MR cholangiography: clinical evaluation in 40 cases.

Hall-Craggs, M. A.; Allen, Clare; Owens, C M; Theis, B; Donald, J. J.; Paley, M; Wilkinson, Iain D.; Chong, W.K.; Hatfield, A. R. W.; Lees, WR

doi:10.1148/radiology.189.2.8210370

Cited by 134 publications

(49 citation statements)

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“…Initially, MRCP images were reported with gradient-echo balanced steady-state free precision technique to study biliary obstruction [26][27][28] . Subsequently, various sequences including fast spin-echo (FSE) pulse, rapid acquisition with rapid enhancement, HASTE and fast-recovery fast spin echo have been used to improve spatial resolution and hasten acquisition times [29][30][31][32] .…”

Section: Discussionmentioning

confidence: 99%

Role of magnetic resonance cholangiopancreatography in diagnosing choledochal cysts: Case series and review

Sacher

Davis²,

Sleeman³

et al. 2013

WJR

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AIM:To determine the merits of magnetic resonance cholangiopancreatography (MRCP) as the primary diagnostic test for choledochal cysts (CC's). METHODS:Between 2009 and 2012, patients who underwent MRCP for perioperative diagnosis were identified. Demographic information, clinical characteristics, and radiographic findings were recorded. MRCP results were compared with intraoperative findings. A PubMed search identified studies published between 1996-2012, employing MRCP as the primary preoperative imaging and comparing results with either endoscopic retrograde cholangiopancreatography (ERCP) or operative findings. Detection rates for CC's and abnormal pancreaticobiliary junction (APBJ) were calculated. In addition detection rates for clinically related biliary pathology like choledocholithiasis and cholangiocarcinomas in patients diagnosed with CC's were also evaluated. RESULTS:Eight patients were identified with CC's. Six patients out of them had type Ⅳ CC's, 1 had type I and 1 had a new variant of choledochal cyst with confluent dilatation of the common bile duct (CBD) and cystic duct. Seven patients had an APBJ and 3 of those had a long common-channel. Gallstones were found in 2 patients, 1 had a CBD stone, and 1 pancreatic-duct stone was also detected. In all cases, MRCP successfully identified the type of CC's, as well as APBJ with ductal stones. From analyzing the literature, we found that MRCP has 96%-100% detection rate for CC's. Additionally, we found that the range for sensitivity, specificity, and diagnostic accuracy was 53%-100%, 90%-100% and 56%-100% in diagnosing APBJ. MRCP's detection rate was 100% for choledocholithiasis and 87% for cholangiocarcinomas with concurrent CC's. CONCLUSION:After initial ultrasound and computed tomography scan, MRCP should be the next diagnostic test in both adult and pediatric patients. ERCP should be reserved for patients where therapeutic intervention is needed.© 2013 Baishideng. All rights reserved.Key words: Magnetic resonance cholangiopancreatography; Choledochal cyst; Abnormal pancreaticobiliary junction; Diagnostic test; Choledocholithiasis; Cholangiocarcinomas Core tip: Magnetic resonance cholangiopancreatography (MRCP) is used as primary diagnostic approach in various biliary pathologies. This is the first literature review of published studies discussing MRCP as a diagnostic modality for choledochal cysts. This review further outlines how recent imaging techniques have improved diagnostic accuracy of MRCP in diagnosing choledochal cysts and their associated anatomic variants. Advantages, disadvantages and contraindication for MRCP with respect to endoscopic retrograde cholangiopancreatography are also discussed.

