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History: A 45-year-old female patient who was previously healthy presented after several weeks of fullness in the right upper quadrant of the abdomen. The patient did not experience pain, nausea, vomiting, or jaundice, and had no contributory past medical or surgical history, including no history of malignancy. Upon examination, vital signs were within normal limits and the patient appeared well, with soft palpable fullness in the right upper quadrant. The abdomen was nontender and nondistended. Laboratory investigation revealed no abnormalities, with a normal complete blood cell count and normal serum tumor markers that included α-fetoprotein (<2.0 ng/mL; reference, <8.3 ng/mL), cancer antigen 19-9 (21.6 U/mL; reference, <35 U/mL), and carcinoembryonic antigen (1.3 ng/mL; reference, <5 ng/mL). CT of the abdomen and pelvis was performed with intravenous contrast material in the emergency department. Subsequently, combined MRI and MR cholangiopancreatography of the abdomen was performed with and without intravenous contrast material for further evaluation. CT of the chest performed during the same encounter was unremarkable.

History: A 45-year-old female patient who was previously healthy presented after several weeks of fullness in the right upper quadrant of the abdomen. The patient did not experience pain, nausea, vomiting, or jaundice, and had no contributory past medical or surgical history, including no history of malignancy. Upon examination, vital signs were within normal limits and the patient was appeared well with soft palpable fullness in the right upper quadrant. The abdomen was nontender and nondistended. Laboratory investigation revealed no abnormalities, with a normal complete blood cell count and normal serum tumor markers that included α-fetoprotein (<2.0 ng/mL; reference, <8.3 ng/mL), cancer antigen 19-9 (21.6 U/mL; reference, <35 U/mL), and carcinoembryonic antigen (1.3 ng/mL; reference, <5 ng/mL). CT of the abdomen and pelvis was performed with intravenous contrast material in the emergency department (Fig 1). Subsequently, combined MRI and MR cholangiopancreatography of the abdomen was performed with and without intravenous contrast material for further evaluation (Fig 2). CT of the chest performed during the same encounter was unremarkable.

Chronic pancreatitis is an inflammatory condition of the pancreas with clinical manifestations ranging from abdominal pain, acute pancreatitis, exocrine and/or endocrine dysfunction, and pancreatic cancer. There is a need for longitudinal studies in well-phenotyped patients to ascertain the utility of cross-sectional imaging findings of chronic pancreatitis for diagnosis and assessment of disease severity. CT and MR cholangiopancreatography are the most common cross-sectional imaging studies performed for the evaluation of chronic pancreatitis. Currently, there are no universal reporting standards for chronic pancreatitis. Several features of chronic pancreatitis are applied clinically, such as calcifications, parenchymal T1 signal changes, focal or diffuse gland atrophy, or irregular contour of the gland. Such findings have not been incorporated into standardized diagnostic criteria. There is also lack of consensus on quantification of disease severity in chronic pancreatitis, other than by using ductal features alone as described in the Cambridge classification. The Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC) was established by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Cancer Institute in 2015 to undertake collaborative studies on chronic pancreatitis, diabetes mellitus, and pancreatic adenocarcinoma. CPDPC investigators from the Adult Chronic Pancreatitis Working Group were tasked with development of a new consensus approach to reporting features of chronic pancreatitis aimed to standardize diagnosis and assessment of disease severity for clinical trials. This consensus statement presents and defines features of chronic pancreatitis along with recommended reporting metrics. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Megibow in this issue.

