Pancreaticobiliary Lesions Research Articles

Curriculum for diagnostic endoscopic ultrasound training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.

The European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in diagnostic endoscopic ultrasound (EUS). This manuscript represents the outcome of a formal Delphi process resulting in an official Position Statement of the ESGE and provides a framework to develop and maintain skills in diagnostic EUS. This curriculum is set out in terms of the prerequisites prior to training; the recommended steps of training to a defined syllabus; the quality of training; and how competence should be defined and evidenced before independent practice. 1: Trainees should have achieved competence in upper gastrointestinal endoscopy before training in diagnostic EUS. 2: The development of diagnostic EUS skills by methods that do not involve patients is advisable, but not mandatory, prior to commencing formal training in diagnostic EUS. 3: A trainee's principal trainer should be performing adequate volumes of diagnostic EUSs to demonstrate maintenance of their own competence. 4: Training centers for diagnostic EUS should offer expertise, as well as a high volume of procedures per year, to ensure an optimal level of quality for training. Under these conditions, training centers should be able to provide trainees with a sufficient wealth of experience in diagnostic EUS for at least 12 months. 5: Trainees should engage in formal training and supplement this with a range of learning resources for diagnostic EUS, including EUS-guided fine-needle aspiration and biopsy (FNA/FNB). 6: EUS training should follow a structured syllabus to guide the learning program. 7: A minimum procedure volume should be offered to trainees during diagnostic EUS training to ensure that they have the opportunity to achieve competence in the technique. To evaluate competence in diagnostic EUS, trainees should have completed a minimum of 250 supervised EUS procedures: 80 for luminal tumors, 20 for subepithelial lesions, and 150 for pancreaticobiliary lesions. At least 75 EUS-FNA/FNBs should be performed, including mostly pancreaticobiliary lesions. 8: Competence assessment in diagnostic EUS should take into consideration not only technical skills, but also cognitive and integrative skills. A reliable valid assessment tool should be used regularly during diagnostic EUS training to track the acquisition of competence and to support trainee feedback. 9: A period of supervised practice should follow the start of independent activity. Supervision can be delivered either on site if other colleagues are already practicing EUS or by maintaining contacts with the training center and/or other EUS experts. 10: Key performance measures including the annual number of procedures, frequency of obtaining a diagnostic sample during EUS-FNA/FNB, and adverse events should be recorded within an electronic documentation system and evaluated.

Magnetic Resonance Cholangiopancreatography (MRCP) Evaluation of Pancreatico-Biliary Diseases

Introduction: Magnetic Resonance Cholangiopancreatography (MRCP) is a non-invasive and important imaging modality useful for study of pancreas and biliary system using advanced rapid imaging and invention of new sequences for pancreatic and biliary ductal system. Aims and Objectives: To study role of Magnetic Resonance Cholangiopancreatography (MRCP) finding in various pancreatico-biliary pathologies. Results: Total 60 cases were studied with various pancreatico-biliary conditions. Variety of study showed that 37(62%) out of 60 cases were encountered with biliary pathologies followed by pancreatic lesion in 17(29%) cases and pancreatic-biliary lesions were present in 6 (9%) cases. Among the lesions, most common cases were of obstructive etiology in 24(40%) followed by inflammatory condition in 21(36%), congenital lesions in 7(11%), neoplastic lesions seen in 6(10%) and strictures in the 2 (3%) cases. Conclusion: According to our study, MRCP is an advanced and noninvasive diagnostic imaging of choice for the pancreatico-biliary lesions.

EUS accuracy against MRCP for detection of pancreaticobiliary lesions

EUS accuracy against MRCP for detection of pancreaticobiliary lesions

Pancreaticobiliary involvement in treated type 1 autoimmune pancreatitis: Imaging pattern and risk factors for disease relapse

