MR cholangiopancreatography: techniques and clinical applications.
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Artifacts↗
Biomedical subjects
M A Barish
Publications and source records attributed to M A Barish.
Magnetic resonance cholangiography: comparison with endoscopic retrograde cholangiopancreatography.
BACKGROUND & AIMS: Magnetic resonance cholangiography (MRC) is a noninvasive diagnostic modality capable of producing high-quality images of the biliary tree. The purpose of this study was to determine in a prospective, blinded fashion the sensitivity and specificity of three-dimensional fast spin-echo (3D FSE) MRC for the evaluation of biliary tract abnormalities. METHODS: Forty-six patients referred for elective direct cholangiography (45 endoscopic retrograde cholangiopancreatography and 1 percutaneous transhepatic cholangiography) were studied prospectively with 3D FSE MRC during a 1-year period. All images were interpreted blindly by two radiologists. The presence of dilatation, strictures, and intraductal abnormalities was recorded. Sensitivity and specificity of 3D FSE MRC were determined using findings on direct cholangiography as the gold standard. RESULTS: MRC images of diagnostic quality were obtained in 44 (95.7%) of the patients. Sensitivity for the detection of bile duct dilatation (n = 27), biliary strictures (n = 10), and intraductal abnormalities (n = 7) was 96.3%, 90%, and 100%, respectively. In addition, the MRC showed 16 of 17 patients with normal bile ducts (specificity, 94.1%). CONCLUSIONS: MRC has a very high sensitivity and specificity in the evaluation of the biliary tract. Based on these data, we believe that the efficacy of MRC using 3D FSE is sufficient to warrant its use in the routine diagnosis of biliary tract disease.
Adolescent↗
MR cholangiopancreatography after unsuccessful or incomplete ERCP.
PURPOSE: To assess the value of magnetic resonance (MR) cholangiopancreatography in patients in whom endoscopic retrograde cholangiopancreatography (ERCP) was unsuccessful or did not completely delineate ductal abnormalities. MATERIALS AND METHODS: MR cholangiopancreatography was performed in 37 consecutive patients because ERCP was unsuccessful (n = 20), postsurgical biliary-enteric anatomy was present (n = 10), or evidence of complete pancreatic duct obstruction was found ar ERCP (n = 7). RESULTS: MR cholangiopancreatography was successful in all patients. Eleven patients had normal MR findings and required no further intervention. Eight patients has abnormalities that were detected with MR but were followed up clinically. Eleven patients subsequently underwent laparotomy, three underwent therapeutic percutaneous transhepatic cholangiography (PTC), two underwent diagnostic (PTC), and one underwent ultrasound-guided biopsy. CONCLUSIONS: MR cholangiopancreatography plays an important role in the care of patients in whom ERCP is unsuccessful or incomplete and when technical difficulties can be anticipated.
Bile Duct Diseases↗
Magnetic resonance cholangiopancreatography of the biliary ducts: techniques, clinical applications, and limitations.
Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive method capable of generating images of the biliary tree that resemble those provided by direct invasive cholangiographic techniques. MRCP is based on the ability of heavily T2-weighted sequences to obtain images in which static fluid in the bile ducts appears bright against a dark background. MRCP allows display of both cross-sectional and projectional information without the need for contrast media injection. Because the projectional images resemble those of direct cholangiography, they are readily accepted by gastroenterologists and surgeons. Although the exact role of MRCP for the evaluation of the biliary system has not been fully defined, continued advances in both technique and experience have begun to clarify the potential uses of MRCP in the workup of biliary diseases. This review will discuss these developing clinical roles and their implications for patient management as well as the imaging principles, techniques, limitations, and artifacts of MRCP.
Artifacts↗
Pancreatic duct: MR cholangiopancreatography with a three-dimensional fast spin-echo technique.
