score of 1 or 2 in overall image quality. Regarding the conspicuity of BD-IPMN, a conspicuity score of 1 or 2 was rendered in 31 (14%) patients in 3D NT MRCP group. Conversely, 3D BH zoomed MRCP showed a score of 3 or 4 in 29 (94%) of these 31 patients. 3D BH zoomed MRCP plays a complementary role to 3D NT MRCP, and may improve the conspicuity of BD-IPMNs in patients with irregular breathing pattern. 4 TECHNICAL EFFICACY: Stage 2.

Jasmine tea as a negative oral contrast agent in magnetic resonance cholangiopancreatography (MRCP)

Fluids of gastrointestinal system produce a high signal in 2D T2 Half-Fourier Acquisition Single-shot Turbo Spin Echo (HASTE) thick-slab MRCP which can overlap the biliary system image. This is the first experimental study use jasmine tea as oral contrast agent and aimed to evaluate it in improving the image quality of MRCP. This study was tested by phantom and healthy volunteers. Different types of tea phantom were tested which then calculated its signal-to-noise ratio (SNR) value and analyzed the manganese content. 15 healthy volunteers performed 2D T2 HASTE thick-slab MRCP scanning before and after administration of jasmine tea with a variation of 3 minutes, 6 minutes and 9 minutes scanning time. Qualitative analysis was carried out by MRCP questionnaire which was examined by radiologist and quantitative analysis was conducted by measuring the contrast-to-noise ratio (CNR) values. After jasmine tea administration, the image information was significantly different and CNR MRCP was increased compared to before giving negative oral contrast agent. The most optimal time to start scanning was 3 minutes after administration of jasmine tea with a volume of 300 ml (0.648 mg/dl manganese). Jasmine tea can be used as an alternative safe natural negative oral contrast agent and can improve MRCP image quality and reduce the intensity of gastrointestinal signals.

Endoscopic treatment including a single-operator peroral cholangioscopy-guided electrohydraulic lithotripsy and endoscopic nasogallbladder drainage combined laparoscopic cholecystectomy for Mirizzi syndrome

Mirizzi Syndrome (MS) is rare among gallbladder diseases and may be difficult to treat. In particular, endoscopic treatment often fails owing to unable to access or capture the impacted cystic duct stone. We report a case of MS grade III that were successfully managed by an endoscopic treatment and interval laparoscopic cholecystectomy. A 59-year-old women was admitted our hospital presenting with upper abdominal pain and fever up to 38.5℃. She was mildly jaundiced with scleral icterus with a positive Murphy's sign. An abdomen computed tomography scan and T2-weight magnetic resonance cholangiopancreatography image demonstrated about 1.4cm stone at junction of the cystic duct and mid-common bile duct with cholecysto-choledochal fistula, compatible with MS type III and acute calculus cholecystitis. A digital single-operator cholangioscopy (DSOC)-guided eletrohydraulic lithotripsy (EHL) was performed. Elective laparoscopic cholecystectomy was performed after the stones were completely removed. The patient was discharged without any complications on the 5th day after surgery. The treatment of MS is mainly surgical and consists of partial or complete cholecystectomy with or without common bile duct exploration. However, in the era of minimal invasive treatment, laparoscopy treatment for low grade MS is being tried steadily. In our case, through preoperative intervention using DSOC guided EHL, the effect of downgrading MS could be achieved, and this resulted in a safe laparoscopic surgical approach. In conclusion, DSOC guided EHL with ENGBD may allow a minimally invasive approach for management of high grade MS.

Efficacy of an artificial neural network algorithm based on thick-slab magnetic resonance cholangiopancreatography images for the automated diagnosis of common bile duct stones.

