MR Cholangiography with Volume Rendering
Receiver Operating Characteristic Curve Analysis in Patients with Choledocholithiasis
Hiroshi Kondo1,
Masayuki Kanematsu1,
Yoshimune Shiratori2,
Kyo Itoh3,
Takamichi Murakami4,
Masatoshi Hori4,
Ichiro Yasuda2,
Masayuki Matsuo1,
Hironobu Nakamura4,
Hiroaki Hoshi1 and
Hisataka Moriwaki2
1
Department of Radiology, Gifu University School of Medicine, 40 Tsukasamachi,
Gifu 500-8705, Japan.
2
First Department of Internal Medicine, Gifu University School of Medicine,
Gifu 500-8705, Japan.
3
Department of Radiology, Kyoto University Faculty of Medicine, Kyoto 606-8501,
Japan.
4
Department of Radiology, Osaka University Medical School, Osaka 565-0871,
Japan.
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Fig. 1. —Histogram shows opacity percentage plotted against Hounsfield
value. Trapezoid was placed so that voxels located at interface between bile
and calculi were seen. Four fixed points were used to determine position of
trapezoid: -980 to -680 H at 0% opacity level, and -900 to -700 H at 100%
opacity level.
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Fig. 2A. —58-year-old man with common bile duct calculus
(arrows, A-C). Anterior MR cholangiograms with
maximum-intensity-projection (A), volume-rendered (B), and
thick-section half-Fourier rapid acquisition with relaxation enhancement
(C) sequences show that visibility of calculus is comparable for all
three types of images. However thick-section MR cholangiography is less
blurred as result of 1-sec data acquisition during respiratory suspension.
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Fig. 2B. —58-year-old man with common bile duct calculus
(arrows, A-C). Anterior MR cholangiograms with
maximum-intensity-projection (A), volume-rendered (B), and
thick-section half-Fourier rapid acquisition with relaxation enhancement
(C) sequences show that visibility of calculus is comparable for all
three types of images. However thick-section MR cholangiography is less
blurred as result of 1-sec data acquisition during respiratory suspension.
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Fig. 2C. —58-year-old man with common bile duct calculus
(arrows, A-C). Anterior MR cholangiograms with
maximum-intensity-projection (A), volume-rendered (B), and
thick-section half-Fourier rapid acquisition with relaxation enhancement
(C) sequences show that visibility of calculus is comparable for all
three types of images. However thick-section MR cholangiography is less
blurred as result of 1-sec data acquisition during respiratory suspension.
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Fig. 3A. —48-year-old woman with gallbladder and common bile duct
calculi (arrows, B). Anterior MR cholangiograms with
maximum-intensity-projection (A), volume-rendered (B), and
thick-section half-Fourier rapid acquisition with relaxation enhancement
(C) sequences show that image in B shows both calculi more
clearly than other types of images.
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Fig. 3B. —48-year-old woman with gallbladder and common bile duct
calculi (arrows, B). Anterior MR cholangiograms with
maximum-intensity-projection (A), volume-rendered (B), and
thick-section half-Fourier rapid acquisition with relaxation enhancement
(C) sequences show that image in B shows both calculi more
clearly than other types of images.
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Fig. 3C. —48-year-old woman with gallbladder and common bile duct
calculi (arrows, B). Anterior MR cholangiograms with
maximum-intensity-projection (A), volume-rendered (B), and
thick-section half-Fourier rapid acquisition with relaxation enhancement
(C) sequences show that image in B shows both calculi more
clearly than other types of images.
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Fig. 4A. —68-year-old man with numerous calculi in upper biliary tract,
common bile duct, and gallbladder. Anterior MR cholangiograms with
maximum-intensity-projection (A), volume-rendered, (B), and
thick-section half-Fourier rapid acquisition with relaxation enhancement
(C) sequences show that calculi in upper biliary tract (straight
arrows, B and C) are better shown in B and C
than in A. Note that image in B clearly shows calculus in upper
biliary tract that is superimposed by signal intensity of gastric juice
(curved arrow, B).
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Fig. 4B. —68-year-old man with numerous calculi in upper biliary tract,
common bile duct, and gallbladder. Anterior MR cholangiograms with
maximum-intensity-projection (A), volume-rendered, (B), and
thick-section half-Fourier rapid acquisition with relaxation enhancement
(C) sequences show that calculi in upper biliary tract (straight
arrows, B and C) are better shown in B and C
than in A. Note that image in B clearly shows calculus in upper
biliary tract that is superimposed by signal intensity of gastric juice
(curved arrow, B).
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Fig. 4C. —68-year-old man with numerous calculi in upper biliary tract,
common bile duct, and gallbladder. Anterior MR cholangiograms with
maximum-intensity-projection (A), volume-rendered, (B), and
thick-section half-Fourier rapid acquisition with relaxation enhancement
(C) sequences show that calculi in upper biliary tract (straight
arrows, B and C) are better shown in B and C
than in A. Note that image in B clearly shows calculus in upper
biliary tract that is superimposed by signal intensity of gastric juice
(curved arrow, B).
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Fig. 5. —Graph shows receiver operating characteristic curves for
detection of bile duct calculi by radiologist 1 for
maximum-intensity-projection ([UNK]) (Az = 0.771),
volume-rendered ([UNK]) (Az = 0.791), and thick-section
( ) (Az = 0.722) MR cholangiograms. Observer
performance with maximum-intensity-projection and volume-rendered MR
cholangiography tends to exceed that with thick-section MR
cholangiography.
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Fig. 6. —Graph shows receiver operating characteristic curves for
detection of bile duct calculi by radiologist 2 for
maximum-intensity-projection ([UNK]) (Az = 0.887),
volume-rendered ([UNK]) (Az = 0.952), and thick-section
() (Az = 0.834) MR cholangiograms. Observer
performance with volume-rendered MR cholangiography significantly (p
< 0.04) exceeds that with thick-section MR cholangiography, and marginally
(p < 0.08) exceeds that with maximum-intensity-projection MR
cholangiography.
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Fig. 7. —Graph shows receiver operating characteristic curves for
detection of bile duct calculi by radiologist 3 for
maximum-intensity-projection ([UNK]) (Az = 0.777),
volume-rendered ([UNK]) (Az = 0.848), and thick-section
() (Az = 0.830) MR cholangiography. Observer
performance with volume-rendered MR cholangiography marginally (p
< 0.08) exceeds that with maximum-intensity-projection MR
cholangiography.
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