Improved technique for pancreatic MRI: value of oblique fat suppression imaging with oral barium administration

Our goal was to determine the efficacy of a dedicated protocol for pancreatic MRI using fat suppression, oblique plane orientation, and barium as an oral contrast agent.

Fifty-two patients were enrolled in our study. In each patient, the stomach and duodenum were opacified with 300 ml oral barium. In all patients conventional SE T1- and T2-weighted images and fat-suppressed axial and oblique T1-weighted images of the upper abdomen and the pancreas, respectively, were obtained. The different T1-weighted sequences were compared for visualization of the pancreas and for lesion conspicuity. Oblique images were obtained in a plane parallel to the overall axis of the pancreas. All sequences were qualitatively assessed by two independent blinded readers and statistically compared.

The combination of fat suppression and oblique imaging significantly improved the visualization of the different anatomic portions of the normal pancreas as well as pathologic findings in the pancreas in 70-92% of the cases compared with conventional axial T1-weighted imaging (p < 0.001) and in 52-75% of the cases compared with axial fat-suppressed T1-weighted imaging (p < 0.001), respectively. Increased image noise and blurring artifacts resulted in slight image degradation after Gd-DTPA administration. Barium as a duodenal contrast agent was beneficial for delineation of the pancreatic head from the adjacent bowel structures.

In pancreatic imaging, fat-suppressed T1-weighted imaging is superior to conventional T1-weighted imaging, and oblique imaging is superior to axial imaging. Intravenous Gd-DTPA administration was useful only in selected cases.