Purpose To develop a three-dimensional breath-hold (BH) magnetic resonance (MR) cholangiopancreatographic protocol with sampling perfection with application-optimized contrast using different flip-angle evolutions (SPACE) acquisition and sparsity-based iterative reconstruction (SPARSE) of prospectively sampled 5% k-space data and to compare the results with conventional respiratory-triggered (RT) acquisition. Materials and Methods This HIPAA-compliant prospective study was institutional review board approved. Twenty-nine patients underwent conventional RT SPACE and BH-accelerated SPACE acquisition with 5% k-space sampling at 3 T. Spatial resolution and other parameters were matched when possible. BH SPACE images were reconstructed by enforcing joint multicoil sparsity in the wavelet domain (SPARSE-SPACE). Two board-certified radiologists independently evaluated BH SPARSE-SPACE and RT SPACE images for image quality parameters in the pancreatic duct and common bile duct by using a five-point scale. The Wilcoxon signed-rank test was used to compare BH SPARSE-SPACE and RT SPACE images. Results Acquisition time for BH SPARSE-SPACE was 20 seconds, which was significantly (P < .001) shorter than that for RT SPACE (mean ± standard deviation, 338.8 sec ± 69.1). Overall image quality scores were higher for BH SPARSE-SPACE than for RT SPACE images for both readers for the proximal, middle, and distal pancreatic duct, but the difference was not statistically significant (P > .05). For reader 1, distal common bile duct scores were significantly higher with BH SPARSE-SPACE acquisition (P = .036). More patients had acceptable or better overall image quality (scores ≥ 3) with BH SPARSE-SPACE than with RT SPACE acquisition, respectively, for the proximal (23 of 29 [79%] vs 22 of 29 [76%]), middle (22 of 29 [76%] vs 18 of 29 [62%]), and distal (20 of 29 [69%] vs 13 of 29 [45%]) pancreatic duct and the proximal (25 of 28 [89%] vs 22 of 28 [79%]) and distal (25 of 28 [89%] vs 24 of 28 [86%]) common bile duct. Conclusion BH SPARSE-SPACE showed similar or superior image quality for the pancreatic and common duct compared with that of RT SPACE despite 17-fold shorter acquisition time. (©) RSNA, 2016.

Purpose: To determine the cumulative incidence, disease-specific mortality, and all-cause mortality of pancreatic cancer (PC) in patients with intraductal papillary mucinous neoplasms (IPMNs) and to identify imaging findings that are associated with these outcomes., Materials and Methods: This retrospective study had institutional review board approval, and the need to obtain patient consent was waived. Data from an electronic database were analyzed and supplemented by chart reviews for 285 patients with nonresected IPMNs who were periodically followed up with imaging (1273 multidetector computed tomography and 750 magnetic resonance cholangiopancreatography examinations). The Kaplan-Meier method was used to estimate the cumulative development of PC, PC mortality, and all-cause mortality (factors were compared by using the log-rank test)., Results: Over a median imaging follow-up period of 39 months, 12 (4.2%) of 285 patients developed PC; the cumulative 5-year PC incidence was 3.9% for branch duct (BD)-IPMNs, 45.5% for main duct (MD)-IPMNs (P < .01), 7.7% for cysts 30 mm or larger, and 5.3% for cysts smaller than 30 mm (P = .82). Over a median survival follow-up period of 47.5 months, seven (2.5%) of 285 patients died of PC and 14 (4.9%) patients died of other causes. Cumulative 5-year PC mortality was 2.1% for BD-IPMNs, 18.5% for MD-IPMNs (P < .01), 2.6% for cysts 30 mm or larger, and 2.8% for cysts smaller than 30 mm (P = .90). Cumulative 5-year all-cause mortality was 5.5% for BD-IPMNs, 18.5% for MD-IPMNs (P < .01), 12.5% for cysts 30 mm or larger, and 5.9% for cysts smaller than 30 mm (P = .89)., Conclusion: Five-year PC development, disease-specific mortality, and all-cause mortality were approximately 4%, 2%, and 6% for BD-IPMNs and 46%, 19%, and 19% for MD-IPMNs, respectively. The presence of an MD-IPMN, but not cyst size, was significantly associated with PC development and subsequent mortality., (© RSNA, 2015)

