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Biliary cancer, also known as cholangiocarcinoma, is a primary malignant epithelial neoplasm arising in the bile duct. Cholangiocarcinoma can be classified into intrahepatic, perihilar, and distal cholangiocarcinoma according to anatomic location. Multiphase thin-section computed tomography is the primary imaging modality for diagnosis and treatment planning. MR imaging with magnetic resonance cholangiopancreatography provides additional information for differential diagnosis, complex biliary anatomy, and tumor extent. For preoperative assessment of extrahepatic cholangiocarcinoma, longitudinal tumor extent, vascular involvement, lymph node and distant metastasis, and remnant liver volume are the key features. The adoption of recent advances in imaging techniques enables enhanced image quality and helps to offer optimal treatment options., Competing Interests: Disclosure Conflict of Interest: None of the authors have any conflicts of interest to declare., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Imaging of the biliary system has improved and has allowed MR to become a key noninvasive tool for evaluation of the biliary system. A variety of magnetic resonance cholangiopancreatography techniques have been developed, with improved visualization of the biliary system and biliary pathology. Key avenues of advancement include increasing the speed of acquisition, improving spatial resolution, and reducing artifacts. T1-weighted imaging using gadolinium-based hepatobiliary contrast agents allows for evaluation in additional indications, such as liver donor evaluation, biliary leak identification, and choledochal cyst confirmation. There is potential for further increased utility of MR in the evaluation of the biliary system., Competing Interests: Disclosure B.M. Yeh disclosures: Grants: General Electric Healthcare, Guerbet, Philips Healthcare, NIH. Consultant: General Electric Healthcare. Speaker: General Electric Healthcare, Philips Healthcare. Shareholder: Nextrast, Inc. Book Royalties: Oxford University Press. No Other Disclosures., (Copyright © 2020 Elsevier Inc. All rights reserved.)

MR imaging can be optimized to evaluate a spectrum of pancreatic disorders with advanced sequences aimed to provide quantitative results and increase MR diagnostic capabilities. The pancreas remains a challenging organ to image because of its small size and location deep within the body. Besides its anatomic limitations, pancreatic pathology can be difficult to identify in the early stages. For example, subtle changes in ductal anatomy and parenchymal composition seen in early chronic pancreatitis are imperceptible with other modalities, such as computed tomography. This article reviews the application of MR imaging techniques and emerging MR sequences used in pancreas imaging., Competing Interests: Disclosure Dr T. Tirkes is supported by National Cancer Institute and National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award numbers 1R01DK116963 and U01DK108323 (Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health., (Copyright © 2020 Elsevier Inc. All rights reserved.)