Magnetic resonance cholangiopancreatography (MRCP) can accurately diagnose common bile duct (CBD) stones but is laborious to interpret. We developed an artificial neural network (ANN) capable of automatically assisting physicians with the diagnosis of CBD stones. This study aimed to evaluate the ANN's diagnostic performance for detecting CBD stones in thick-slab MRCP images and identify clinical factors predictive of accurate diagnosis. The presence of CBD stones was confirmed via direct visualization through endoscopic retrograde cholangiopancreatography (ERCP). The absence of CBD stones was confirmed by either a negative endoscopic ultrasound accompanied by clinical improvements or negative findings on ERCP. Our base networks were constructed using state-of-the-art EfficientNet-B5 neural network models, which are widely used for image classification. In total, 3156 images were collected from 789 patients. Of these, 2628 images from 657 patients were used for training. An additional 1924 images from 481 patients were prospectively collected for validation. Across the entire prospective validation cohort, the ANN achieved a sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of 93.03%, 97.05%, 97.01%, 93.12%, and 95.01%, respectively. Similarly, a radiologist achieved a sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy 91.16%, 93.25%, 93.22%, 90.20%, and 91.68%, respectively. In multivariate analysis, only bile duct diameter>10mm (odds ratio=2.45, 95% confidence interval [1.08-6.07], P=0.040) was related to ANN diagnostic accuracy. Our ANN algorithm automatically and quickly diagnoses CBD stones in thick-slab MRCP images, therein aiding physicians with optimizing clinical practice, such as whether to perform ERCP.

Three-dimensional visualization technique compared with magnetic resonance cholangiopancreatography for evaluation of anatomic variants of pediatric congenital choledochal cysts.

The aim of this study was to compare the application of a three-dimensional (3D) visualization technique and magnetic resonance cholangiopancreatography (MRCP) for diagnosis of pediatric congenital choledochal cysts. Thin slices of coronal heavily T2-weighted pulse sequences of MRI pertaining to 35 patients were retrospectively used to reconstruct 3D models. Diagnoses and variants of the biliary system were evaluated based on the 3D models and MRCP imaging. The quality of delineation of the biliary duct system and the Todani classification were evaluated. Wilcoxon and Chi-squared tests were used for statistical analysis. Two cases that were diagnosed as type II congenital choledochal cysts using the 3D model were diagnosed as type I using MRCP imaging. Significant differences were observed between the two modalities with respect to the delineation of the right anterior bile duct, right posterior bile duct, and left hepatic duct. The excellent and good rates obtained with the 3D model (65.7%) were much better than that obtained with MRCP (37.1%) imaging. Two cases with accessory hepatic ducts (5.7%), one case with an accessory pancreatic duct (2.8%), and two cases with biliary strictures at the hepatic hilum (5.7%) were detected using the 3D models. In contrast, only one case with an accessory hepatic duct and one case with a biliary stricture at the hepatic hilum were detected using MRCP. The 3D visualization technique facilitated more precise morphological evaluation of congenital choledochal cysts and provided comprehensive spatial anatomic information for diagnosis.

Measurement of the Diameter of the Common Bile Duct and Pancreatic Duct among Healthy Adult Sudanese Subjects using Magnetic Resonance Cholangiopancreatography

The purpose of our study was to evaluate the common bile duct (CBD) and pancreatic duct (PD) diameter among healthy adult Sudanese subjects using magnetic resonance cholangiopancreatography (MRCP). In addition, this study aimed to determine the effects of age, gender, and body height and weight on the CBD and PD diameters to establish a reference range for these ducts on MRCP, which is very useful in a daily clinical setting where MRCP is commonly performed to evaluate suspected biliary tract disease. Methods and Results: This study included 80 asymptomatic subjects who underwent MRCP. The widest diameter of the CBD and PD was measured perpendicular to their long axes using the electronic caliper. The applied MRCP imaging technique was in line with the guidelines used by Chen et al.(2012) The age, gender, medical history, body height and body weight were recorded. Among the 80 subjects, the mean CBD diameter on MRCP was 6.17±0.69 mm (range of 4-8 mm). There was a significant correlation between the CBD diameter and weight (r=0.407, P&lt;0.001). The mean PD diameter on MRCP was 3.80±0.50mm (range of 2-5 mm). There was also a significant correlation between the PD diameter and weight (r=0.407, P&lt;0.001). In the cohort of 80 subjects, the mean CBD diameter in females was larger than in males(6.50±0.632mm and 5.95±0.677mm, respectively), and this difference was statistically significant (P&lt;0.05). Also, the mean PD diameter in females was statistically larger than in males (6.03±0.66mm and 5.58±0.675mm, respectively), and this difference was statistically significant (P&lt;0.05). Our results demonstrate no significant correlation between the diameter of CBD and PD and participants' height and age. Conclusion: The importance of the current study lies in it’s being one of the few studies whose intention was to use MRCP to bridge the knowledge gap in the literature about the measurement of the CBD and PD diameter among healthy adult Sudanese subjects.