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Section: Discussionmentioning

confidence: 99%

Role of magnetic resonance cholangiopancreatography in diagnosing choledochal cysts: Case series and review

Sacher

Davis²,

Sleeman³

et al. 2013

WJR

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“…Interobserver agreement between 3D-MRCP and ERCP/PTC was quantified using statistics. A value of less than 0.20 was considered to indicate poor agreement; a value of 0.20 -0.39, fair agreement; a value of 0.40 -0.59, moderate agreement; a value of 0.60 -0.79, substantial agreement; and a value of 0.80 or greater, excellent agreement (22).…”

Section: Discussionmentioning

confidence: 99%

“…3D-MRCP has a higher resolution (1 mm 3 ), excellent image quality, and was superior to ERCP/PTC in assessing hilar ductal obstruction. Indeed, several previous studies demonstrated that the accuracy of 2D-MRCP in assessing the level and feature of bile duct obstruction was comparable to that of ERCP/PTC (1,6,12,17,(22)(23)(24)(25)(26). However, at the same time, in several studies where surgical and pathological findings were used as a standard of reference, 2D-MRCP showed a relatively low accuracy regarding tumoral extent of the biliary tree (25)(26)(27).…”

Section: D Mrcp In Malignant Obstructionmentioning

confidence: 99%

Navigator‐triggered isotropic three‐dimensional magnetic resonance cholangiopancreatography in the diagnosis of malignant biliary obstructions: Comparison with direct cholangiography

Choi

Lee

et al. 2007

Magnetic Resonance Imaging

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Purpose:To compare the diagnostic accuracy of navigatortriggered isotropic three-dimensional (3D) MR cholangiopancreatography (MRCP) using parallel imaging for malignant biliary obstruction with direct cholangiography. Materials and Methods:A total of 23 patients with malignant biliary obstruction underwent MRCP and endoscopic retrograde cholangiopancreatography (ERCP)/percutaneous transhepatic cholangiography (PTC). Two observers retrospectively evaluated 3D-MRCP and ERCP/PTC and recorded the level of obstruction and extent of tumor along with their confidence. The quality of images and morphologic appearance of stricture were also evaluated by two reviewers. The results of MRCP and ERCP/PTC were compared with surgical and histopathological data.Results: 3D-MRCP was of diagnostic quality and free of artifacts in all patients, whereas ERCP/PTC examinations failed in three patients. For the evaluation of level of obstruction, there was no statistical significance between 3D-MRCP and ERCP/PTC. 3D-MRCP was superior to ERCP/ PTC in the assessment of anatomical extent of hilar bile duct involvement, but did not show statistical significance. The accuracy of 3D-MRCP in determining tumoral extent of hilar cancer was higher than that of ERCP/PTC, but it was not statistically significant. The image quality of 3D-MRCP was superior to ERCP/PTC. There was good agreement between morphologic appearance at MRCP and those at ERCP/PTC. Conclusion: 3D-MRCP can accurately assess the level of obstruction and extent of tumor in patients with malignant biliary obstruction.

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“…Nos últimos anos, a CPRM passou a ter destaque na literatura radiológica, com diversos trabalhos discutindo o seu potencial diagnóstico e o comparando com o de outros métodos de diagnóstico por imagem [7][8][9][10][11][12][13] . 9 demonstraram uma boa acurácia da CPRM no diagnóstico de malformações ductais pancreáticas.…”

Section: Discussionunclassified

“…Podem ser aventadas, como aplicações clínicas da CPRM, o estudo pré-operatório de pacientes a serem submetidos à colecistectomia laparoscópica, controles de drenagens das vias biliares e estudo das vias biliares e pancreáticas em casos de insucesso diagnóstico da CPGRE ou da CTPH [7][8][9][10][11][12][13] CPRM em diversas condições (figs. 1-4), com destaque para a possibilidade de utilização do método em pacientes submetidos previamente à anastomose biliodigestiva, nos quais os estudos contrastados endoscópicos podem ser tecnicamente difí-ceis de serem realizados.…”

Section: Discussionunclassified

Colangiopancreatografia por ressonância magnética: uma nova forma de avaliar as vias biliares e pancreáticas

Rocha¹,

Ueda²,

Machado³

et al. 1998

Rev. Assoc. Med. Bras.

