MR Cholangiopancreatography of Bile and Pancreatic Duct Abnormalities with Emphasis on the Single-Shot Fast Spin-Echo Technique1
Kenneth M. Vitellas, MD,
Mary T. Keogan, MD,
Charles E. Spritzer, MD and
Rendon C. Nelson, MD
1 From the Department of Radiology, Ohio State University Medical Center, S-209 Rhodes Hall, 450 W 10th Ave, Columbus, OH 43210 (K.M.V.); the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (M.T.K.); and the Department of Radiology, Duke University Medical Center, Durham, NC (C.E.S., R.C.N.). Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received April 21, 1999; revision requested May 12 and received July 13; accepted July 14. Address correspondence to K.M.V.
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Figure 1a. Normal cholangiographic findings. (a) Thick-section (20-mm) MRCP image demonstrates the posterior right bile duct incompletely (long straight solid arrow) because of volume averaging with the gallbladder (open arrow). Note the duodenum (curved arrow) and pancreatic duct (short straight solid arrows). (b) Thinner-section (10-mm) MRCP image shows the gallbladder removed from the field of view; however, a portion of the common hepatic duct has been excluded (straight arrow). Note the cystic duct (curved arrow).
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Figure 1b. Normal cholangiographic findings. (a) Thick-section (20-mm) MRCP image demonstrates the posterior right bile duct incompletely (long straight solid arrow) because of volume averaging with the gallbladder (open arrow). Note the duodenum (curved arrow) and pancreatic duct (short straight solid arrows). (b) Thinner-section (10-mm) MRCP image shows the gallbladder removed from the field of view; however, a portion of the common hepatic duct has been excluded (straight arrow). Note the cystic duct (curved arrow).
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Figure 2. Normal cholangiographic findings. Three-dimensional reconstruction MR image obtained with an MIP algorithm shows normal findings.
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Figure 3a. Normal cholangiographic findings. (a) Right posterior oblique thick-section (20-mm) MRCP image shows the distal pancreatic duct. (b, c) Straight coronal MRCP image (b) and left posterior oblique (LPO) MRCP image obtained at a shallow angle (c) show the anteriorly located common hepatic duct, left bile ducts, and more proximal pancreatic duct.
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Figure 3b. Normal cholangiographic findings. (a) Right posterior oblique thick-section (20-mm) MRCP image shows the distal pancreatic duct. (b, c) Straight coronal MRCP image (b) and left posterior oblique (LPO) MRCP image obtained at a shallow angle (c) show the anteriorly located common hepatic duct, left bile ducts, and more proximal pancreatic duct.
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Figure 3c. Normal cholangiographic findings. (a) Right posterior oblique thick-section (20-mm) MRCP image shows the distal pancreatic duct. (b, c) Straight coronal MRCP image (b) and left posterior oblique (LPO) MRCP image obtained at a shallow angle (c) show the anteriorly located common hepatic duct, left bile ducts, and more proximal pancreatic duct.
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Figure 4a. Normal cholangiographic findings. LPO MRCP images obtained at a shallow angle (a, b) and at a steep angle (c, d) 15° apart show the more posteriorly located right bile ducts, distal common bile duct, ampulla, and most distal pancreatic duct more clearly.
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Figure 4b. Normal cholangiographic findings. LPO MRCP images obtained at a shallow angle (a, b) and at a steep angle (c, d) 15° apart show the more posteriorly located right bile ducts, distal common bile duct, ampulla, and most distal pancreatic duct more clearly.
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Figure 4c. Normal cholangiographic findings. LPO MRCP images obtained at a shallow angle (a, b) and at a steep angle (c, d) 15° apart show the more posteriorly located right bile ducts, distal common bile duct, ampulla, and most distal pancreatic duct more clearly.
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Figure 4d. Normal cholangiographic findings. LPO MRCP images obtained at a shallow angle (a, b) and at a steep angle (c, d) 15° apart show the more posteriorly located right bile ducts, distal common bile duct, ampulla, and most distal pancreatic duct more clearly.
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Figure 5. Choledocholithiasis. (5) Thin-section single-shot fast spin-echo MR image shows a stone in the distal common bile duct (straight arrow) with extrahepatic and intrahepatic ductal dilatation. Note the gallstones (curved arrows).
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Figure 6a. (6a) Thin-section (3-mm) fast spin-echo MRCP image shows multiple stones in the extrahepatic bile duct (arrowheads), which produce ductal dilatation. (6b) Three-dimensional MIP reconstruction image shows the distal common bile duct stones (curved arrow), but the more proximal common bile duct stones are obscured by surrounding high-signal-intensity bile. Note the dilated pancreatic duct (straight arrows). (6c) ERCP image shows multiple common bile duct stones (arrows) and ductal dilatation.
