The role of Magnetic Resonance Cholangiopancreatography in the evaluation of biliary tree: A pictorial review

Transcription

1 The role of Magnetic Resonance Cholangiopancreatography in the evaluation of biliary tree: A pictorial review Poster No.: C-0522 Congress: ECR 2013 Type: Educational Exhibit Authors: E. Alvarez-Hornia, M. Aguilar Muniz, F. GARCIA DELGADO, G. Solis Polo; Bilbao/ES Keywords: Biliary Tract / Gallbladder, Abdomen, Liver, MR, Diagnostic procedure, Education, Calcifications / Calculi, Cancer, Dilatation DOI: /ecr2013/C-0522 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 61

2 Learning objectives To offer a spectrum of imaging findings in different biliary tract diseases, emphasizing the role of magnetic resonance imaging according to the appropriate clinical context and their advantages and limitations. Page 2 of 61

3 Images for this section: Fig. 1 Page 3 of 61

4 Background Magnetic resonance (MR) cholangiopancreatography (MRCP) is widely used in the evaluation of pancreatobiliary disorders, providing a fast and noninvasive alternative to endoscopic retrograde Cholangiopancreatography (ERCP). Its accuracy has been demonstrated in the evaluation of choledocolithiasis, malignant obstruction, postsurgical alterations and various pancreatobiliary abnormalities. Page 4 of 61

5 Images for this section: Fig. 2 Page 5 of 61

6 Imaging findings OR Procedure details Retrospective analysis of 175 patients (85 male and 90 female) underwent MRI Cholangiopancreatography in our Department in the last 10 months (May 2011February2012). The age range was years, mean age 75 years. Fig. 3 on page 9 All studies were performed on a 1.5-T. MRCP is performed using heavily T2-weighted sequences that depict the hyperintense fluid contained within the bile ducts with high signal intensity, whereas suppression of the signal of surrounding, non-fluid containing structures is achieved due to the long echotime. Fig. 4 on page 9 Fig. 5 on page 10 Preliminary sagittal, coronal and axial Half-Fourier acquisition single-shot turbo spin echo (HASTE) sequences were performed to allow a panoramic evaluation of the abdominal region. We always add the evaluation of the upper abdomen with the following sequences acquired on the transverse plane Fig. 6 on page 11 : Fat-suppressed T1-weighted images. T2-weighted Turbo Gradient Spin Echo Motion Correction (BLADE) Short Tau Inversion-Recovery (STIR). Diffusion Weighted Imaging (DWI). Apparent Diffusion Coefficient (ADC) map. When intravenous contrast agent was used, T1-weighted 3D-VIBE sequence was performed immediately before and after administration of 0.05 mmol/kg of body weight of gadobenate dimeglumine followed by 20 ml of saline flush at a rate of 2 ml/s by using a power injector. Post-contrast images were acquired during the early arterial, portal venous and late equilibrium phases. Fig. 7 on page 12 All images were evaluated on a dedicated console. In the evaluation of three-dimensional images we use Maximum Intensity Projection (MIP), Multiplanar Reconstruction (MPR) and Three-Dimensional Volume Rendering (VR). Fig. 8 on page 13 Page 6 of 61

