MRI combined with MR cholangiopancreatography versus helical CT in the evaluation of patients with suspected periampullary tumors: a prospective comparative study

Abstract

MRI with MRCP was significantly more accurate than CT in differentiating between malignant and benign lesions in patients with suspected periampullary tumors, mainly due to the information obtained on the MRCP images of the biliary and pancreatic duct anatomy.

Diagnostic Accuracy of MRCP as Compared to Ultrasound/CT in Patients with Obstructive Jaundice

“…Andersson M et al, [16] concluded in their study that MRI with MRCP was more accurate than CT in differentiating between malignant and benign lesions in patients with suspected periampullary tumors. This is consistent with present study where MRI/MRCP showed 100 % accuracy in diagnosing cases with periampullary carcinoma.…”

Differentiation of noncalculous periampullary obstruction: comparison of CT with negative-contrast CT cholangiopancreatography versus MRI with MR cholangiopancreatography

“…MRI with MRCP represents one of the most comprehensive imaging examinations currently available for evaluating periampullary obstruction. MRCP can outline the morphology of the bile and pancreatic ducts, and conventional MRI may improve the specificity of MRCP by allowing observation of periductal masses and pancreatic parenchymal abnormalities [8,9,20]. An earlier study suggested that MRI combined with MRCP was a more accurate technique than CT in differentiating between malignant and benign lesions in patients with suspected periampullary tumours.…”

“…Patients with bile duct stones were excluded because biliary calculi are strongly associated with benign obstructions and require choledocholithotomy or endoscopic management [4]. The inclusion criteria were as follows: (1) a dilatation of bile duct must be present, one that was more than 7 mm of the extrahepatic ducts in patients<60 years of age and 10 mm in patients with cholecystectomy [9] accompanying clinical findings (including right upper quadrant abdominal pain, jaundice, elevated total serum bilirubin, and/or phosphatase levels); (2) both nonenhanced dual-phase enhanced CT combined with nCTCP and MR with MRCP examinations had to be performed before the operation; (3) both CT and MR image qualities were diagnostic; (4) direct cholangiography, such as ERCP or percutaneous transhepatic cholangiography (PTC) must be performed after both CT and MRI; and (5) final clinical diagnoses based on surgical specimens, biopsy under laparotomy, ERCP, and CT or MRI follow-up>12 months for the enrolled patients must be available. 139 patients were excluded from the study for one of the following reasons: (1) neither CT nor MR examinations (n=15) or incomplete CT or MR examinations (n=5); (2) only CT without MR examinations (n=57) or only MR without CT examinations (n=38); (3) both thick-slab and 3D MRCP image qualities were not diagnostic, in which a severe respiratory motion artefact affected the diagnostic evaluation (n=6); (4) direct cholangiography performed before CT or MRI (n=3); and (5) final clinical diagnoses were not established (n=15).…”

“…Benign periampullary obstruction was considered present on CT and MRI if there was: (1) a dilated bile duct showing gradually tapering from the proximal extrahepatic bile duct down to the obstructive site with smooth and symmetric ductal wall [4,9], (2) a short-segment involvement with smooth concentric narrowing of the bile duct lumen as well as a central biliary dilatation without a discernible mass [14], or (3) a perceivable mass < 13 mm [4] with relatively hyperdense/intense or isodense/intense enhancement during the portal venous phase CT and MRI to the normal pancreatic parenchyma or duodenal mucosa [15]. Malignant periampullary obstruction was considered on CT and MRI if there was: (1) direct visualization of a hypodense or hypointense mass relative to the normal pancreatic or hepatic parenchyma at the obstructive level [8,16,17], (2) an irregular thickened ductal wall that obliterated the lumen and demonstrated contrast enhancement [14,18], or (3) a thickened duodenal wall with relatively narrowed duodenal lumen or irregular overhanging edges in the periampullary regions with an abrupt and asymmetric obstruction of bile duct with proportional dilated duct [17].…”

“…Currently, when biliary obstructive diseases are suspected, there is an emphasis on the combination of imaging approaches, such as conventional magnetic resonance imaging (MRI) with MRCP for the improvement of diagnostic accuracy [8][9][10]. However, MR examinations are not suitable for all patients, as some contraindications (cardiac pacemaker, aneurysm clips, severely ill, etc.)…”