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Figure 6b. (6a) Thin-section (3-mm) fast spin-echo MRCP image shows multiple stones in the extrahepatic bile duct (arrowheads), which produce ductal dilatation. (6b) Three-dimensional MIP reconstruction image shows the distal common bile duct stones (curved arrow), but the more proximal common bile duct stones are obscured by surrounding high-signal-intensity bile. Note the dilated pancreatic duct (straight arrows). (6c) ERCP image shows multiple common bile duct stones (arrows) and ductal dilatation.
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Figure 6c. (6a) Thin-section (3-mm) fast spin-echo MRCP image shows multiple stones in the extrahepatic bile duct (arrowheads), which produce ductal dilatation. (6b) Three-dimensional MIP reconstruction image shows the distal common bile duct stones (curved arrow), but the more proximal common bile duct stones are obscured by surrounding high-signal-intensity bile. Note the dilated pancreatic duct (straight arrows). (6c) ERCP image shows multiple common bile duct stones (arrows) and ductal dilatation.
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Figure 7. Benign stricture. Three-dimensional MIP reconstruction image from fast spin-echo MRCP shows a stricture of the ampullary portion of the common bile duct (arrow) from pancreatitis, along with proximal ductal dilatation.
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Figure 8a. Primary sclerosing cholangitis. (a) Single-shot fast spin-echo MRCP image shows multifocal strictures and dilatations of the intrahepatic bile ducts. (b) ERCP image shows similar findings.
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Figure 8b. Primary sclerosing cholangitis. (a) Single-shot fast spin-echo MRCP image shows multifocal strictures and dilatations of the intrahepatic bile ducts. (b) ERCP image shows similar findings.
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Figure 9a. Pancreatic adenocarcinoma in a 76-year-old woman with painless jaundice. (a) LPO thick-section single-shot fast spin-echo MR image obtained at a shallow angle shows dilatation of the bile duct (straight arrow) and pancreatic duct (curved arrows), findings suggestive of a pancreatic head neoplasm. Note the dilatation of the left intrahepatic bile ducts. (b) LPO MR image obtained at a steeper angle shows an abrupt, high-grade stricture of the distal common bile duct (straight arrow). Note the dilated gallbladder (curved arrow).
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Figure 9b. Pancreatic adenocarcinoma in a 76-year-old woman with painless jaundice. (a) LPO thick-section single-shot fast spin-echo MR image obtained at a shallow angle shows dilatation of the bile duct (straight arrow) and pancreatic duct (curved arrows), findings suggestive of a pancreatic head neoplasm. Note the dilatation of the left intrahepatic bile ducts. (b) LPO MR image obtained at a steeper angle shows an abrupt, high-grade stricture of the distal common bile duct (straight arrow). Note the dilated gallbladder (curved arrow).
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Figure 10a. Cholangiocarcinoma in a 29-year-old man with ulcerative colitis and primary sclerosing cholangitis who presented with jaundice and abdominal pain. (a) Single-shot fast spin-echo MRCP image shows a long, narrowed segment of the common hepatic and common bile ducts (arrows) with proximal ductal dilatation. (b) ERCP image shows a high-grade, long stricture of the common hepatic duct (arrows). Brush cytologic biopsy revealed cholangiocarcinoma. Note how the extent of the stricture was overestimated with MRCP because the common bile duct was collapsed.
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Figure 10b. Cholangiocarcinoma in a 29-year-old man with ulcerative colitis and primary sclerosing cholangitis who presented with jaundice and abdominal pain. (a) Single-shot fast spin-echo MRCP image shows a long, narrowed segment of the common hepatic and common bile ducts (arrows) with proximal ductal dilatation. (b) ERCP image shows a high-grade, long stricture of the common hepatic duct (arrows). Brush cytologic biopsy revealed cholangiocarcinoma. Note how the extent of the stricture was overestimated with MRCP because the common bile duct was collapsed.
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Figure 11. Cholangiocarcinoma in a 50-year-old man with primary sclerosing cholangitis, weight loss, and jaundice. Axial single-shot fast spin-echo MR image (8-mm section thickness, echo time of 90 msec) shows soft-tissue signal intensity in the periductal regions (straight arrows). Note the dilated right hepatic duct (curved arrow). Brush cytologic biopsy revealed cholangiocarcinoma.