Purpose: To determine the feasibility of directly and noninvasively visualizing physiologic bile flow in the extrahepatic bile duct by means of nonpharmacologic cine-dynamic magnetic resonance (MR) cholangiopancreatography with a spatially selective inversion-recovery (IR) pulse and assess the flow dynamic pattern of bile in the extrahepatic bile duct., Materials and Methods: The institutional review board approved this retrospective study and waived the need for informed consent. Thirty-five patients without known pancreatobiliary diseases and 11 patients with dilatation of the extrahepatic bile duct were included. Cine-dynamic MR cholangiopancreatography with a spatially selective IR pulse was performed by imaging every 15 seconds over a 5-minute interval (20 images acquired total). The images were evaluated for the visualization of bile flow, the frequency that bile flow was observed in the extrahepatic bile duct, and the distance the bile moved within the area of the IR pulse. Statistical analysis was performed by using Spearman rank correlation coefficient and Mann-Whitney U tests., Results: Antegrade bile flow was observed in 29 of 35 patients (83%) in the nondilated group. Bile flow was observed much more frequently in the nondilated group than in the dilated group (4.4 times vs 1.8 times, P = .029). The distance that bile moved forward within the area of the IR pulse was significantly greater in the nondilated group than in the dilated group (mean grade, 0.44 vs 0.14; P = .033), suggesting stagnation or slowdown of antegrade bile flow in patients with biliary dilatation. Reversed bile flow was also observed in 26 of 35 patients (74%) in the nondilated group without biliary diseases., Conclusion: Nonpharmacologic cine-dynamic MR cholangiopancreatography with a spatially selective IR pulse allows direct and noninvasive visualization of bile flow in the extrahepatic bile duct, demonstrating that reversed bile flow is a physiologic phenomenon., (RSNA, 2013)

Purpose: To assess the feasibility of visualizing noninvasively the physiologic flow of pancreatic juice by using serial magnetic resonance cholangiopancreatography (MRCP) with a spatially selective inversion-recovery (IR) pulse in volunteers and patients with pancreatic disease., Materials and Methods: The study was approved by the institutional review board, and informed consent was obtained. Twelve healthy volunteers and three patients with acute pancreatitis were included. MRCP with a spatially selective IR pulse was repeatedly performed every 15 seconds during a total of 10 minutes (total of 40 images). MRCP images were evaluated for the presence, frequency, and magnitude of pancreatic juice inflow within the tagged area. The two groups were compared by using the Mann-Whitney test., Results: Pancreatic juice inflow was observed in all healthy volunteers and in two of three patients with acute pancreatitis. The pancreatic fluid inflow was observed 25-37 times (median, 32 times; mean, 31.4 times; range, 25-37 times) in a series of 40 images in 12 healthy volunteers, while it was seen 0-11 times (median, 2 times; mean, 4.3 times; range, 0-11 times) in a series of 40 images in the three patients with acute pancreatitis (P = .009). No regularity in the timing of the pancreatic fluid inflow was noted. The distance that the pancreatic fluid moved in the pancreatic duct within the tagged area was significantly longer in healthy volunteers (median grade, 2.46; mean grade, 2.41; range, 1.6-3.3) than in patients with acute pancreatitis (median grade, 0.05; mean grade, 0.13; range, 0-0.35) (P = .009)., Conclusion: The physiologic flow of the pancreatic juice can be visualized noninvasively with serial MRCP by using a spatially selective IR pulse., (RSNA, 2011)