PurposeTo evaluate the imaging pattern of pancreaticobiliary lesions in patients with treated type 1AIP, to determine the incidence of disease relapse and malignancy, and to identify the risk factors. MethodThe institutional review board approval was acquired. All patients gave written informed consent. From a prospective clinico-radiological database since 2012, consecutive patients with type 1 AIP who were treated and followed up (≥18 months) were identified. The presence/absence of pancreaticobiliary lesion(s) development during follow-up were assessed. The etiology was determined and the imaging pattern was compared to the initial attack. Risk factors were identified by univariate and multivariate analysis. ResultsAmong 103 patients with treated type 1 AIP, 44 (42.7%) developed pancreaticobiliary lesions during follow up (median time interval to initial diagnosis: 17 months, range 3–62 months), mostly after steroid discontinuation (63.6%) or during maintenance therapy (29.5%). All lesions were disease relapse, which responded to steroid treatment. At relapse, pancreatic involvement was less frequent (81.8% vs 100%, p = 0.003), and the pancreas size was smaller (p < 0.01), whereas extra-pancreatic bile duct (ExPanBD) involvement was more severe and extensive (both p < 0.01). Multivariate analysis revealed ExPanBD involvement at initial diagnosis (hazard ratio 2.437, 95% CI 1.343–7.402, p = 0.002) and serum IgG4 response ratio at the induction phase (hazard ratio 0.357, 95% CI 0.055-0.804, p = 0.011) as significant independent predictors of relapse. ConclusionsIn treated type 1 AIP, although imaging pattern may differ, pancreaticobiliary lesions are usually manifestations of disease relapse. ExPanBD involvement and poor serum response suggests high risk of relapse.

Review of the 2017 European Society of Gastrointestinal Endoscopy Guidelines for Endoscopic Ultrasound - Guided Sampling in Pancreaticobiliary Lesions

EUS currently plays an important role in the diagnosis and treatment of digestive diseases. In addition, EUS-guided sampling has been applied to pancreaticobiliary lesions for the accurate diagnosis of pancreaticobiliary lesions. Many new instruments and studies for EUS-guided sampling are being developed and attempted. This review introduces and summarizes the key recommendations made in the recent guideline for EUS-guided sampling developed by the European Society of Gastrointestinal Endoscopy.

Digital Pancreaticocholangioscopy for Mapping of Pancreaticobiliary Neoplasia: Can We Alter the Surgical Resection Margin?

In patients with pancreaticobiliary lesions anticipating surgical resection, digital pancreaticocholangioscopy can be used to identify the extent of disease. This presurgical"mapping" could change the surgical plan and optimize patient care. Patients with pancreaticobiliary lesions anticipating surgery who underwent endoscopic retrograde cholangiopancreatography with digital pancreaticocholangioscopy from 9 international centers were included. Primary outcome was whether pancreaticocholangioscopy altered the surgical plan. Secondary outcome was correlation between surgical and endoscopic histology and adverse events. A total of 118 patients were included (64% male, mean age 69 y): cholangioscopy in 105 patients (89%), pancreatoscopy in 13 patients (11%). Pancreaticocholangioscopy changed the surgical plan in 39 (34%) of patients: 8 of 13 in the pancreatic duct, 32 of 105 in the bile duct. In the bile duct, 6 patients (5%) had less extensive surgery, 26 patients (25%) avoided surgery. In the pancreatic duct, 4 patients (31%) had more extensive surgery and 4 patients (31%) had less extensive surgery. Four patients with downstaged surgery had positive margins on surgical resection; 1 required additional surgical intervention. Overall correlation between endoscopy and surgical histology was 88%. Adverse events included post endoscopic retrograde cholangiopancreatography pancreatitis in 3 patients (2.5%). Digital pancreaticocholangioscopy can be effectively used as a mapping tool to delineate the degree of involvement of biliary lesions before surgical resection, in some cases altering the surgical plan. Prospective studies are needed, especially when downstaging surgery.

Synchronous Presentation of Three Distinct Pancreaticobiliary Tumors: Pancreatic Ductal Adenocarcinoma, Cholangiocarcinoma, and a Pancreatic Neuroendocrine Tumor