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Figure 12a. Cholangiocarcinoma in a 70-year-old woman with jaundice in whom ERCP was unsuccessful. (a) Thick-section single-shot fast spin-echo MRCP image shows a focal, high-grade stricture of the common hepatic duct (straight arrow) with proximal dilatation. The distal common bile duct is collapsed (curved arrow). (b, c) Intraoperative cholangiograms show complete obstruction of the common hepatic duct (arrow). Both antegrade (b) and retrograde (c) cholangiograms were required to demonstrate the extent of disease.
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Figure 12b. Cholangiocarcinoma in a 70-year-old woman with jaundice in whom ERCP was unsuccessful. (a) Thick-section single-shot fast spin-echo MRCP image shows a focal, high-grade stricture of the common hepatic duct (straight arrow) with proximal dilatation. The distal common bile duct is collapsed (curved arrow). (b, c) Intraoperative cholangiograms show complete obstruction of the common hepatic duct (arrow). Both antegrade (b) and retrograde (c) cholangiograms were required to demonstrate the extent of disease.
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Figure 12c. Cholangiocarcinoma in a 70-year-old woman with jaundice in whom ERCP was unsuccessful. (a) Thick-section single-shot fast spin-echo MRCP image shows a focal, high-grade stricture of the common hepatic duct (straight arrow) with proximal dilatation. The distal common bile duct is collapsed (curved arrow). (b, c) Intraoperative cholangiograms show complete obstruction of the common hepatic duct (arrow). Both antegrade (b) and retrograde (c) cholangiograms were required to demonstrate the extent of disease.
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Figure 13. Chronic pancreatitis in a 51-year-old alcoholic man with chronic, episodic abdominal pain. Thick-section single-shot fast spin-echo MRCP image shows ectasia and irregularity of the main pancreatic duct and side branches (arrows), findings compatible with chronic pancreatitis.
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Figure 14a. Chronic pancreatitis. (a) Single-shot fast spin-echo MRCP image shows multifocal strictures and dilatations of the main pancreatic duct and dilatation of the side branches (open arrows). Note the calculus obstructing the main duct in the pancreatic body (solid arrows). (b) Axial fast spin-echo MR image also shows the calculus (arrows).
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Figure 14b. Chronic pancreatitis. (a) Single-shot fast spin-echo MRCP image shows multifocal strictures and dilatations of the main pancreatic duct and dilatation of the side branches (open arrows). Note the calculus obstructing the main duct in the pancreatic body (solid arrows). (b) Axial fast spin-echo MR image also shows the calculus (arrows).
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Figure 15. Pseudocysts in a 42-year-old woman with alcoholic pancreatitis. Axial thin-section single-shot fast spin-echo MRCP image shows multiple peripancreatic pseudocysts (arrows).
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Figure 16. Pseudocyst. Single-shot fast spin-echo MRCP image shows a large pseudocyst (large arrow) displacing the main pancreatic duct inferiorly (small arrows).
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Figure 17a. Pseudocyst. (a) Thick-section single-shot fast spin-echo MRCP image shows a large pseudocyst (arrowheads) obscuring the distal common bile duct and pancreatic duct. (b) Oblique MRCP image obtained at a steep angle shows the distal common bile duct (white arrow) and pancreatic duct (black arrow) more clearly.
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Figure 17b. Pseudocyst. (a) Thick-section single-shot fast spin-echo MRCP image shows a large pseudocyst (arrowheads) obscuring the distal common bile duct and pancreatic duct. (b) Oblique MRCP image obtained at a steep angle shows the distal common bile duct (white arrow) and pancreatic duct (black arrow) more clearly.
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Figure 18. Biliary cystadenocarcinoma in a 65-year-old woman with abdominal pain. Single-shot fast spin-echo MRCP image shows a large, fluid-filled mass in the left hepatic lobe (solid arrows), with proximal dilatation of the left intrahepatic bile ducts. The low-signal-intensity filling defects in the mass are related to polypoid masses of the wall, and the low-signal-intensity filling defect in the common hepatic duct (open arrow) is related to mucin secreted by the mass.
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Figure 19. Choledochojejunostomy. Single-shot fast spin-echo MRCP image shows normal cholangiographic findings.
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Figure 20a. Stricture in a 56-year-old woman with jaundice who underwent choledochojejunostomy for a benign bile duct stricture. (a) Thick-section single-shot fast spin-echo MRCP image shows a high-grade obstruction at the choledochojejunostomy site (arrow). (b) Percutaneous cholangiogram shows successful stent placement.