This article presents the magnetic resonance protocols, imaging features, diagnostic criteria, and complications of commonly encountered emergencies in pancreaticobiliary imaging. Pancreatic trauma, bile leak, acute cholecystitis, biliary obstruction, and pancreatitis are discussed. Various classifications and complications that can arise with these conditions, as well as artifacts that may mimic pathology, are also included., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background/purpose: Various different regimes exist for the treatment of hereditary pancreatitis in childhood. Here, we propose a therapeutic pathway with emphasis on endoscopic and surgical procedures., Methods: From 2006 to 2013, 12 patients with a diagnosis of hereditary pancreatitis were prospectively included in a therapeutic step-up schema. The treatment outcome was evaluated and correlated to aetiological factors and pathoanatomic findings., Results: After diagnostic work-up (laboratory data, ultrasound examination, magnetic resonance cholangiopancreatography and genetic testing), all 12 patients underwent early endoscopic retrograde cholangiopancreatography (ERCP), which was successfully performed in ten children. Obstructive pancreatitis was found in eight children, and required sphincterotomy, dilation and stenting for 12 months. In two children with unsuccessful ERCP, open surgical drainage procedures were performed. After a mean follow-up of 32 months all children are free of recurrence of pancreatitis without any impairment of everyday activities., Conclusions: For children with hereditary pancreatitis, a therapeutic step plan with early ERCP and open surgical drainage procedures in case of impossible or insufficient endoscopic treatment prevents recurring pancreatitis and offers a normal quality of life without any major complications., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Magnetic resonance cholangiopancreatography (MRCP) is an extremely useful tool for evaluating a wide variety of disorders affecting the pancreaticobiliary system in neonates/infants, children, and adolescents. This imaging technique has numerous distinct advantages over alternative diagnostic modalities, such as endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography, including its noninvasive nature and lack of ionizing radiation. Such advantages make MRCP the preferred first-line method for advanced imaging the pediatric pancreaticobiliary tree, after ultrasonography. This article presents a contemporary review of the use of MRCP in the pediatric population, including techniques, indications, and the imaging appearances of common and uncommon pediatric disorders., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Pancreatic magnetic resonance (MR) imaging has become a useful tool in evaluating pancreatic disorders. Technical innovations in MR imaging have evolved over the last decade, with most sequences being performed in one or a few breath-holds. Three-dimensional sequences with thin, contiguous slices allow for improved spatial resolution on the postgadolinium images and MR cholangiopancreatography (MRCP). The diagnostic potential of MRCP is equivalent to endoscopic retrograde pancreatography, particularly when intravenous secretin is used to enhance the pancreatic duct assessment. This article highlights the advantages and disadvantages of state-of-the-art and emerging pulse sequences and their application to imaging pancreatic diseases., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Multiple disorders may cause chronic pancreatitis (CP) through recurrent inflammation of the pancreatic parenchyma. Chronic calcifying pancreatitis caused by excessive alcohol intake accounts for most cases of CP. However, there are multiple other causes of CP, including obstructive chronic pancreatitis, autoimmune pancreatitis, groove pancreatitis, tropical, and hereditary pancreatitis. This article reviews the multiple imaging techniques, some of which are accepted as first-line modalities in patients with suspected CP, and the imaging features associated with the different causes of CP., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Magnetic resonance cholangiopancreatography (MRCP) is an elegant MR technique for noninvasively delineating the biliary system. Technologic advances in MRCP acquisition and processing and the routine availability of three-dimensional sequences have facilitated detailed assessment of biliary anatomy and pathologic or congenital processes; therefore, invasive endoscopic retrograde cholangiopancreatography is rarely needed for establishing a diagnosis. MRCP can be combined with contrast-enhanced MR imaging to enable concurrent evaluation of organs such as the liver and pancreas in addition to functional biliary imaging. This review focuses on the current use of MRCP to evaluate nonmalignant processes affecting the biliary system., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Objective: The aim of this study is to report the technical details, early outcomes, and lessons learned from laparoscopic repair of 190 cases of choledochal cyst., Method: The operation was performed using 4 ports. The cystic duct was identified and divided. The liver was elevated by 2 stay-sutures: one on the round ligament and the other on the distal cystic duct. The choledochal cyst was isolated and removed completely, and then biliary-digestive continuity was reestablished., Results: From January 2007 to April 2009, 190 patients were operated on. There were 144 girls and 46 boys. Ages ranged from 2 months to 16 years (mean, 46.9 +/- 29.3 months). Cyst diameter ranged from 10 to 184 mm. A total of 106 patients were classified as Todani type I cysts, and 84 were type IV. Cystic excision and hepaticoduodenostomy were performed in 133 patients and hepaticojejunostomy in 57 patients. The operating time varied from 70 to 505 minutes (mean, 186 minutes). Conversion to open surgery was required in 2 patients. Intraoperative blood transfusion was required in 4 patients. There were no perioperative deaths. Postoperative anastomotic leakage occurred in 7 patients, resolving spontaneously in 6 and requiring a second operation in 1. Postoperative hospital stay ranged from 5 to 27 days (mean, 7.2 +/- 3.3 days). Follow-up occurred between 1 and 24 months postdischarge (mean, 9 +/- 2.2 months) and was obtained in 161 patients (84.7%). Of these patients, cholangitis occurred in 4 patients (2.4%)., Conclusion: Laparoscopic repair is a safe and effective procedure for choledochal cyst.

Introduction: We routinely perform intraoperative endoscopy (IOE) of the intrahepatic bile duct (IHBD) and intrapancreatic bile duct (IPBD) with a pediatric cystoscope during excision of choledochal cyst (CC). Here we compare extended long-term follow-up patients with a series of recent cases., Methods: We compared 25 CC patients treated over the past 5 years (group 1) with 69 CC patients treated between 1986 and 1998 and followed up for more than 10 years (group 2), focusing on stone formation., Results: In group 1 (mean follow-up, 2.6 years) IOE identified IHBD debris in 7 (28%) of 25 and IPBD protein plugs in 9 (36%) of 25. In group 2 (mean follow-up, 14.6 years) IOE identified IHBD debris in 11 (16%) of 69 and IPBD protein plugs in 17 (25%) of 69. There was no relation between type of CC and incidence of IHBD debris or IPBD protein plugs. The incidence of postoperative stones to date is 0% in group 1 and 2.9% in group 2, rates far lower than those reported in the literature., Conclusions: We attribute our lower incidence of stones directly to IOE and recommend that it be performed routinely during cyst excision. It is simple, is effective, and improves outcome., (Copyright 2010 Elsevier Inc. All rights reserved.)