Introduction: Pancreatic ductal adenocarcinoma (PDAC) accounts for 3% of all cancers in the United States though it comprises approximately 85% of pancreatic cancers. Less common pancreaticobiliary tumors include cholangiocarcinoma and pancreatic neuroendocrine tumors, which have an incidence of approximately 8,000 and 1,000 cases annually in the United States, respectively. Case Presentation: We present a case of a 71 year-old female with a previous history of a cholecystectomy initially presenting with a suspicious mass in the body of the pancreas. CT imaging with pancreas protocol demonstrated a pancreatic neck mass that on EUS biopsy showed pancreatic adenocarcinoma. The CT also showed a second, ill-defined lesion near the common bile duct (CBD) that on ERCP was proximal to the cystic duct remnant. Brush biopsies demonstrated high-grade dysplasia. The patient was treated surgically with a total pancreatectomy including proximal resection of the CBD and portal lymphadenectomy. Her post-operative course was uneventful. Pathology demonstrated a poorly-differentiated PDAC of the neck (T3N1) and a moderately-differentiated cholangiocarcinoma arising from an intraductal papillary neoplasm of bile duct (T2N0). Incidentally, the removed pancreas also demonstrated a sub-centimeter, well-differentiated neuroendocrine tumor. Discussion: Synchronous primary tumors of the pancreas occur in up to 20% of cases, typically involving pancreatic ductal adenocarcinoma and intrapapillary mucinous neoplasms. Synchronous pancreaticobiliary cancer is much less common. After a literature review, we identified fewer than ten reported cases of synchronous pancreatic cancer and gallbladder/bile duct cancer and no prior case reports from patients in the United States. This case provides a unique synchronous presentation of three distinct neoplasms within the pancreaticobiliary region. Although this presentation is extremely rare, it should be considered when assessing multiple pancreaticobiliary lesions.1452.tif Figure 1: CT imaging of the abdomen with contrast using a three-phase pancreas protocol approach. Red circle demonstrates a 1.9 x 1.3 cm mass in the common biliary duct at the level of the upper pancreatic head. Yellow circle demonstrates a 2.9 x 1.9 cm mass in the body of the pancreas.

FLT-PET CT Scan can avoid radical surgery in masquerading pancreatobiliary lesions

Background: The purpose of this study was to evaluate the efficacy of this marker (FLT-PET CT scan) and to compare it with FDG-PET scan in differentiating benign from malignant diseases in suspected bilio-pancreatic tumors. Methodology: It is a prospective observational study from July 2013 to April 2017. Suspected Pancreaticobiliary malignancies were included. FDG-PET/CT and FLT-PET/CT was done. Histopathology of the resected specimen or FNAC was considered the gold standard for diagnosis. Results: Fifty-six patients harboring 58 suspected lesions of pancreatobiliary malignancy were included in this study Two patients had synchronous lesions in gall bladder and pancreas. Majority of patients(75.8%,44/58) had gall bladder carcinoma. Thirty-five patients underwent laparotomy, thirty of them were resorted to radical surgery. Eighteen lesions(31%) were confirmed as benign(XGC+Chr. Cholecystitis=14, Ch.Pancreatitis+Pancreatic lipodystrophy=4) on histological examination. The result of FLT-PET were better than FDG-PET. The sensitivity, specificity, PPV and NPV & accuracy of FLT-PET was 92.5%, 100%, 100%, 84.2% and 94.6% respectively. The sensitivity, specificity, PPV and NPV & accuracy of FDG-PET was 97.5%, 31.2%, 78%, 83.3% and 78.5% respectively. Adding CA19-9 for detecting malignancy accuracy increases to 98.2%. On analyzing with ROC, at SUVmax = 2 on FLT-PET, the sensitivity and specificity for detecting malignancy in all pancreaticobiliary lesions was 92.5% and 100% respectively(AUC = 0.91). AUC for FDG-PET CT in pancreaticobiliary lesions was 0.624. Conclusion: FLT-PET is better than FDG-PET scan in differentiating benign pancreaticobiliary lesions. By employing FLT-PET CT as the diagnostic tool, it is predicted that 43.3% of radical surgery done for benign bilio-pancreatic lesions can be avoided.

The Outcomes of “Atypical” Biliary Brushings in the Identification of Pancreaticobiliary Lesions: An Eight-Year Single Institution Retrospective Review

The Outcomes of “Atypical” Biliary Brushings in the Identification of Pancreaticobiliary Lesions: An Eight-Year Single Institution Retrospective Review

Endoscopic ultrasonography guided-fine needle aspiration for the diagnosis of solid pancreaticobiliary lesions: Clinical aspects to improve the diagnosis.

Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been applied to pancreaticobiliary lesions since the 1990s and is in widespread use throughout the world today. We used this method to confirm the pathological evidence of the pancreaticobiliary lesions and to perform suitable therapies. Complications of EUS-FNA are quite rare, but some of them are severe. Operators should master conventional EUS observation and experience a minimum of 20-30 cases of supervised EUS-FNA on non-pancreatic and pancreatic lesions before attempting solo EUS-FNA. Studies conducted on pancreaticobiliary EUS-FNA have focused on selection of suitable instruments (e.g., needle selection) and sampling techniques (e.g., fanning method, suction level, with or without a stylet, optimum number of passes). Today, the diagnostic ability of EUS-FNA is still improving; the detection of pancreatic cancer (PC) currently has a sensitivity of 90%-95% and specificity of 95%-100%. In addition to PC, a variety of rare pancreatic tumors can be discriminated by conducting immunohistochemistry on the FNA materials. A flexible, large caliber needle has been used to obtain a large piece of tissue, which can provide sufficient histological information to be helpful in classifying benign pancreatic lesions. EUS-FNA can supply high diagnostic yields even for biliary lesions or peri-pancreaticobiliary lymph nodes. This review focuses on the clinical aspects of EUS-FNA in the pancreaticobiliary field, with the aim of providing information that can enable more accurate and efficient diagnosis.

The Papanicoloau Society of Cytopathology Guidelines for the Classification of Pancreaticobiliary Lesions

The Papanicoloau Society of Cytopathology Guidelines for the Classification of Pancreaticobiliary Lesions

Pancreaticobiliary tract cytology: Journey toward "Bethesda" style guidelines from the Papanicolaou Society of Cytopathology.

The current series of articles related to the Papanicolaou Society of Cytopathology (PSC) guidelines for pancreaticobiliary cytology are the product of significant efforts by many experts working on different PSC guidelines committees.[1] The PSC guidelines for cytologic interpretation and reporting of variety of body site specimens have been described previously.[2,3,4,5,6] These are comparable to the guidelines from the National Cancer Institute for cervical cytology[7] and fine needle aspiration cytology of breast and thyroid.[8,9] Most of these systems are designed to stratify the risk of malignancy with diagnostic categories for guiding appropriate management algorithms. The current guidelines[10,11,12,13,14] follow the strategies comparable to the Bethesda System for Reporting Thyroid Cytopathology. The guidelines not only consider diagnostic categories and criteria, but also attempt to provide details on other aspects including techniques for obtaining specimens, which patient would benefit most from cytologic evaluation, information on ancillary testing, and patient follow-up/management. The scheme addresses the wide spectrum of approaches to acquire diagnostic material for cytopathologic evaluation from a variety of pancreaticobiliary lesions. A six-tiered system is recommended for the standardized nomenclature in pancreaticobiliary cytology. The categories proposed are: Non-diagnostic, negative, atypical, neoplastic (benign or other), suspicious, and positive.[12] “Atypical” and “suspicious” categories have relatively well reported malignancy risks.[15,16] Potentially, the most challenging and controversial category is “neoplastic (benign and other)” with the widest range of interpretations. The entities included in this category range from innocuous lesions such as benign cystic neoplasms (serous cystadenoma) to others like pre-malignant mucinous cysts (cystic mucinous neoplasm and intraductal papillary mucinous neoplasm), low-grade well-differentiated neuroendocrine tumors (NETs), and solid-pseudopapillary neoplasms. The premalignant mucinous cysts without unequivocal features of malignancy would fall in this category with very wide management options.[17] The NETs similarly have many challenges with controversies related to their categorical assignment. Due to their malignant potential, some favor these neoplasms be categorized as “malignant.” European Neuroendocrine Tumor Society (ENETS) and World Health Organization categorize low and intermediate grades of these as “tumor” or “neoplasm” in the absence of high-grade criteria (>50 mitoses per 50 high power field for NETs of pancreas and >20 mitoses per 10 high power field or Ki-67 index >20% for NETs of other sites).[18,19] Undoubtedly, the lesions with unequivocal cytological features of either small cell carcinoma or large cell undifferentiated carcinoma belong to the “malignant” category. An increasing trend with incidental NETs in surgically unfit older patients, favors a conservative approach for small NETs as an alternative management strategy. The categories proposed in the current guidelines permit practical flexibility by surgeons in order to assure that conservative strategies may be a better option than the surgery. This would be more confusing if these cases of low grade neoplasms automatically fell in a “malignant” category! Utilization of ancillary testing including molecular testing in cystic lesions is also addressed in appropriate areas.[13] With input from the guidelines by the National Cancer Center Network (www.nccn.org) and by the multidisciplinary international groups in the field of pancreatology, post cytologic evaluation and management are also covered.[14] A “triple test” approach similar to that applied for FNA of breast lesions is recommended. Patient management should be determined by correlating the clinical findings in concert with endoscopic, imaging, and cytologic findings. Effective application of such guidelines is heavily dependent on the collaborative, multidisciplinary interactions between endoscopists, pancreaticobiliary surgeons, radiologists, and cytopathologists. The current CytoJournal supplement issue with individual articles[10,11,12,13,14] covering various areas highlighted above would be a great resource under Open access platform[20,21] for all involved in the management of pancreaticobiliary lesions. These PSC guideline articles published under Open Access charter may be disseminated by multiple journals/platforms[22,23,24,25,26] including e-CytoJournal issue http://www.cytojournal.com/browse.asp?sabs=n.[27]