Evaluation of Intrahepatic Bile Duct Variations in Magnetic Resonance Cholangiopancreatography

Introduction: A detailed knowledge of normal branching pattern of intrahepatic bile duct and their variations is of utmost importance for any liver or biliary tract surgery to avoid severe post-surgery complications and morbidity. The objective of this study was to evaluate variations of intrahepatic bile ducts in Magnetic Resonance Cholangiopancreatography (MRCP) examinations in Nepalese population.Methods: This quantitative, cross sectional study was performed in patients referred for MRCP examinations for various clinical indications to Tribhuvan University Teaching Hospital, Maharajgunj, Nepal. Data were collected for a period of four months from August to November 2019 after IRB approval. Convenience sampling was employed and a total of 90 examinations were included. Data were obtained from the 1.5T Magnetom Amira Siemens MRI scanner. The 3D MRCP images were visually analyzed and classified into 7 Types according to the classification given by Choi et al.Results: In our study 47.8% patients had Type 1/normal IHBD (n=43). 20% had Type 2 (n=18), 3.3% had Type 3A (n=3), 5.6% had Type 3B. Type 5A (n=5), 7.8% had 5B (n=7), 3.3% had Type 6 (n=3) and 6.7% had Type 7 (n=6). No patients were found to have Type 3C and Type 4 IHBD variation. Among the total number of Type 1 cases, 67.44% (n=29) were female and rest were male.Conclusions: Typical IHBD was only found in a 47.8% patients and common other variations were also noted in our population. Type 2 and Type 5B were found in 20% and 7.8% patients respectively.

Does preoperative MRCP imaging predict risk for conversion to subtotal cholecystectomy in patients with acute cholecystitis?

Subtotal cholecystectomy (SC) is a useful procedure for avoiding bile duct injury in patients with difficult gallbladder. However, risk factors for conversion to SC, especially preoperative magnetic resonance cholangiopancreatography (MRCP) findings that predict conversion to SC, have not been investigated in detail. A total of 290 patients with acute cholecystitis who underwent laparoscopic cholecystectomy at our hospital between November 2011 and March 2020 were included. Patient characteristics and perioperative outcomes were reviewed, and preoperative clinical factors predicting conversion to SC were investigated. Forty-three patients underwent SC, whereas the remaining 247 patients underwent total cholecystectomy. An American Society of Anesthesiologists (ASA) score of 3 or greater (p = 0.011), surgery on or after 9days from symptom onset (p < 0.001), obscuration of the gallbladder wall around the neck on MRCP images (p = 0.010) and disruption of the common hepatic duct on MRCP images (p < 0.001) were significantly associated with conversion to SC. Logistic regression analyses revealed that an ASA score of 3 or greater (odds ratio = 2.667, p = 0.020), surgery on or after 9days from symptom onset (odds ratio = 4.229, p < 0.001) and disruption of the common hepatic duct on MRCP images (odds ratio = 4.478, p = 0.002) were independent predictors for conversion to SC. Early surgery yielded a lower risk for conversion to SC. Disruption of the common hepatic duct on preoperative MRCP images is associated with a risk for conversion to SC.

What is the Treatment Role of Transpapillary Cholecystostomy for Delayed Cholecystectomy in the Coexistence of Acute Cholecystitis and Cholangitis.