7 We present examples of normal anatomy and pathological entities in different locations and with different etiologies. Fig. 9 on page 14 Fig. 10 on page 15 Normal anatomy and congenital anomalies. Normal anatomy Fig. 11 on page 16 Fig. 12 on page 17 Congenital variants Fig. 13 on page 18 Fig. 14 on page 19 Duodenal diverticulum Fig. 15 on page 20 Gallbladder agenesis. Fig. 16 on page 21 Lithiasic disease. Cholelithiasis Fig. 17 on page 22 Choledocholithiasis Fig. 18 on page 23 Inflammatory disease: Cholecystitis Fig. 19 on page 24 Fig. 20 on page 25 Cholangitis Fig. 21 on page 26 Fig. 22 on page 27 Malignancies. Vesicular Carcinoma. Fig. 23 on page 28 Fig. 24 on page 29 Cholangiocarcinoma Fig. 25 on page 30 Fig. 26 on page 31 Fig. 27 on page 32 Periampular carcinoma Fig. 28 on page 33 Pancreatic tumor Fig. 29 on page 34 Fig. 30 on page 35 Fig. 31 on page 36 Fig. 32 on page 37 Fig. 33 on page 38 Fig. 34 on page 39 Fig. 35 on page 40 Fig. 36 on page 41 Metastatic disease Fig. 37 on page 42 Pancreatic disease. Acute Pancreatitis Fig. 38 on page 43 Fig. 39 on page 44 Chronic Pancreatitis. Fig. 40 on page 45 Fig. 41 on page 46 Pseudocyst. Fig. 42 on page 47 Non biliary findings. Diffuse hepatocellular cirrhosis Fig. 43 on page 48 Hepatosplenomegaly Fig. 44 on page 49 Congestive heart failure Fig. 45 on page 50 Postsurgical changes. Cholecystectomy. Fig. 46 on page 51 Abscess. Fig. 47 on page 52 Page 7 of 61

8 Strictures. Fig. 48 on page 53 Biliary leakage. Fig. 49 on page 54 Fig. 50 on page 55 Fig. 51 on page 56 Page 8 of 61

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58 Conclusion MRI offers a noninvasive method of obtaining images of the biliary system with the advantage of not using iodized contrast and no radiation. MRCP plays a crucial role evaluating postsurgical biliary tract anomalies, congenital anomalies, gallstones and neoplastic disease. Fig. 52 on page 59 Page 58 of 61

59 Images for this section: Fig. 52 Page 59 of 61

60 References 1.Christine O. Menias, Venkateswar R. Surabhi, Srinivasa R. Prasad, Hanlin L. Wang, Vamsi R. Narra, and Kedar N. Chintapalli. Continuing Medical Education: Mimics of Cholangiocarcinoma: Spectrum of Disease Radiographics : Yuji Watanabe, Masako Nagayama, Akira Okumura, Yoshiki Amoh, Takashi Katsube, Tsuyoshi Suga, Shingo Koyama, Kohya Nakatani, and Yoshihiro Dodo Continuing Medical Education: MR Imaging of Acute Biliary Disorders Radiographics : Hiroyuki Irie, Hiroshi Honda, Toshiro Kuroiwa, Kengo Yoshimitsu, Hitoshi Aibe, Kenji Shinozaki, Kouji Masuda, Pitfalls in MR Cholangiopancreatographic Interpretation. RadioGraphics 2001; 21: Graham G, Winder RJ, Ellis PK et al. Magnetic Resonance Cholangiopancreatography - Evaluation of Image Quality in Breath-hold and Non-breath-hold Technique. Radiography 2004; 10: Girometti R, Cereser L, Como G, et al. Biliary complications after orthotopic liver transplantation: MRCP findings. Abdom Imaging 2008;33: Wallner BK, Schumacher KA, et al. Dilated biliary tract: evaluation with MR cholangiography with a T2-weighted contrast-enhanced fast sequence. Radiology 1991;181: Guibaud L, Bret PM, Reinhold C, Atri M, Barkun AN. Bile duct obstruction and choledocholithiasis: diagnosis with MR cholangiography. Radiology 1995; 197: Dushyant V. Sahani, Rajgopal Kadavigere, Anuradha Saokar, Carlos Fernandezdel Castillo, William R. Brugge and Peter F. Hahn. Cystic Pancreatic Lesions: A Simple Imaging-based Classification System for Guiding Management. RadioGraphics November-December 2005 vol. 25 no Page 60 of 61

61 Personal Information Clinica IMQ Zorrotzaurre Departamento de RM. Ballets Olaeta 4, Bilbao. Spain Page 61 of 61