Magnetic resonance cholangiopancreatography (MRCP) has become established as an essential modality in the evaluation of pancreatic and biliary abnormalities in children. New advances, such as faster imaging parameters, newer sequences, and contrast agents, are available to improve image quality. This article discusses conventional and advanced MRCP techniques used in children and applications of the techniques in evaluating common diseases of the pancreas and biliary tree.

Soon after its introduction in 1991, MR cholangiopancreatography has become an established diagnostic tool for the evaluation of the pancreaticobiliary ductal system at a field strength of 1.5T. It remains unclear whether MR cholangiopancreatography performed at 3T will benefit from the higher magnetic field strength or whether a field strength of 1.5T should continue to be considered the gold standard for MR cholangiopancreatography. This article reviews the current literature on the benefits and drawbacks of MR cholangiopancreatography at 3T compared with a standard field strength of 1.5T. Field strength-related artifacts that affect MR cholangiopancreatography at 3T also are discussed.

Background/purpose: Refluxes through pancreaticobiliary maljunctions play an important role in the pathophysiology of choledochal cysts. Dynamic studies of the pancreaticobiliary tract were performed using secretin-stimulated magnetic resonance cholangiopancreatography., Methods: Six patients with choledochal dilation were recruited for this study. Four patients exhibited cystic and 2 exhibited fusiform dilatation of the common bile duct (CBD). Magnetic resonance cholangiopancreatography images were obtained every minute during the 15-minute period after secretin stimulation. The sequential morphological changes in the biliary trees, pancreas, and duodenum were assessed, and the total pixel values of these organs were measured for each image, then plotted as a ratio against the baseline image., Results: In 2 cases involving cystic dilatation, the intensity of bile duct images continued to rise after secretin stimulation. In a case involving fusiform dilatation, a transitory elevation in CBD intensity was observed. In 3 cases involving fusiform or cystic dilatation, the intensity of CBD did not change notably. In all cases, the duodenum was filled well after secretin stimulation., Conclusions: The sustained elevation in bile duct intensity after secretin stimulation indicates reflux and bile stasis. Transitory elevation may indicate reflux without stasis. This method allows assessment of the dynamics of pancreatic and bile fluid under more physiologic condition.

Purpose: A new generation of magnetic resonance imaging scanner offers a 3-dimensional magnetic resonance cholangiopancreatography (MRCP) with very high spatial resolution using a non-breath-hold technique with prospective navigator gating. The study aimed to investigate the new technology of the MRCP in infants with suspected pancreaticobiliary diseases., Methods: Seven patients (4 girls, 3 boys; mean age, 2.8 years; range, 3 months to 5.6 years) were examined. All patients underwent magnetic resonance imaging examination using a 1.5-T whole-body scanner (Magnetom Avanto, Siemens Medical, Erlangen, Germany). For MRCP, a heavily T2-weighted (time to echo, 678 ms) 3-dimensional turbo spin echo in coronal plane was performed with the voxel size of 1 x 1 x 1.5 mm. To enable non-breath-holding imaging, a diaphragm navigator sequence was simultaneously carried out. The MRCP findings were compared prospectively with the endoscopic retrograde cholangiopancreatography and/or with the surgical findings in 6 of 7 cases. In 1 patient, the follow-up was considered reference standard., Results: The high spatial resolution of the images without breathing artifacts allowed an excellent demonstration of all relevant pancreaticobiliary ducts and of the pathologic findings. All patients (n = 4) with choledocholithiasis were identified through MRCP. The finding of a high pancreaticobiliary junction (n = 3) was confirmed by endoscopic retrograde cholangiopancreatography in all cases. The length of the common channel ranged from 16 to 24 mm. In 1 patient, the long common channel was associated with a choledochal cyst. In a 1.7-year-old boy with recurrent abdominal pain and mild pancreatitis, the rare case of a gastric duplication with connection to the main pancreatic duct was diagnosed. A regular gastric wall with normal mucosa and parts of the duodenal wall with a circular layer of muscle (pylorus-like) were found in histology after surgical resection of the mass., Conclusion: The newly developed technique may be a reliable tool in the workup of pancreaticobiliary diseases in infants.