Purpose: To determine and describe the magnetic resonance (MR) imaging-MR cholangiopancreatographic pancreatic and extrapancreatic findings of autoimmune pancreatitis (AIP) and the probability, site, and MR features of recurrent AIP after steroid therapy., Materials and Methods: This retrospective study was approved by the institutional review board, and the requirement for informed patient consent was waived. The data of 27 patients with AIP were included in the study. All patients had undergone MR imaging with MR cholangiopancreatography before and after steroid treatment and during follow-up (median follow-up period, 45 months). Image analysis included assessment of pancreatic parenchyma enlargement, signal intensity on T1- and T2-weighted MR images, contrast enhancement, and presence of bile duct and/or renal involvement. The probability of AIP recurrence was assessed by using Kaplan-Meier curves and the unadjusted Cox model., Results: At the time of diagnosis, the AIP-affected pancreatic parenchyma showed diffuse enlargement in 14 (52%) of the 27 patients and segmental enlargement in 13 (48%). The pancreatic parenchyma appeared hypointense on T1-weighted images in all 27 (100%) patients, hyperintense on T2-weighted images in 25 (93%), and isointense in two (7%). During the pancreatic phase of the dynamic contrast material-enhanced study, the affected pancreatic parenchyma appeared hypointense in 25 (93%) patients and isointense in two (7%). During the portal venous and delayed phases, the images of 19 (70%) patients showed delayed enhancement. Bile duct involvement was observed in 10 (37%) patients, and renal involvement was observed in two (7%). After steroid treatment, six (22%) patients had recurrent AIP, with a median disease-free interval of 20.6 months. The sites of recurrence were the pancreas and the kidneys in three of the six patients, solely the pancreas in two patients, and the biliary ducts in one patient., Conclusion: MR imaging with MR cholangiopancreatography enables the diagnosis of pancreatic and extrapancreatic AIP and the assessment of changes after steroid therapy., (© RSNA, 2011.)

Purpose: To describe the magnetic resonance (MR) findings of intraductal growing (IDG)-type cholangiocarcinoma (CC) and to identify the features that differentiate it from nodular-type CC., Materials and Methods: The institutional review board approved this retrospective study and waived the informed consent requirement. Thirty-nine patients with pathologically proved IDG-type (n = 19) or nodular-type (n = 20) CCs who had undergone preoperative gadolinium-enhanced MR imaging with MR cholangiography were included in this study. Analysis of MR findings included determination of the (a) shape, enhancement degree, and pattern of the tumor; (b) outer caliber of the tumor-bearing segment; and (c) presence of tumor multiplicity, upstream and downstream bile duct dilatation, bile duct wall thickening adjacent to the tumor, and adjacent organ invasion. The significance of these findings was determined with the χ² test., Results: Significant features in the differentiation of IDG-type CCs from nodular-type CCs included papillary or irregular polypoid shape, lack of constriction of the tumor-bearing segment, hypoenhancement of the tumor to the liver during the equilibrium phase, tumor multiplicity, upstream and downstream bile duct dilatation, and no bile duct wall thickening adjacent to the tumor (P < .05). When at least two of these six imaging features were used in combination, sensitivity and specificity in the diagnosis of IDG-type CCs were 95% and 70%, respectively., Conclusion: By using characteristic MR features, one can differentiate IDG-type CC from nodular-type CC with a high degree of accuracy at biliary MR imaging with MR cholangiography., (© RSNA, 2010.)

Purpose: To define the differential imaging features of pancreatobiliary- and intestinal-type ampullary carcinomas at magnetic resonance (MR) imaging and to correlate these features with pathologic findings., Materials and Methods: This retrospective study was approved by the institutional review board; informed consent was waived. Fifty patients with surgically confirmed ampullary carcinoma and preoperative MR results were included. Two radiologists, blinded to histologic type of cancer, evaluated imaging findings in consensus. Univariate and multiple logistic regression analysis were performed to define imaging findings that were useful for differentiation of the two types of carcinomas., Results: On the basis of hematoxylin-eosin and immunohistochemical staining, 35 patients were classified as having pancreatobiliary type; and 15 patients, intestinal type. At MR, all of 15 intestinal carcinomas were nodular, whereas 16 (46%) of 35 pancreatobiliary carcinomas were infiltrative. Intestinal carcinomas were isointense (13 [87%] of 15) to hyperintense (two [13%] of 15), whereas 34% (12 of 35) of pancreatobiliary carcinomas manifested as hypointense compared with the duodenum on T2-weighted MR images (P = .034). Intestinal carcinoma commonly manifested with an oval filling defect at the distal end of the bile duct on MR cholangiopancreatographic (MRCP) images (11 [73%] of 15 vs four [11%] of 35 in pancreatobiliary type) (P < .001). At endoscopy, intestinal carcinoma manifested with an extramural protruding mass (n = 15, 100%) with a papillary surface (n = 11, 73%), whereas pancreatobiliary carcinoma manifested with intramural protruding (n = 5, 28%) or ulcerating (n = 1, 6%) gross morphologic features (P = .047) with a nonpapillary surface (n = 17, 94%) (P < .001). Multiple logistic regression analysis showed that an oval filling defect at the distal end of the bile duct was the only independent finding for differentiating intestinal from pancreatobiliary carcinoma (P = .027)., Conclusion: An oval filling defect at the distal end of the bile duct on MRCP images and an extramural protruding appearance with a papillary surface at endoscopy are likely to suggest intestinal ampullary carcinoma., (© RSNA, 2010.)

