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Diagnosing Biliary Disease With MRCP

March 26, 2009
Written by: , Filed in: Diagnostic Imaging
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Diagnosing Biliary Disease With MRCP

A recent study was conducted to assess the diagnostic potential of high-spatial-resolution isotropic 3-dimensional (3D) fast-recovery fast spin-echo (FSE) magnetic resonance cholangiopancreatography (MRCP) sequence with parallel imaging in evaluating possible biliary disease.

The study, recently reported in Radiology, concludes that respiratory-triggered isotropic 3-dimensional fast-recovery fast spin-echo MRCP sequence with parallel imaging demonstrates excellent diagnostic potential in evaluating possible biliary disease, especially for calculi measuring ≥4 mm in size.

The Study
95 patients had undergone high-spatial-resolution isotropic 3D fast-recovery FSE MRCP sequence with parallel imaging as well as endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) within 100 days of each other.

MRI examinations were performed with a 1.5-Tesla system.

Imaging sequences included T2-weighted single-shot FSE, breath-hold T1-weighted dual echo spoiled gradient recalled echo, respiratory triggered fat-suppressed T2-weighted FSE, 3D fast-recovery FSE MRCP, and 3D spoiled gradient recalled echo prior to and following dynamic administration of IV gadolinium.

The 3D fast-recovery FSE MRCP sequence was reviewed independently by 2 radiologists.

The degree of image degradation by artifacts was graded on a 5-point scale, whereby a score of 1 was unreadable, and a score of 5 was without artifacts.

Results of Study

None of the FSE MRCP images were considered unreadable by either reviewer. Image degradation by severe artifacts receiving a score of 2 arose from breathing motion artifact despite respiratory triggering or insufficient signal secondary to massive ascites.

Sensitivity for presence and location of strictures ranged between 86% and 88%, and specificity was 94%. False-positive strictures of the distal common bile duct were due to mild prominence of the common bile duct and non-visualization of its distal segment.

Sensitivity for presence and location of biliary dilatation was 96% to 98%, and specificity was 100%.

False-negative results arose when a period of >30 days elapsed between MRCP and ERCP studies, probably resulting in interim caliber change.

Sensitivity and specificity ranges for presence and location of intraductal filling defects, which subsequently proved to be choledocholithiasis, were 68% to 75% and 97% to 99%, respectively.

There was a sensitivity range of 94% to 100% for calculi ≥4 mm, while only 33% to 42% for those measuring ≤3 mm. Therefore, there was excellent diagnostic performance in detecting calculi measuring ≥4 mm.

Reviewer’s Comments
The results of this study are useful in demonstrating that high-spatial-resolution isotropic 3D fast-recovery FSE MRCP sequence with parallel imaging has excellent potential in evaluating for possible biliary disease.

Biliary strictures, dilatation, and filling defects measuring ≥4 mm are adequately demonstrated.

A limitation noted in this study was that there was some verification bias, since only patients who had undergone MRCP and ERCP or PTC were included in the study.

Consequently, a high overall disease prevalence resulted as low-risk patients would not likely undergo invasive examinations.

Author: John C. Sabatino, MD, MSD

Reference:
Nandalur KR, Hussain HK, et al. Possible Biliary Disease: Diagnostic Performance of High-Spatial-Resolution Isotropic 3D T2-Weighted MRCP. Radiology; 2008;249 (December): 883-890

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