PWE-058 Tissue Acquisition from Solid Pancreatic Lesions – Endoscopy or Surgery

IntroductionThe accurate diagnosis of solid pancreatic masses is important in directing appropriate management of patients. The methods commonly used are percutaneous, laparoscopic and EUS guided biopsy of these lesions. Laparoscopic...

Does on-site adequacy assessment by cytotechnologists improve results of EUS guided FNA of solid pancreaticobiliary lesions?

Rapid onsite adequacy assessment is stated to improve the diagnostic performance of EUS-FNA.The aim of this study was to establish if the introduction of adequacy assessment performed by a biomedical scientist (cytotechnologist) to an established EUS service improved the diagnostic accuracy of EUS guided FNA of solid pancreaticobiliary lesions.This retrospective study includes all patients with solid pancreaticobiliary lesions who underwent EUS-FNA from April 2009 to September 2010. An in room cytotechnologist was present for 2 out of the 4 weekly EUS lists and therefore there were two groups identified: Group 1, cytotechnologist absent; and Group 2, cytotechnologist present.There were 82 patients in Group 1 and 97 patients in Group 2. There was no statistically significant difference in the number of passes (4.1 vs. 4.3), the inadequate aspirate rate (7.3% vs. 5.1%) or the mean size of the lesions (34.7 vs. 32.6 mm) between the groups. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value in Group 1 were 89%, 88%, 100%, 100% and 50% respectively. The results in Group 2 were 91%, 90%, 100%, 100% and 69% respectively. There was no statistically significant difference between the two groups.In this study the adequacy assessment performed by a cytotechnologist did not improve the diagnostic accuracy of EUS-FNA. In an established EUS-FNA service with low inadequate aspirate rates, onsite adequacy assessment may not improve results of the test.

Diagnostic Yield, Accuracy and Pitfalls of Endoscopic Ultrasound Guided Fine Needle Aspiration Cytology of Gastrointestinal Tract, with Emphasis on Pancreatico-biliary Lesions: A Five Year Retrospective Review with Cytologic-histologic Correlation

Diagnostic Yield, Accuracy and Pitfalls of Endoscopic Ultrasound Guided Fine Needle Aspiration Cytology of Gastrointestinal Tract, with Emphasis on Pancreatico-biliary Lesions: A Five Year Retrospective Review with Cytologic-histologic Correlation

Impact of on-site adequacy assessment for EUS FNA of solid pancreatic lesions

IntroductionThere are a number of factors which can influence the accuracy of EUS FNA but the presence of an in-room cytotechnician (IRC) has been shown to be one of the...

Pancreaticobiliary Endoscopic Ultrasound (EUS): Current Status at Delhi Apollo Hospital

To evaluate the results of EUS in patients having pancreaticobiliary lesions. EUS was performed in 45 patients (CBD lesions in 20, pancreatic in 19 and periampullary in 6 patients using EUS equipment. Final diagnosis was achieved by either diagnostic and or FNA in al patients. None had any complications. Results are very similar to what has been reported from established centers.