Purpose: To compare the image quality and diagnostic performance with T2-weighted magnetic resonance (MR) cholangiopancreatographic images obtained before and after dynamic MR imaging performed with gadoxetic acid., Materials and Methods: This retrospective study was approved by the institutional review board, and informed consent was waived. Fifty-six patients suspected of having pancreatic or biliary disease underwent two-dimensional (2D) single-section and three-dimensional (3D) multisection MR cholangiopancreatography before and after dynamic imaging with gadoxetic acid. One radiologist measured the mean signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) of the common bile duct on precontrast and postcontrast images. Two radiologists independently reviewed the 2D and 3D MR cholangiopancreatographic images in random order. The depiction of each segment of the pancreaticobiliary duct, the presence of artifacts, background suppression, and overall image quality were assessed according to a four-point scale. Paired t, McNemar, and Wilcoxon signed rank tests were performed with a power analysis. Interobserver agreement was assessed by using the kappa statistic., Results: Mean SNRs at precontrast MR imaging (2D, 50.8 +/- 45.1 [standard deviation]; 3D, 54.7 +/- 25.5) were similar to those at postcontrast MR imaging (2D, 48.5 +/- 45.7; 3D, 51.5 +/- 21.6). Mean CNRs were also similar between precontrast and postcontrast MR imaging (2D, 45.5 +/- 43.0 vs 44.2 +/- 45.2; 3D, 51.4 +/- 24.3 vs 48.7 +/- 21.0). Depiction scores for each segment of the pancreaticobiliary duct were also similar between 2D and 3D precontrast and postcontrast images. Both radiologists found that scores for background suppression were improved on postcontrast 2D MR images (3.79 and 3.84) compared with precontrast images (3.25 and 3.64). One of the two radiologists found that scores for artifacts (precontrast, 1.23; postcontrast, 1.09) and for overall image quality (precontrast, 3.54; postcontrast, 3.71) were improved at 2D postcontrast MR cholangiopancreatography., Conclusion: Both 2D and 3D MR cholangiopancreatography can be effectively performed immediately after gadoxetic acid-enhanced dynamic MR imaging in patients suspected of having biliary or pancreatic disease.

