MR cholangiopancreatography: efficacy of three-dimensional turbo spin-echo technique

The purpose of this study was to correlate a new three-dimensional turbo spin-echo MR cholangiopancreatography technique with endoscopic cholangiopancreatography or percutaneous cholangiography to determine the efficacy of the new technique for visualizing and diagnosing diseases of the pancreatic and biliary ducts. It was hypothesized that the new technique would provide diagnostic images without prolonged breath holding or a surface coil as required by previous MR techniques.

We describe a respiratory-triggered, heavily T2-weighted, three-dimensional, multislab turbo spin-echo sequence for MR cholangiopancreatography. Thirty patients with suspected biliary or pancreatic disease were randomly selected from referrals for endoscopic retrograde cholangiopancreatography. All patients were imaged with the optimized MR technique prior to attempted endoscopic or percutaneous cholangiopancreatography. The MR images were evaluated without additional clinical or radiographic information by consensus opinion of two of the authors for visualization and caliber of the ducts. When the ducts were abnormal, the level and probable cause were categorized as follows: normal, periampullary stricture, localized duct stenosis, multifocal strictures, calculous disease, duct anomalies, and cystic disease. The images obtained by conventional percutaneous or endoscopic cholangiopancreatography were evaluated in the same manner with the exception that additional clinical and radiologic information was provided. The diagnostic categories determined by MR and direct cholangiopancreatography were compared. Patients were included in the analysis only if endoscopic or percutaneous opacification of the biliary or pancreatic ducts was successful.

Diagnostic MR images were obtained in 29 (97%) of 30 patients. Endoscopic or percutaneous cholangiopancreatography was successful in 21 of the 29 patients for the common bile duct and in 17 of the 29 patients for the pancreatic duct. The diagnosis for the common bile duct by the MR technique agreed with the diagnosis by endoscopic or percutaneous cholangiopancreatography in 19 (90%) of 21 patients. For diagnosis of diseases of the pancreatic duct, there was agreement in 15 (88%) of 17 patients.

Respiratory-triggered, multislab, three-dimensional turbo spin-echo MR cholangiopancreatography is a noninvasive technique for visualization of the pancreatic and biliary ductal systems. It is capable of providing diagnostic information equivalent to invasive techniques in a large percentage of patients and should be the technique of choice when invasive techniques are incomplete, unsuccessful, or technically difficult.