This study aims to investigate the role of main bile duct drainage and gallbladder transpapillary drainage in the treatment of patients who diagnosed with acute cholecystitis and acute cholangitis because of choledocholithiasis. Patients who were admitted to the hospital with the diagnosis of acute cholecystitis between January 2018 and December 2019, have hyperbilirubinemia in their laboratory tests, and who were diagnosed with choledochal stone by magnetic resonance imaging and magnetic resonance cholangiopancreatography imaging because of the findings of cholangitis were included in this study. These patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and choledochus stone extraction procedure and gallbladder drainage with the transpapillary pigtail. The demographic data, success rates, and complications of the patients were evaluated. A total of 19 patients were included in the study. Choledochus was cannulated in all patients, but gallbladder drainage could not be achieved in 2 patients. These 2 patients were recorded under the unsuccessful method use. Although 2 patients could not be operated because of high comorbidity (American Society of Anesthesiologists IV), they underwent percutaneous cholecystostomy because of the development of cholecystitis arising from an obstruction in the pigtail catheter in the 11th and 12th weeks. Treatments of the remaining 15 patients and subsequent cholecystectomy procedures were successful. The mean age of the patients was 54.52 years. Of the patients, 9 were female and 6 were male. In the 6th week of follow-up, 15 patients underwent laparoscopic cholecystectomy with ERCP 1 day after removal of the stent and pigtail catheter. Transpapillary cholecystectomy with ERCP is a successful method of treatment in patients with acute cholecystitis with the symptoms of cholangitis because of choledochal stone.

Fully automated detection of primary sclerosing cholangitis (PSC)-compatible bile duct changes based on 3D magnetic resonance cholangiopancreatography using machine learning.

To develop and evaluate a deep learning algorithm for fully automated detection of primary sclerosing cholangitis (PSC)-compatible cholangiographic changes on three-dimensional magnetic resonance cholangiopancreatography (3D-MRCP) images. The datasets of 428 patients (n = 205 with confirmed diagnosis of PSC; n = 223 non-PSC patients) referred for MRI including MRCP were included in this retrospective IRB-approved study. Datasets were randomly assigned to a training (n = 386) and a validation group (n = 42). For each case, 20 uniformly distributed axial MRCP rotations and a subsequent maximum intensity projection (MIP) were calculated, resulting in a training database of 7720 images and a validation database of 840 images. Then, a pre-trained Inception ResNet was implemented which was conclusively fine-tuned (learning rate 10-3). Applying an ensemble strategy (by binning of the 20 axial projections), the mean absolute error (MAE) of the developed deep learning algorithm for detection of PSC-compatible cholangiographic changes was lowered from 21 to 7.1%. Sensitivity, specificity, positive predictive (PPV), and negative predictive value (NPV) for detection of these changes were 95.0%, 90.9%, 90.5%, and 95.2% respectively. The results of this study demonstrate the feasibility of transfer learning in combination with extensive image augmentation to detect PSC-compatible cholangiographic changes on 3D-MRCP images with a high sensitivity and a low MAE. Further validation with more and multicentric data is now desirable, as it is known that neural networks tend to overfit the characteristics of the dataset. • The described machine learning algorithm is able to detect PSC-compatible cholangiographic changes on 3D-MRCP images with high accuracy. • The generation of 2D projections from 3D datasets enabled the implementation of an ensemble strategy to boost inference performance.

Abdominal lymphatic system visibility, morphology, and abnormalities in children as seen on routine MCRP and its association with immune-mediated diseases.

(1) To assess the visibility and diameters of the thoracic duct (TD) and cisterna chyli (CC) on MR cholangiopancreatography (MRCP) in children. (2) To evaluate for the presence of any lymphatic abnormalities and assess their association with diseases in which the immune system is implicated in etiopathogenesis. This retrospective study included 142 MRCPs performed in children 8-17years old and without prior surgeries. Two radiologists reviewed all exams for visibility and diameters of the TD and CC, and presence of abnormal lymphatic collaterals. TD and CC diameters in various disease processes were compared using Student's t tests. The association of collaterals with immune-mediated diseases was assessed using Fisher's exact tests. The TD and CC were seen in 134/142 (93.7%) cases with mean diameter of 3.25 ± 1.07mm and 126/142 (88.7%) cases with mean diameter of 4.55 ± 1.37mm respectively. The mean diameter of CC was larger in patients with portal hypertension (p = 0.021). There were no significant differences in the TD and CC diameters between immune-mediated and non-immune-mediated diseases. Retroperitoneal collaterals were seen in 41/142 (28.8%) of cases and were associated with both portal hypertension (p = 0.0019) and immune-mediated diseases (p = 0.0083). The TD and CC can be visualized in the majority of children on routine MRCP images, and CC has larger diameter in patients with portal hypertension. The association of collaterals with immune-mediated diseases supports a potential role of the lymphatic system in the etiopathogenesis of immune-mediated diseases. • The lymphatic system has been increasingly implicated in a number of inflammatory and immune-mediated diseases. • The abdominal lymphatic system can be visualized in the majority of children above 8years on routine MRCP images. Similar to adult studies, the cisterna chyli is significantly larger in children with portal hypertension. • Retroperitoneal lymphatic collaterals, seen in 29% children, are associated with immune-mediated diseases, which supports the potential role of the lymphatic system in the pathogenesis of immune-mediated diseases.