Purpose: To test the null hypothesis that there is no quantitative or qualitative difference between respiratory-triggered three-dimensional (3D) T2-weighted magnetic resonance (MR) cholangiography performed before or after administration of gadoxetate disodium., Materials and Methods: For this retrospective HIPAA-compliant dual-center study, institutional review board approval was obtained, and a waiver of informed consent was granted. Between July and December 2008, 60 patients (age range, 18-82 years) who were referred for liver MR imaging with gadoxetate disodium underwent respiratory-triggered 3D MR cholangiography before and immediately after completion of portal venous phase contrast material-enhanced T1-weighted MR imaging. Quantitative signal-to-noise ratio (SNR) measurements were obtained in the extrahepatic biliary tract in both MR cholangiographic data sets in each patient. Qualitative assessment was performed by four readers with a four-point scale to assess the depiction of extra- and intrahepatic ducts up to the third order. Statistical analysis consisted of a one-sided Wilcoxon signed rank test, with a P value of less than .05 indicating a significant difference., Results: There was a significant decrease in mean SNR in the MR cholangiographic data set after injection of gadoxetate disodium. SNR was 96 + or - 50 [standard deviation] and 78 + or - 47 before and after contrast media administration, respectively (P < .0001). For all readers, qualitative differences were most obvious in the depiction of the common bile duct and second- and third-order biliary branches, with the precontrast MR cholangiographic data sets being preferred (P < .0001). Precontrast data sets were also significantly preferred in the assessment of the right and left hepatic ducts by all readers., Conclusion: Gadoxetate disodium adversely affects respiratory-triggered 3D MR cholangiography, both qualitatively and quantitatively. We recommend that such a sequence be performed before injection of gadoxetate disodium.

Purpose: To intraindividually compare the accuracy of magnetic resonance (MR) cholangiography at 3.0 and 1.5 T for depicting biliary anatomy with intraoperative cholangiography as the reference standard and to compare the image quality for biliary tract visualization at these two field strengths., Materials and Methods: After obtaining institutional review board approval and informed consent, 52 living potential liver donors underwent MR cholangiography at both 1.5 and 3.0 T. The protocol included projectional single-section rapid acquisition with relaxation enhancement (RARE) and respiratory-triggered three-dimensional (3D) fast spin-echo (SE) T2-weighted sequences. Two readers independently analyzed images, scoring the visualization of all first- and second-order biliary branches on a four-point scale and determining the number of visible third-order branches., Results: MR cholangiography at 3.0 T correctly depicted biliary anatomy in 90.4% of subjects on combined analysis of both sequences by both readers, in 88.5% with projectional RARE images for both readers, and in 84.6% and 88.5% with 3D fast SE images for readers 1 and 2, respectively. MR cholangiography at 1.5 T showed 86.5% and 84.6% accuracy on combined analysis for readers 1 and 2, respectively; 78.8% and 75.0% accuracy on projectional RARE images for readers 1 and 2, respectively; and 84.6% and 86.5% accuracy with 3D fast SE images for readers 1 and 2, respectively. With the projectional RARE sequence, 3.0-T MR cholangiography demonstrated significantly higher mean visualization scores for second-order branches (reader 1: 2.29 vs 1.78, P = .01; reader 2: 2.52 vs 2.10, P < .01) and mean numbers of visible third-order branches (reader 1: 5.53 vs 4.21, P < .01; reader 2: 5.91 vs 3.74, P < .01) than did 1.5-T MR cholangiography., Conclusion: Compared with 1.5-T MR cholangiography, 3.0-T MR cholangiography did not significantly increase accuracy for identification of biliary anatomy. Projectional RARE images at 3.0 T enabled better visualization of second- and third-order branches than did those at 1.5 T., ((c) RSNA, 2010)

