MR cholangiopancreatography: technique, potential indications, and diagnostic features of benign, postoperative, and malignant conditions |
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Authors: | C D Becker M Grossholz G Mentha R de Peyer F Terrier |
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Institution: | (1) Department of Radiology, Division of Diagnostic and Interventional Radiology, University Hospital of Geneva, CH-1211 Geneva, Switzerland, CH;(2) Department of Surgery, University Hospital of Geneva, CH-1211 Geneva, Switzerland, CH;(3) Division of Gastroenterology, University Hospital of Geneva, CH-1211 Geneva, Switzerland, CH |
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Abstract: | The objective of this article is to review technical aspects, discuss potential clinical indications for MR cholangiopancreatography
(MRCP) and demonstrate the spectrum of diagnostic findings in benign, postoperative, and malignant conditions. We describe
our current imaging protocol in comparison with other available techniques. Using a non-breath-hold, heavily T2-weighted fast-spin-echo
(FSE) sequence with or without respiratory gating we obtained coronal and axial source images and maximum intensity projections
(MIPs) in 102 patients with suspected abnormalities of the biliary or pancreatic ducts. Based on this series we demonstrate
the diagnostic appearance of a variety of benign, postoperative, and malignant conditions of the biliary and pancreatic ducts
and discuss potential clinical indications for MRCP. The non-breath-hold FSE technique enables a consistent image quality
even in patients who cannot cooperate well. Respiratory gating increased the rate of diagnostic examinations from 79 to 95
%. Acquisition of coronal and axial source images enables detection of bile duct stones as small as 2 mm, although calculi
that are impacted and not surrounded by hyperintense bile may sometimes be difficult to detect. The MIP reconstructions help
to determine the level of obstruction in malignant jaundice, delineate anatomical variants and malformations, and to diagnose
inflammatory conditions, e. g., sclerosing cholangitis, the Mirizzi syndrome and inflammatory changes in the main pancreatic
duct. The MRCP technique also correctly demonstrates the morphology of bilio-enteric or bilio-biliary anastomoses. Because
MRCP provides sufficient diagnostic information in a wide range of benign and malignant biliary and pancreatic disorders,
it could obviate diagnostic endoscopic retrograde cholangiopancreatography (ERCP) in many clinical settings. The ERCP technique
may be increasingly reserved for patients in whom nonsurgical interventional procedures are anticipated.
Received 25 July 1996; Revision received 1 October 1996; Accepted 5 November 1996 |
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Keywords: | : MR Bile ducts Pancreatic duct |
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