Biliary excretion of gadobenate dimeglumine causing degradation of magnetic resonance cholangiopancreatography (MRCP)

To assess the effect of gadobenate dimeglumine on magnetic resonance cholangiopancreatography (MRCP) and determine an appropriate time frame for performing MRCP sequences. 2D MRCP sequences obtained after intravenous administration of gadobenate dimeglumine or gadobutrol over 14months 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 ≥ 15min were included. 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 7.2-9.4min (95% confidence interval; mean 8.3min). Bile duct clarity degraded on MRCP images with an increasing delay following gadobenate dimeglumine injection. 2D MRCP, thus, should be performed within 7.2min after obtaining the arterial phase sequence to ensure good visualization of the entire biliary system.

SAT271 - Quantitative magnetic resonance cholangiopancreatography imaging in patients with primary sclerosing cholangitis - feasibility and preliminary analysis for prediction of clinical outcomes

SAT271 - Quantitative magnetic resonance cholangiopancreatography imaging in patients with primary sclerosing cholangitis - feasibility and preliminary analysis for prediction of clinical outcomes

The efficacy of pineapple juice as a negative oral contrast agent in magnetic resonance cholangiopancreatography.

BackgroundDuring magnetic resonance cholangiopancreatography (MRCP), the pancreatobiliary ducts can be obscured by the high-intensity signal from the stomach and duodenum. Pineapple juice may be an alternative to commercially available negative contrast agents, but has not been evaluated locally.ObjectivesTo evaluate the efficacy of a local, off-the-shelf pineapple juice preparation as a negative oral contrast agent for MRCP.MethodAn observational, analytical study was conducted during January–December 2017. A 1.5 Tesla MRCP sequence was performed immediately before and after ingestion of 250 mL of a local, commercially-available pineapple juice preparation. Image evaluation was performed by two radiologists with independent, blind assessment of gastric/duodenal signal intensity and biliary /pancreatic duct visibility, before and after pineapple juice.ResultsFifty adult patients (F = 44, 88%) with median age 44 years (IQR: 34.75, 57) were included. After pineapple juice administration, there was significant measured (1661.51 vs. 1409.94, p < 0.01) and perceived (2.16 vs. 2.72, p < 0.01) duodenal signal reduction but no significant change in measured (1081.17 vs. 1044.38, p = 0.34) or perceived (2.73 vs. 2.84, p = 0.14) gastric signal intensity. Visibility of the common bile duct was significantly improved (3.67 vs. 3.86, p < 0.01), whilst that of the main pancreatic duct showed no significant change (2.92 vs. 2.86, p = 0.44).ConclusionThe local pineapple juice preparation used in this study is an effective, affordable and natural negative oral contrast agent for enhancement of MRCP images, and specifically improves visualisation of the common bile duct.

Surgical planning with patient-specific three-dimensional printed pancreaticobiliary disease models - Cross-sectional study.