Purpose: To prospectively measure pancreatic apparent diffusion coefficient (ADC) before and after secretin administration in subjects with and without chronic pancreatitis (CP) who underwent magnetic resonance (MR) cholangiopancreatography with diffusion-weighted (DW) imaging at 3.0 T., Materials and Methods: Institutional review board approval of this HIPAA-compliant study was obtained. Healthy volunteers, and patients with suspected and/or known CP who were scheduled for MR cholangiopancreatography, were recruited and gave written informed consent. All subjects underwent 3.0-T MR cholangiopancreatography, including serial DW imaging sequences (b = 0, 200, and 400 sec/mm(2)) acquired for 15 minutes after secretin administration. The referring gastroenterologist then classified subjects as healthy or with mild or severe CP, given endoscopic retrograde cholangiopancreatographic and/or clinical findings. CP severity was analyzed for sex and age. Mean presecretin and maximum postsecretin ADCs were compared between groups. Pairwise mean ADCs for healthy versus mild CP patient groups, healthy versus severe CP patient groups, and mild versus severe CP patient groups were compared. Presecretin ADC threshold levels for CP discrimination were calculated (P < .05)., Results: Thirty-two subjects were imaged; four CP patients were excluded owing to severe artifact, and the remaining 28 (15 healthy patients, five with mild CP, and eight with severe CP) comprised the study population. All CP patients had endoscopic retrograde cholangiopancreatographic confirmation of CP. Mild or severe CP patients were older than healthy patients; sex distribution did not vary among groups. Mean presecretin and maximum postsecretin ADCs were higher in healthy patients than in either mild or severe CP groups (P < .01), but did not vary between mild and severe CP groups (P = .25-0.28). An ADC of less than 220 x 10(-5) mm(2)/sec was optimal for delineating between healthy and CP patients., Conclusion: Pancreatic ADC obtained with DW imaging at 3.0 T prior to secretin administration may help diagnose CP; postsecretin ADC response does not distinguish CP severity.

Purpose: To retrospectively assess the diagnostic performance of magnetic resonance cholangiopancreatography (MRCP) performed by using a high-spatial-resolution isotropic three-dimensional (3D) fast-recovery fast spin-echo (FSE) sequence with parallel imaging for the evaluation of possible biliary disease., Materials and Methods: This HIPAA-compliant study was approved by the institutional review board; informed consent was waived. Ninety-five patients (58 female, 37 male; mean age, 51 years; range, 15-91 years) underwent MRCP by using the respiratory-triggered isotropic 3D fast-recovery FSE sequence and endoscopic or percutaneous direct visualization between March 2003 and June 2007. Two independent readers evaluated the MRCP images for strictures, dilatation, and intraductal filling defects. Sensitivity, specificity, and interobserver agreement (kappa statistics) were determined., Results: The respective sensitivity and specificity for strictures, dilatation, and intraductal filling defects (all choledocholithiasis) were 86% (40 of 47) and 94% (45 of 48), 98% (57 of 58) and 100% (37 of 37), and 68% (19 of 28) and 97% (65 of 67) for reader 1 and 88% (41 of 47) and 94% (45 of 48), 96% (56 of 58) and 100% (37 of 37), and 75% (21 of 28) and 99% (66 of 67) for reader 2. The sensitivity for stones larger than 3 mm was 94% (15 of 16) for reader 1 and 100% (16 of 16) for reader 2, whereas the sensitivity for stones 3 mm or smaller was 33% (four of 12) for reader 1 and 42% (five of 12) for reader 2. Agreement between readers was good to excellent, with kappa values of 0.76, 0.85, and 0.98 for strictures, dilatation, and choledocholithiasis, respectively., Conclusion: MRCP by using the respiratory-triggered isotropic 3D fast-recovery FSE sequence with parallel imaging demonstrates excellent diagnostic capabilities for possible biliary disease, although it is limited for stones 3 mm or smaller in size., (RSNA, 2008)

This HIPAA-compliant study had institutional review board approval, with waiver of informed consent. The purpose was to test the hypothesis that, compared with a standard magnetic resonance (MR) cholangiography sequence, MR cholangiography with a sampling perfection with application optimized contrasts using different flip angle evolutions (SPACE) sequence reduces ghosting artifacts while maintaining image quality and sufficient contrast-to-noise ratio (CNR) at 3.0 T. The study population consisted of 15 women and 14 men (mean age, 47.2 years +/- 18.1 [standard deviation]) who were consecutively referred for MR cholangiography between November 2004 and November 2005. Acquisition times were lower and N/2 ghosting artifacts were eliminated with SPACE. However, the SPACE sequence yielded images that were visually grainier and had lower CNR. Overall, the readers preferred the appearance of images obtained with the SPACE sequence, most likely because of the elimination of N/2 ghosting artifacts., ((c) RSNA, 2008.)