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O diagnóstico por imagens das vias biliares e pancreáticas evoluiu significativamente a partir da década de 70, com as técnicas não-invasivas da ultra-sonografia (US) e da tomografia computadorizada (TC).Porém, a despeito das constantes evoluções da US e da TC, a colangiopancreatografia transparieto-hepática (CTPH) e a colangiografia retrógrada endoscópica (CPGRE) continuaram sendo consideradas por cirurgiões do aparelho digestivo como os métodos de imagem com maior precisão na avaliação das vias biliares, mesmo quando não se considera uma potencial ação terapêutica através da CTPH ou da CPGRE 1,2 . Em parte, a preferência dos cirurgiões por esses métodos de contrastação direta das vias biliares pode ser atribuída à relativa maior facilidade de compreensão de suas imagens, já que todas as informações são obtidas a partir de imagens nas quais os referenciais anatômicos estão presentes, dispostos em plano frontal.As imagens de TC, por sua vez, são obtidas no plano transversal e têm de ser reconstruídas mentalmente para que o cirurgião tenha, por exemplo, um entendimento do real ponto de obstrução das vias biliares em um determinado caso.As ressalvas dos cirurgiões para com as imagens geradas na US são ainda maiores, com a citação constante de que se trata de um método excessivamente operador dependente e que não apresenta todos os referenciais anatômicos necessários para o entendimento de suas imagens 2 . A colangiopancreatografia por ressonância magnética (CPRM) foi descrita como uma técnica de diagnóstico por imagem das vias biliares e pancreáticas na qual as imagens são apresentadas de forma semelhante ao que ocorre nos mé-todos de opacificação direta das vias biliares (CTPH e CPGRE) 1-3 . DESCRIÇÃO DO MÉTODONão é nosso objetivo, neste trabalho, discutir a física da ressonância magnética, porém podemos dizer que as suas imagens baseiam-se na densidade protônica, no tempo de relaxamento T1, no tempo de relaxamento T2 e na existência de fluxo na estrutura analisada.Programando-se a aquisição das imagens para uma maior ponderação em T2, as estruturas com conteúdo líquido se apresentarão com um hipersinal (brancas nas imagens), enquanto as vísceras parenquimatosas terão graus variáveis de sinal (diferentes tons de cinza nas imagens).A CPRM baseia-se na obtenção de imagens acentuadamente ponderadas em T2, a tal ponto de praticamente eliminar o sinal residual das estruturas parenquimatosas e permanecer apenas com o hipersinal (branco na imagem) das estruturas com conteúdo líquido 1 . Estabelecendo-se a região do hipocôndrio direito e epigástrio como área de obtenção do sinal, conseguese uma imagem das vias biliares e pancreáticas.Como o sinal formador da imagem provém da natureza líquida da bile e do suco pancreático, não há necessidade de utilização de nenhum meio de contraste.Outras estruturas com conteúdo líquido que se projetem na região analisada também podem ser observadas, e por isto preconiza-se jejum prévio ao exame, para evitar presença de grande quantidade de líquido no estômago e duodeno.O tempo para a ...

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MR cholangiography: clinical evaluation in 40 cases.

Abstract: Three-dimensional MR cholangiography shows particular promise for the assessment of complex strictures, in which conventional cholangiography carries a higher risk of sepsis, for planning optimal drainage before intervention.

Cited by 134 publications

References 0 publications

Role of magnetic resonance cholangiopancreatography in diagnosing choledochal cysts: Case series and review

Role of magnetic resonance cholangiopancreatography in diagnosing choledochal cysts: Case series and review

Navigator‐triggered isotropic three‐dimensional magnetic resonance cholangiopancreatography in the diagnosis of malignant biliary obstructions: Comparison with direct cholangiography

Colangiopancreatografia por ressonância magnética: uma nova forma de avaliar as vias biliares e pancreáticas

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