Comparison of MR Cholangiopancreatographic Techniques with Contrast-Enhanced Cholangiography in the Evaluation of Sclerosing Cholangitis
Kenneth M. Vitellas1,
Robert A. Enns2,
Mary T. Keogan3,
Kelly S. Freed4,
Charles E. Spritzer5,
John Baillie6 and
Rendon C. Nelson5
1
Department of Radiology, Ohio State University Medical Center, 450 W. 10th
Ave., S-255 Rhodes Hall, Columbus, OH 43210.
2
Department of Gastroenterology, St. Paul's Hospital, University of British
Columbia, Vancouver, British Columbia, Canada.
3
Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline
Ave., Boston, MA 02215.
4
Department of Radiology, Lehigh Valley Hospital, Cedar Crest and 1-78, P. O.
Box 689, Allentown, PA 18105-1556.
5
Department of Radiology, Duke University Medical Center, Box 3189, Durham, NC
27710.
6
Department of Gastroenterology, Duke University Medical Center, Durham, NC
27710.
View larger version (105K):
[in a new window]
|
Fig. 1. —Thick-slab MR cholangiopancreatogram of 72-year-old woman
with primary sclerosing cholangitis shows focal narrowing of anterior right
hepatic duct (arrow) with proximal dilatation compatible with
stricture. In addition, nonvisualization of common hepatic duct
(arrowhead), which should normally be well visualized, with
intrahepatic bile ductal dilatation, also implies stricture.
|
|
View larger version (43K):
[in a new window]
|
Fig. 2. —Bar graph shows extent of ductal visualization (>50%) in
sclerosing cholangitis (n = 20) and comparison of thick-slab MR
cholangiopancreatography (checkered bar) and contrast-enhanced
cholangiography (striped bar). Consensus visualization is greater
than 50%.
|
|
View larger version (23K):
[in a new window]
|
Fig. 3. —Bar graph shows extent of ductal visualization (>50%) in
normal volunteers (n = 19) and comparison of thick-slab
(checkered bar) and thin-slab (striped bar) MR
cholangiopancreatography. Consensus visualization is greater than 50%.
|
|
View larger version (27K):
[in a new window]
|
Fig. 4. —Bar graph shows bile duct strictures in sclerosing
cholangitis and comparison of thick-slab MR cholangiopancreatography
(checkered bar) and contrast-enhanced cholangiography (striped
bar). Consensus visualization is greater than 50%.
|
|
View larger version (136K):
[in a new window]
|
Fig. 5. —MR cholangiopancreatogram in 24-year-old healthy male
volunteer shows good visualization of central bile ducts. Note that peripheral
ducts are not visualized.
|
|
View larger version (87K):
[in a new window]
|
Fig. 6A. —42-year-old man with primary sclerosing cholangitis. MR
cholangiopancreatogram shows multiple intrahepatic ductal strictures and
dilatation. Signal void of common hepatic duct and bifurcation is compatible
with stricture. Common bile duct is collapsed because of central strictures
(arrowhead). Note good visualization of peripheral ducts.
|
|
View larger version (111K):
[in a new window]
|
Fig. 6B. —42-year-old man with primary sclerosing cholangitis. T-tube
cholangiogram in same patient as in A better illustrates stricture of
common hepatic duct (straight arrow) and stricture of left main
hepatic duct (curved arrow). However, right hepatic ducts could not
be opacified. Note that peripheral ducts are better visualized on MR
cholangiopancreatogram.
|
|
View larger version (124K):
[in a new window]
|
Fig. 7A. —33-year-old man with primary sclerosing cholangitis.
Thick-slab MR cholangiopancreatogram shows common hepatic and intrahepatic
ductal dilatation. Nonvisualization of distal common bile duct is compatible
with stricture or pneumobilia at choledochojejunostomy site (straight
arrow). In addition, strictures (curved arrows) and stone
(arrowhead) are present in central left duct.
|
|
View larger version (116K):
[in a new window]
|
Fig. 7B. —33-year-old man with primary sclerosing cholangitis.
Thick-slab MR cholangiopancreatogram shows that left hepatic duct could not be
opacified at percutaneous transhepatic cholangiography because of stricture
and stone.
|
|
View larger version (120K):
[in a new window]
|
Fig. 8A. —36-year-old woman with sclerosing cholangitis. Thick-slab MR
cholangiopancreatogram shows multiple focal strictures of peripheral
(arrow) and central (arrowheads) ducts. Dilatation of ducts
proximal to central strictures produces good visualization.
|
|
View larger version (139K):
[in a new window]
|
Fig. 8B. —36-year-old woman with sclerosing cholangitis. Bilateral
percutaneous transhepatic cholangiogram shows findings similar to those in
A. Note central hilar stricture (arrows).
|
|
View larger version (117K):
[in a new window]
|
Fig. 9A. —53-year-old woman with sclerosing cholangitis. MR
cholangiopancreatogram shows poor visualization of central right and left
intrahepatic ducts and portion of common hepatic duct (arrows)
compatible with strictures. Note mild peripheral ductal dilatation.
|
|
View larger version (137K):
[in a new window]
|
Fig. 9B. —53-year-old woman with sclerosing cholangitis. Endoscopic
retrograde cholangiopancreatogram shows findings similar to A,
compatible with central strictures (arrows) and better visualization
of peripheral ducts.
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2002 by the American Roentgen Ray Society.