Purpose: To retrospectively evaluate the technical quality of and the visibility of the biliary tree and pancreatic duct on magnetic resonance (MR) cholangiopancreatographic (MRCP) images obtained with a single-breath-hold three-dimensional (3D) fast-recovery fast spin-echo (FRFSE) sequence in comparison with conventional two-dimensional (2D) single-shot fast spin-echo (SSFSE) thin-section and thick-slab sequences., Materials and Methods: Institutional review board approval was obtained; informed consent was not required for this HIPAA-compliant study. MRCP was performed at 1.5 T in 53 consecutive patients (25 men and 28 women, aged 23-84 years). A single-breath-hold volume acquisition was performed by using the 3D FRFSE sequence and the conventional 2D SSFSE sequences. Two radiologists graded studies obtained with each sequence in a blinded fashion, and the paired Student t test was used to assess differences in technical quality, visibility of eight individual ductal segments of the biliary tree and pancreatic duct, and number of ductal segments visualized per patient., Results: Studies obtained with 3D FRFSE were of significantly higher technical quality than those obtained with thin-section 2D SSFSE (P < .02 for both readers). The 3D FRFSE maximum intensity projection reconstruction and 2D SSFSE thick-slab sequence proved statistically equivalent with regard to the overall visibility of the biliary tree and pancreatic duct and the number of ductal segments visualized per patient. In comparison with 2D SSFSE thin-section imaging, however, 3D FRFSE imaging produced an improved overall duct segment visibility grade of 0.45 on a three-point visibility scale (P < .001), with a corresponding average per-patient improvement of 1.9 out of eight possible fully visualized duct segments (P < .001)., Conclusion: The 3D FRFSE sequence shows promise for improved visibility of the pancreatic duct and biliary tree, compared with the conventional 2D SSFSE thin-section and thick-slab approach, while permitting the entire MRCP examination to be performed in a single breath hold., ((c) RSNA, 2005)

Purpose: To retrospectively compare accuracy of multi-detector row computed tomography (CT), combined with two-dimensional (2D) curved reformations, and that of magnetic resonance (MR) cholangiopancreatography (MRCP) for characterization of intraductal papillary mucinous neoplasm (IPMN) as malignant, with pathologic examination as reference standard., Materials and Methods: Institutional review board approval was obtained, informed consent was waived, and study was HIPAA compliant. Twenty-five patients (12 women, 13 men; age range, 44-88 years) with pathologically proved IPMN were examined with dual-phase CT with 1.25-mm-thick sections for pancreatic phase; 2D curved reformations along main pancreatic duct (MPD) were generated. T2-weighted MRCP included thick- and thin-slab single-shot fast spin-echo imaging and transverse fast spin-echo imaging. Two radiologists, blinded to surgical and pathologic findings, evaluated images for lesion location, septa, mural nodules, communication with MPD, extent and diameter of MPD dilatation, calcifications, and vascular encasement. Malignancy was suspected when one of the following was present: MPD diameter larger than 10 mm, mural nodules, vascular encasement, peripancreatic lymphadenopathy, or metastases. Sensitivity and specificity values for prediction of malignancy were calculated for CT and MRCP. Interobserver variability was determined (kappa analysis)., Results: Excellent correlation between modalities was observed. Cyst communication was seen in 20 and 21 of 24 branch pancreatic duct (BPD) IPMNs with CT and MRCP, respectively. Sensitivity, specificity, and accuracy for detection of malignancy were 70%, 87%, and 76% (CT) and 70%, 92%, and 80% (MRCP), respectively. Interobserver agreement was good to perfect for both readers in all comparisons (overall, kappa = 0.70-1.00)., Conclusion: CT combined with 2D curved reformation can provide imaging details of IPMN, including communication of BPD IPMN with MPD, that are almost equivalent to those provided at MRCP. Presence of mural nodules, dilated MPD (>10-mm diameter), or thick septa at CT or MRCP may be used as independent predictors of malignancy., ((c) RSNA, 2005)