3D Magnetic Resonance Cholangiopancreatography (MRCP) in Symptomatic Post Cholecystectomy Patients: Ideal Imaging Plane of Source Volume Images

Abstract

Objectives: The purpose of our study was to find out the ideal 3D-MRCP acquisition plane among coronal and axial source datasets for bile duct assessment in patients with persistent post cholecystectomy pain. Methods: This was a cross sectional analytical study carried out in Radiology department of a teaching hospital from 1st January 2016 to 30 May 2017. 78 symptomatic patients for MRCP in the duration were included. Age range was 20 to 70 years and patients had persistent or recurrent post cholecystectomy symptoms like abdominal pain, vomiting or jaundice. Data was collected retrospectively from the hospital’s database so the need of informed consent was waivered off by permission from hospital’s ethical committee. MRCP was performed for all patients on 1.5 tesla GE MRI machine with breath-hold multi-slice acquisition using dedicated multichannel surface coils covering the abdomen. Both 2D and 3D MRCP were done. Coronal MIP was reconstructed based on each dataset. Data was analyzed using Microsoft excel and SPSS version 22. Results were compared for the ideal 3D plane to assess pancreatic and biliary ducts. Results: The encountered post cholecystectomy biliary findings were strictures (48%), retained biliary stones (35.8%), which were located either intrahepatic or extra-hepatic, most commonly in distal CBD causing obstructive jaundice and rest of the patients had either cholangiocarcinoma at hilum, pancreatitis or post op complications like complete bile duct transaction, bile duct ligation etc. The most common finding was biliary stricture. CHD and proximal CBD were better assessed for presence of strictures and stones on 3D coronal (P value <0.05) as compared to the axial images. Peri-ampullary, distal CBD, intrahepatic and hilar confluence duct strictures were better visualized on 3D axial (P value <0.05). 3D axial was also better than coronal raw data sets regarding visualization of calculi in distal CBD, intrahepatic biliary ducts, GB remnant, cystic duct and hilar biliary confluence. 3D coronal was better for post op ligature whereas 3D axial was more helpful deciding the level of duct injury and to assess the site of biliary leakage. Conclusion: The results of our study suggest that 3D axial primary dataset of MRCP is preferable for visualization and evaluation of distal CBD, ampulla and hilar confluence whereas for overall evaluation of bile ducts status, coronal reconstructions with MIP are preferred. Most common finding in our study was biliary strictures.