Three-dimensional (3D) printing has been increasingly used in medical applications with the creation of accurate patient-specific 3D printed models in medical imaging data. This study has been planned based on the fact that research on 3D printing in pancreaticobiliary disease is limited due to lack of studies on validation of model accuracy. This is an innovative study where general surgery residents are presented 5 distinct hepatopancreatobiliary disease scenarios to generate a perception and required to compare their perception level of these cases with magnetic resonance cholangiopancreatography (MRCP), 3D images and 1:1 solid models that the pathology, diverse diagnosis and presurgery diagnosis stages can be observed. This study is single-centered. The dilated pancreaticobiliary intervention based on scenarios for general surgery residency was more original since there was no prior study that includes both model building and the evaluation of the perception created by the model. Five scenarios provided qualitative assessment with results showing the usefulness of 3D models when used as clinical tools in preoperative planning, simulation of interventional procedures, surgical education, and training. The perception level in the 3D model, MRCP (Z: 3.854, p: 0.000) and the 3D image (Z: 2.865, p: 0.004) was higher; likewise, the 3D-STL image was higher compared to the MRCP image (Z: 3.779, p: 0.000). All subspecialists agree that 3D models provided better understanding of dilated pancreaticobiliary pathoanatomy and improved surgical planning. A thoroughly outlined genuine patient situation layout aimed for general surgery training can be installed and monitored with the support of 3D printing technology of this study. This can be utilized to develop the comprehension of pathoanatomical variations of complex pancreaticobiliary illness and to adopt a surgical approach.

Magnetic resonance cholangiopancreatography findings in early chronic pancreatitis diagnosed according to the Japanese Diagnostic Criteria

ObjectivesIt is important for diagnosing early chronic pancreatitis (CP), which may be improved by therapeutic intervention. We aimed to examine the pancreatic ductal changes on magnetic resonance cholangiopancreatography (MRCP) in patients with early CP defined by the Japanese Diagnostic Criteria. MethodsThis retrospective study included patients suspected early CP and performed both endoscopic ultrasonography (EUS) and MRCP from January 2010 to August 2018. We assessed the diameter of the main pancreatic duct (MPD) and the number of irregularly dilated duct branches using MRCP imaging in early CP. ResultsWe enrolled 165 patients and 25 patients (15%) fulfilled the diagnostic criteria for early CP. Irregular dilatation of ≥ 3 duct branches on MRCP was more often observed in early CP compared to non-early CP (P = 0.004), although MPD diameter was comparable (2.06 mm in early CP vs. 1.96 in non-early CP, P = 0.698). The sensitivity and specificity were 45% and 74%, respectively. The prevalence of positive MRCP findings in patients with ≥ 2 positive EUS findings was higher than that in patients with 1 positive EUS finding (P = 0.08) and in patients without an EUS finding (P < 0.001). There was no difference in the average diameter of MPD. ConclusionPatients with early CP often exhibit alteration in duct branches and not in MPD in addition to parenchymal alteration. Both pancreatic parenchyma and duct branches might need to be evaluated by EUS and MRCP.

Ectopic Partial Intrahepatic Gallbladder: Magnetic Resonance Imaging and Clinical Findings

Ectopic gallbladder (GB) is a very rare anomaly. Ectopic GB can be found in intrahepatic, suprahepatic, retrohepatic, retroperitoneal sites as well as in falciform ligament, intra-abdominal wall, left abdominal quadrant and intrathoracic localizations. A 43-year-old male patient presented with a right upper quadrant pain in the abdomen. Upon detection of a cystic lesion with lobulated contour associated with GB in the liver in ultrasound examination, dynamic magnetic resonance imaging (MRI), MRI cholangiopancreatography, and contrast-enhanced MRI cholangiography were performed on the patient. MRI revealed that the lesion was a partial ectopic intrahepatic GB. In this article, we presented an ectopic partial intrahepatic gall bladder anomaly, which is very uncommon and has been previously described by surgical operations and cadaver studies, according to our literature review. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(8):525-527.

Congenital Anomaly of Gall Bladder Assessed Through Magnetic Resonance Cholangiography in Relation to Its Clinical Relevance

