Non-invasive evaluation of the biliary tree with magnetic resonance cholangiopancreatography: initial clinical experience.

Abstract

Magnetic resonance cholangiopancreatography is a new, non-invasive imaging technique for visualization of the biliary ducts. Magnetic resonance cholangiopancreatography was performed on 136 patients (20-87 years old) with a superconductive magnet at 0.5T (Philips Gyroscan T5). Volumetric images on coronal planes were acquired; a T2 weighted turbo spin echo sequence (TR = 3000; TE = 700; number of excitations = 8; echo train length = 128; Acquisition time = 5'48") with respiratory compensation was performed. Images were reconstructed on coronal planes rotated at different angles using the MIP algorithm. When neoplastic disease was detected additional images on axial planes (SE Tlw: TR/TE 300/10 and turbo spin echo T2w: TR/TE 3000/120) were acquired. Magnetic resonance cholangiopancreatography allowed images of diagnostic value to be obtained in all cases. In choledocholithiasis, the technique had a sensitivity of 91.6%, specificity of 100% and overall diagnostic accuracy of 96.8%. Of the 48 patients with stenotic lesions, 16 cases were correctly characterized as benign and 30 as malignant. Two cases of focal chronic pancreatitis were misdiagnosed as pancreatic head carcinoma. In patients submitted to bilioenteric anastomosis, the technique was able to detect dilation of intrahepatic ducts, stenosis and associated stones in the 8 positive cases. In all 11 patients with chronic pancreatitis, dilated Wirsung duct and the stenotic tracts were revealed. In conclusion, magnetic resonance cholangiopancreatography can be considered as a technique able to completely replace diagnostic endoscopic retrograde cholangiopancreatography. However, further studies are necessary for a better evaluation of potential advantage and disadvantages.