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T2-weighted and dynamic enhanced MRI in acute pancreatitis: comparison with contrast enhanced CT
J Ward1, A G Chalmers, A J Guthrie
1Department of Radiology, St James's University Hospital, Leeds, UK.
Abstract:
The purpose of this study was to compare T2-weighted and dynamic contrast enhanced MRI with contrast enhanced CT in patients with severe acute pancreatitis. Thirty-two patients were examined using axial T2-weighted spin-echo imaging (TR 1801, TE 15/90) and a multi-slice rapid gradient-echo sequence (TR 135, TE 4, FA 80 degrees) (FLASH) in axial and coronal planes. Fifteen 5 mm axial slices at 10 mm intervals were acquired during a single breath-hold of 19 s before, and at 10 and 40 s after a bolus injection of Gd-DTPA. Additional FLASH images in the coronal plane were obtained 2 min after injection of contrast medium. MR was compared with contemporary enhanced CT by two blinded observers who scored pancreatic viability and the content of intra and extra-pancreatic fluid collections. The presence of gas, calcification and haemorrhage was noted. Abnormalities in adjacent organs, evidence of vascular occlusion and indicators of aetiology were also recorded. MR and CT were concordant in distinguishing viable pancreatic tissue from areas of necrosis. MR appeared to be more effective than CT in characterizing the content of fluid collections and in demonstrating gall stones, although CT remains superior in detecting flecks of gas and calcification. MR carries some advantages over CT and can be regarded as an alternative primary technique in patients with severe pancreatitis.
Insights
This study compared MRI and CT for severe acute pancreatitis. MRI excels at characterizing fluid collections and gallstones, while CT is better for gas and calcification detection, offering a viable alternative imaging technique.
Area of Science:
- Radiology
- Medical Imaging
Background:
- Severe acute pancreatitis requires accurate imaging for diagnosis and management.
- Contrast-enhanced computed tomography (CT) is a standard imaging modality.
- Magnetic resonance imaging (MRI) offers advanced visualization capabilities.
Purpose of the Study:
- To compare T2-weighted and dynamic contrast-enhanced MRI with contrast-enhanced CT.
- To evaluate imaging performance in patients with severe acute pancreatitis.
Main Methods:
- Thirty-two patients with severe acute pancreatitis underwent T2-weighted and dynamic contrast-enhanced MRI.
- MRI sequences included spin-echo and rapid gradient-echo (FLASH).
- Gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) was used for contrast enhancement.
Main Results:
- MRI and CT showed concordance in differentiating viable pancreatic tissue from necrosis.
- MRI was more effective than CT in characterizing fluid collection content and detecting gallstones.
- CT remained superior in detecting gas and calcification within the pancreas.
Conclusions:
- MRI offers advantages over CT in specific aspects of severe acute pancreatitis imaging.
- MRI can be considered an alternative primary imaging technique for these patients.