Optimal MR cholangiopancreatographic sequence and its clinical application

To determine the appropriate acquisition parameters for magnetic resonance cholangiopancreatography (MRCP) with a half-Fourier rapid acquisition with relaxation enhancement (RARE) sequence; to determine the optimal MRCP technique by comparing half-Fourier RARE, steady-state free precession (SSFP) two-dimensional (2D) fast spin-echo (SE), and three-dimensional (3D) fast SE sequences; and to clarify the usefulness and limitations of MRCP in diagnosing pancreatic abnormalities.

Half-Fourier RARE MRCP images with varying parameters were compared by using a phantom. Duct conspicuity and contrast-to-noise ratios (C/Ns) were compared for the four MRCP techniques in a phantom and healthy volunteers. The optimal MRCP technique was used to study healthy volunteers and clinical cases. Receiver operating characteristic (ROC) curves were created for data analysis.

A 5-mm-thick section without intersection gap was appropriate for half-Fourier RARE MRCP. Only half-Fourier RARE MRCP could depict a 1-mm duct. C/N was the highest with half-Fourier RARE, followed by 3D fast SE, 2D fast SE, and SSFP sequences. ROC curve analysis revealed no interobserver differences, and the area under the curve for detection of strictures of the main pancreatic duct was as high as 0.89.

Half-Fourier RARE MRCP has the highest contrast and spatial resolution among the four techniques studied and may play an important role in diagnosing pancreatic abnormalities.