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Figure 20b. Stricture in a 56-year-old woman with jaundice who underwent choledochojejunostomy for a benign bile duct stricture. (a) Thick-section single-shot fast spin-echo MRCP image shows a high-grade obstruction at the choledochojejunostomy site (arrow). (b) Percutaneous cholangiogram shows successful stent placement.
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Figure 21. Pancreas divisum. Fast spin-echo MRCP image shows the dorsal duct (open arrows) crossing anterior to the common bile duct to empty into the minor papilla. The more inferior ventral duct (solid arrow) is seen joining the distal common bile duct.
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Figure 22. Thick-section single-shot fast spin-echo MR image (8-mm collimation, echo time of 90 msec) shows the larger dorsal pancreatic duct (arrows) coursing anterior to the common bile duct. Note the ventral pancreatic duct (arrowhead).
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Figure 23. Pneumobilia. Three-dimensional MIP reconstruction image shows two filling defects (arrowheads) in the left hepatic ducts secondary to pneumobilia from a choledochojejunostomy (arrow). The multifocal strictures and dilatation are due to primary sclerosing cholangitis.
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Figure 24a. Pseudo-filling defect. (a) Single-shot fast spin-echo MRCP image shows a filling defect in the common hepatic duct (arrowhead). (b) Thin-section MRCP image shows that a fold is the cause of the filling defect (arrowhead).
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Figure 24b. Pseudo-filling defect. (a) Single-shot fast spin-echo MRCP image shows a filling defect in the common hepatic duct (arrowhead). (b) Thin-section MRCP image shows that a fold is the cause of the filling defect (arrowhead).
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Figure 25. Pseudodilatation. Single-shot fast spin-echo MRCP image shows pseudodilatation and a pseudo-filling defect of the extrahepatic bile duct (arrow) due to medial insertion of the cystic duct.
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Figure 26. Duct nonvisualization. Thick-section single-shot fast spin-echo MRCP image shows the gallbladder (arrow) obscuring the common hepatic duct.
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Figure 27a. Duct nonvisualization. (a) Axial fast spin-echo T2-weighted MR image shows a dilated pancreatic duct (arrows) and common bile duct (arrowhead) due to adenocarcinoma of the pancreatic head. The filling defect in the common bile duct is from a metallic stent. (b) Single-shot fast spin-echo MRCP image obtained 10 minutes after administration of intravenous manganese shows nonvisualization of the intrahepatic bile ducts because of the T2-shortening effects of manganese in the bile. Only a small portion of the distal common bile duct is visualized (solid arrow). The pancreatic duct (open arrows) is dilated upstream from the known mass in the pancreatic head.
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Figure 27b. Duct nonvisualization. (a) Axial fast spin-echo T2-weighted MR image shows a dilated pancreatic duct (arrows) and common bile duct (arrowhead) due to adenocarcinoma of the pancreatic head. The filling defect in the common bile duct is from a metallic stent. (b) Single-shot fast spin-echo MRCP image obtained 10 minutes after administration of intravenous manganese shows nonvisualization of the intrahepatic bile ducts because of the T2-shortening effects of manganese in the bile. Only a small portion of the distal common bile duct is visualized (solid arrow). The pancreatic duct (open arrows) is dilated upstream from the known mass in the pancreatic head.
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Figure 28a. Susceptibility artifact. (a) Axial T1-weighted gradient-echo MR image shows signal void in the right renal fossa from surgical clips. (b, c) Axial (b) and coronal (c) fast spin-echo MR images show less artifact. (d) Coronal single-shot fast spin-echo MRCP image shows elimination of the artifact.
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Figure 28b. Susceptibility artifact. (a) Axial T1-weighted gradient-echo MR image shows signal void in the right renal fossa from surgical clips. (b, c) Axial (b) and coronal (c) fast spin-echo MR images show less artifact. (d) Coronal single-shot fast spin-echo MRCP image shows elimination of the artifact.
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Figure 28c. Susceptibility artifact. (a) Axial T1-weighted gradient-echo MR image shows signal void in the right renal fossa from surgical clips. (b, c) Axial (b) and coronal (c) fast spin-echo MR images show less artifact. (d) Coronal single-shot fast spin-echo MRCP image shows elimination of the artifact.
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Figure 28d. Susceptibility artifact. (a) Axial T1-weighted gradient-echo MR image shows signal void in the right renal fossa from surgical clips. (b, c) Axial (b) and coronal (c) fast spin-echo MR images show less artifact. (d) Coronal single-shot fast spin-echo MRCP image shows elimination of the artifact.
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Copyright © 2000 by the Radiological Society of North America.
