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Ability of MR Cholangiography to Reveal Stent Position and Luminal Diameter in Patients with Biliary Endoprostheses

In Vitro Measurements and In Vivo Results in 30 Patients

¹ Department of Radiology, University Hospitals of Ulm, Robert Koch Str. 8, 89081 Ulm, Germany.
² Department of Internal Medicine I, University Hospitals of Ulm, 89081 Ulm, Germany.

View larger version (75K): [in a new window]   Fig. 1A. —In vitro artifact behavior of three biliary endoprostheses. One asterisk = Smart Stent (Cordis, Miami, FL), two asterisks = polyethylene stent (Cook, Moenchengladbach, Germany), three asterisks = Easy Wallstent (Schneider, Buelach, Switzerland). Half-Fourier acquisition single-shot turbo spin-echo source image (TR/TE, 1.9/95; in-plane resolution, 1 mm; slice thickness, 3 mm; scan orientation, parallel to long stent axis).

View larger version (44K): [in a new window]   Fig. 1B. —In vitro artifact behavior of three biliary endoprostheses. One asterisk = Smart Stent (Cordis, Miami, FL), two asterisks = polyethylene stent (Cook, Moenchengladbach, Germany), three asterisks = Easy Wallstent (Schneider, Buelach, Switzerland). Half-Fourier acquisition single-shot turbo spin-echo source image (1.9/95; in-plane resolution, 1 mm; slice thickness, 3 mm; scan orientation, perpendicular to long stent axis).

View larger version (88K): [in a new window]   Fig. 1C. —In vitro artifact behavior of three biliary endoprostheses. One asterisk = Smart Stent (Cordis, Miami, FL), two asterisks = polyethylene stent (Cook, Moenchengladbach, Germany), three asterisks = Easy Wallstent (Schneider, Buelach, Switzerland). Rapid acquisition with relaxation enhancement image (2800/1000; in-plane resolution, 1 mm; slice thickness, 50 mm; scan orientation, parallel to long stent axis). Lumen of cobalt alloy—based Easy Wallstent is completely overlain with artifact formation. Relative interior lumen of the nitinol-based Smart Stent is visualized at about 50%, and relative interior lumen of polyethylene stent stands at 100%.

View larger version (117K): [in a new window]   Fig. 2A. —46-year-old woman with breast and gastric carcinoma. Percutaneous transhepatic cholangiogram shows occlusion in prepapillary segment of common bile duct (arrow).

View larger version (104K): [in a new window]   Fig. 2B. —46-year-old woman with breast and gastric carcinoma. Percutaneous transhepatic cholangiogram shows cobalt alloy—based Easy Wallstent (10-mm diameter, 70-mm length) (Schneider, Buelach, Switzerland) implanted in common bile duct.

View larger version (107K): [in a new window]   Fig. 2C. —46-year-old woman with breast and gastric carcinoma. Percutaneous transhepatic cholangiogram reveals that stent shown in B is located in transpapillary position in which distal stent end is in contact with opposite wall of duodenum and appears to perforate it (arrow).

View larger version (123K): [in a new window]   Fig. 2D. —46-year-old woman with breast and gastric carcinoma. MR cholangiogram (half-Fourier acquisition single-shot turbo spin-echo source image [TR/TE, 1.9/95; in-plane resolution, 1.5 mm; slice thickness, 3 mm]) reveals stent position, including intraduodenal position of stent end (arrow), whereas stent lumen cannot be evaluated because of artifact formation. Patient's postinterventional course was uneventful.

View larger version (79K): [in a new window]   Fig. 3A. —62-year-old man with gastric carcinoma. Endoscopic retrograde cholangiogram shows patent lumen of nitinol-based Smart Stent (Cordis, Miami, FL).

View larger version (88K): [in a new window]   Fig. 3B. —62-year-old man with gastric carcinoma. MR cholangiogram (rapid acquisition with relaxation enhancement; TR/TE, 2800/1000; in-plane resolution, 1.5 mm; slice thickness, 50 mm) shows that lumen of Smart Stent is totally overlain by artifact formation, whereas stent itself, because of weak associated susceptibility artifact, is inadequately visualized in cranial section of image.

View larger version (76K): [in a new window]   Fig. 4A. —61-year-old man with gastric carcinoma. Radiograph shows nitinol-based Smart Stent (Cordis, Miami, FL) implanted in common bile duct (arrow).

View larger version (124K): [in a new window]   Fig. 4B. —61-year-old man with gastric carcinoma. Percutaneous transhepatic cholangiogram shows patent lumen of nitinol-based Smart Stent (arrow).

View larger version (112K): [in a new window]   Fig. 4C. —61-year-old man with gastric carcinoma. MR cholangiogram (rapid acquisition with relaxation enhancement image; TR/TE, 2800/1000; in-plane resolution, 1.5 mm; slice thickness, 50 mm) shows adequate visualization of inner lumen, whereas stent itself, because of weak susceptibility artifact, is not demarcated.

View larger version (132K): [in a new window]   Fig. 5A. —65-year-old man with chronic pancreatitis. MR cholangiogram (rapid acquisition with relaxation enhancement image; TR/TE, 2800/1000; in-plane resolution, 1.5 mm; slice thickness, 50 mm) inadequately shows patent polyethylene stent (arrows).

View larger version (113K): [in a new window]   Fig. 5B. —65-year-old man with chronic pancreatitis. Half-Fourier acquisition single-shot turbo spin-echo source image (1.9/95; in-plane resolution, 1.5 mm; slice thickness, 3 mm) permits unequivocal evaluation of interior lumen of stent (arrows).

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