AbstractObjective: The overall incidence of Phrygian cap is about 04%. It is an anomaly of gall bladder found congenitally. It can be a misguided pathological diagnosis often seen mimicking a liver mass on imaging of the hepatobiliary tree. Although Phrygian cap is a congenital anomaly, it does not show any pathological significance, In light of this condition, the purpose of this research was to find out the congenital anomalies of the gallbladder through magnetic resonance cholangiopancreatography (MRCP) along with its clinical significance.Methods: A total of 377 patients were selected with a number of 192 females and 185 males, with ages ranging from 16-90 years, with a mean age of 48 years, who had undergone MRCP for diagnosed stone in gallbladder or bile duct on a clinical basis, carcinoma of pancreas and inflammatory changes of pancreatic and/or bile ducts. The patient's imaging was done using a 1.5-T superconductive magnet which was four-channel phase-arrayed body coil and breath-holding technique was utilized, using multi-sliced T2-weighting half-Fourier acquisition single-shot turbo spin-echo (HASTE), MIP reconstruction, and also single-shot T2-weighted turbo-spin-echo sequence rapid acquisition with relaxation enhancement (RARE) having a varying thickness of slices.Results: The MRCP imaging results demonstrated extra hepatic biliary tract anomalies in 94 out of the 377 patients which represented a frequency of 24.93%. However, a Phrygian cap was found to be present in 6 patients with a frequency of 1.6% with 4 females and 2 males.Conclusion: From the results that we achieved, it was made quite apparent that congenital anomalies can be classified as a complex spectrum of variations that have a propensity to occur on a regular basis, emphasizing their value for attention in clinical as well as surgical settings along with the need to be readily identifiable with MRCP.

Hilar cholangiocarcinoma: Value of high-resolution enhanced magnetic resonance imaging for preoperative evaluation

The objective is to assess the accuracy of high-resolution (HR) enhanced magnetic resonance imaging (MRI) images in the preoperative evaluation of biliary and vascular invasion in hilar cholangiocarcinomas. This retrospective study included 36 patients with hilar cholangiocarcinoma who underwent enhanced HR-MRI with an effective section thickness of 1.2 mm at 3.0 T before surgery. Combined HR-MRI and magnetic resonance cholangiopancreatography (MRCP) images were compared with MRCP in evaluating the extent of biliary infiltration according to the Bismuth-Corlette classification. To determine the suitable criterion for HR-MRI in predicting vessel invasion, Labeling 180 and 90 of circumferential contact of the tumor with the vessel were used to predict the invasion. The correlation between imaging findings and surgical and histopathological records was statistically analyzed. The accuracy in detecting biliary neoplastic invasion was higher for combined HR-MRI images (97.2%) than MRCP images (86.1%). HR-MRI images increased the accuracy in delineation of the tumor biliary extent (P < 0.05). The accuracy of Labeling 90 (98.6% in portal venous system and 98.0% in hepatic arterial system) was higher than that of Labeling 180 (96.5% in portal venous system and 94.6% in hepatic arterial system). However, there was no significant statistic difference between them (P > 0.05). Interobserver agreement was high with respect to biliary tract, portal venous, and hepatic arterial system involvement. Enhanced HR-MRI images showed excellent capability for assessing tumor extent and vascular invasion in hilar cholangiocarcinomas. More than 90° of circumferential contact of the tumor with the vessel on HR-MRI may be an appropriate criterion for predicting invasion.

Evaluating the Clinical Application Value of Ferric Citrate Effervescent Granules (FAC) in Magnetic Resonance Cholangio-Pancreatography (MRCP) Inspection

Objective: Assessing the clinical application value of Ferric Citrate Effervescent granules (FAC) in magnetic resonance cholangio-pancreatography (MRCP) inspection. Methods: We invited 10 patients who were diagnosed with diseases of the pancreas system and bile duct system and undergoing magnetic resonance cholangio-pancreatography and use Ferric Citrate Effervescent granules in the MRCP process. The time of their MRCP is from May 2018 to February 2020. In addition, we collected the information from the participants, that the information included Sequence and scanning parameters of Mr Cholangiopancreatography, Image quality score before and after MRCP administration, contrast to noise ratio (CNR) score and comparison score of different parts in MRCP images before and after drug administration. Result: In scanning parameters, the data is standard in research, that the TR and TE of 2d MRCP and 3D MRCP are similar, that are > 6000 and > 500. But Layer thickness/Layer spacing between the objects had big gap in data, that are 50/0 and 1.8/0. Additionally, FOV had little different length, which is 40 vs 36. In NEX, they are same. In image quality score, it has higher score after taking the FAC. The CNR score research is similar, that FAC affect the CNR outcome. Conclusion: the FAC provide the improvement to the outcome of patient in MRCP process, that it improves image quality of MRCP.