PURPOSE: To determine the role of three-dimensional fast spin-echo magnetic resonance (MR) cholangiopancreatography in the evaluation of the normal and abnormal pancreatic duct. MATERIALS AND METHODS: A non-breath-hold MR cholangiopancreatographic technique with use of a body coil was compared with direct pancreatography performed with endoscopic retrograde cholangiopancreatography in 37 patients. RESULTS: MR cholangiopancreatograms of satisfactory quality were obtained in 92% of patients. Sensitivity for detection of pancreatic duct dilatation (n = 15) was 100% and 87% (observers 1 and 2, respectively). Among patients with pancreatic duct strictures (n = 8), 75% of the strictures were detected; there was a single false-positive finding. Specificity for both observers was 69% for the maximum intensity projection reconstructions and increased to 81% with review of the source images. Four of six cases of pancreas divisum (67%) and two cases of pancreatic duct stones were demonstrated. Interobserver agreement was moderate to substantial, as assessed with kappa-analysis. CONCLUSION: MR cholangiopancreatography can accurately demonstrate the normal pancreatic duct as well as various pancreatic duct abnormalities.
Cholangiopancreatography, Endoscopic Retrograde↗
MR cholangiopancreatography: efficacy of three-dimensional turbo spin-echo technique.
OBJECTIVE: The purpose of this study was to correlate a new three-dimensional turbo spin-echo MR cholangiopancreatography technique with endoscopic cholangiopancreatography or percutaneous cholangiography to determine the efficacy of the new technique for visualizing and diagnosing diseases of the pancreatic and biliary ducts. It was hypothesized that the new technique would provide diagnostic images without prolonged breath holding or a surface coil as required by previous MR techniques. SUBJECTS AND METHODS: We describe a respiratory-triggered, heavily T2-weighted, three-dimensional, multislab turbo spin-echo sequence for MR cholangiopancreatography. Thirty patients with suspected biliary or pancreatic disease were randomly selected from referrals for endoscopic retrograde cholangiopancreatography. All patients were imaged with the optimized MR technique prior to attempted endoscopic or percutaneous cholangiopancreatography. The MR images were evaluated without additional clinical or radiographic information by consensus opinion of two of the authors for visualization and caliber of the ducts. When the ducts were abnormal, the level and probable cause were categorized as follows: normal, periampullary stricture, localized duct stenosis, multifocal strictures, calculous disease, duct anomalies, and cystic disease. The images obtained by conventional percutaneous or endoscopic cholangiopancreatography were evaluated in the same manner with the exception that additional clinical and radiologic information was provided. The diagnostic categories determined by MR and direct cholangiopancreatography were compared. Patients were included in the analysis only if endoscopic or percutaneous opacification of the biliary or pancreatic ducts was successful. RESULTS: Diagnostic MR images were obtained in 29 (97%) of 30 patients. Endoscopic or percutaneous cholangiopancreatography was successful in 21 of the 29 patients for the common bile duct and in 17 of the 29 patients for the pancreatic duct. The diagnosis for the common bile duct by the MR technique agreed with the diagnosis by endoscopic or percutaneous cholangiopancreatography in 19 (90%) of 21 patients. For diagnosis of diseases of the pancreatic duct, there was agreement in 15 (88%) of 17 patients. CONCLUSION: Respiratory-triggered, multislab, three-dimensional turbo spin-echo MR cholangiopancreatography is a noninvasive technique for visualization of the pancreatic and biliary ductal systems. It is capable of providing diagnostic information equivalent to invasive techniques in a large percentage of patients and should be the technique of choice when invasive techniques are incomplete, unsuccessful, or technically difficult.
Adolescent↗
MR cholangiopancreatography: findings on 3D fast spin-echo imaging.
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Adult↗
Virtual colonoscopy and colorectal cancer screening.
Colorectal cancer (CRC) is the leading cause of cancer related death in the United States. Virtual colonoscopy is a new method for imaging the colon and has produced promising early results for polyp and cancer detection. The challenge remains to reproduce these favorable results in clinical practice and to evaluate the use of virtual colonoscopy in a purely screening population. Virtual colonoscopy may dramatically improve population participation in screening programs and play a major role in minimizing the impact of CRC.
Colonic Polyps↗