Safety and efficacy of curative intent surgery for peri‐ampullary liver metastasis

The management of patients with peri-ampullary liver metastasis remains controversial. We sought to assess the safety and efficacy of curative intent surgery for peri-ampullary liver metastasis. Between 1993 and 2009, 40 patients underwent curative intent surgery (resection and/or radiofrequency ablation (RFA)) for peri-ampullary liver metastasis. Clinicopathologic and outcome data were collected and analyzed. Location of the primary tumor was pancreas head (n = 20), ampulla of Vater (n = 10), distal bile duct (n = 5), or duodenum (n = 5). Most patients (n = 27) presented with synchronous disease, while 13 patients presented with metachronous disease following a median disease-free interval of 22 months. Most patients (n = 25) presented with hepatic metastasis from pancreaticobiliary origin (pancreatic or distal common bile duct) compared with 15 patients who had metastasis from an intestinal-type primary (ampullary or duodenal). There were no differences in metastatic tumor number or size between these groups (P > 0.05). Post-operative morbidity and mortality was 30% and 5% respectively. Overall 1- and 3-year survival was 55% and 18%. Patients who underwent resection of liver metastasis from intestinal-type tumors experienced a longer survival compared with patients who had pancreaticobiliary lesions (median: 13 months vs. 23 months; P = 0.05). Curative intent surgery for peri-ampullary liver metastasis was associated with post-operative morbidity and a 5% mortality rate. Although the overall survival benefit was modest, patients with liver metastasis from intestinal-type tumors experienced improved survival following resection of liver metastasis compared with pancreaticobiliary lesions.

AN ELECTRONIC RADIAL SCANNING ECHOENDOSCOPE IS SUPERIOR TO A MECHANICAL RADIAL SCANNING ECHOENDOSCOPE IN ULTRASOUND IMAGE QUALITY FOR GASTROINTESTINAL TRACT AND PANCREATICOBILIARY LESIONS

To objectively compare the electronic radial scanning echoendoscope (ER-ES) with the mechanical radial scanning echoendoscope (MR-ES) in the quality of endoscopic ultrasonography (EUS) images of gastrointestinal tract and pancreaticobiliary lesions. Studied were 56 patients: 20 with gastric cancer, 20 with gallbladder lesions, and 16 with intraductal papillary-mucinous neoplasms of the pancreas (IPMN). They were subjected to EUS, half of them using the ER-ES, and the other half using the MR-ES. EUS images thus obtained were evaluated concerning four items in patients with gastric cancer and those with gallbladder lesions, and three items in patients with IPMN. Six endosonographers blindly assessed two EUS images per patient on a visual analogue scale. In each of the three groups of patients, the evaluators' median scores for the ER-ES and MR-ES for each item were compared. The median scores for the ER-ES were significantly higher than those for the MR-ES in all items in patients with gastric cancer and those with IPMN, and in one item in patients with gallbladder lesions. The ER-ES is certainly superior to the MR-ES in the quality of EUS images of gastrointestinal tract and pancreaticobiliary lesions.

Value of magnetic resonance cholangiopanceatography combined with conventional MRI in diagnosis of pancreaticobiliary duct lesions

Objective:To observe the manifestations of magnetic resonance cholangiopanceatography(MRCP) and conventional magnetic resonance imaging(MRI) for pancreaticobiliary duct lesions.Methods:Fifty-eight patients with pancreaticobiliary duct lesions,which were confirmed by pathology and comprehensive imaging,were examined by 3D-MRCP volume scanning with thin slice reconstruction,2D-MRCP projective scanning and conventional MRI.The MRCP and MRI manifestations of different lesions were analyzed and their diagnostic values were discussed.Results:Calculus of bile duct and pancreatic duct was found in 28 patients,chronic pancreatitis in 9,pancreatic cancer in 9,carcinomas of bile duct in 5,metastases to lymph nodes of porta hepatic in 2,congenital choledochus dilatation,cholecystectomy,pancreas divisum,post liver transplantation,and malignant intraductal papillary mucinous tumor of pancreatic duct all in 1.The manifestations of 3D-MRCP volume scanning with thin slice reconstruction,2D-MRCP projective scanning and conventional MRI for pancreaticobiliary duct lesions were different and had their own characteristics.Conclusion:The combinations of 3D-MRCP volume scanning with thin slice reconstruction,2D-MRCP projective scanning and conventional MRI can help to locate and diagnose pancreaticobiliary duct lesions.