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Diagnosis of Intrahepatic Stones: Superiority of MR Cholangiopancreatography over Endoscopic Retrograde Cholangiopancreatography

¹ All authors: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnab-dong, Songpa-ku, Seoul 138-736, Korea.

View larger version (133K): [in a new window]   Fig. 1A. —43-year-old woman with intrahepatic bile duct stones. ERCP image obtained after injection of contrast material with balloon occlusion of duct (arrow) shows dilatation of intrahepatic and extrahepatic bile ducts. No definite stones are seen in bile ducts.

View larger version (103K): [in a new window]   Fig. 1B. —43-year-old woman with intrahepatic bile duct stones. Coronal multislice half-Fourier acquisition single-shot turbo spin-echo MR cholangiopancreatography (MRCP) image (TR/TE, infinite/95) clearly shows intrahepatic stones (arrows) in right posteroinferior segment of liver.

View larger version (153K): [in a new window]   Fig. 1C. —43-year-old woman with intrahepatic bile duct stones. Coronal single-slab rapid acquisition with relaxation enhancement MRCP image (infinite/1200) also shows intrahepatic stones (solid arrow) in right lobe. However, conspicuity of intrahepatic stones is poor compared with visualization in B. Extrahepatic bile duct is not visualized because of biliary air (open arrows).

View larger version (130K): [in a new window]   Fig. 2A. —66-year-old man with intrahepatic bile duct stones. ERCP image shows dilatation of intrahepatic and extrahepatic bile ducts. No definite bile duct stones are visualized.

View larger version (152K): [in a new window]   Fig. 2B. —66-year-old man with intrahepatic bile duct stones. Coronal multislice half-Fourier acquisition single-shot turbo spin-echo MR cholangiopancreatography (MRCP) image (TR/TE, infinite/95) clearly shows intrahepatic stones (arrows) in liver segment IV.

View larger version (142K): [in a new window]   Fig. 2C. —66-year-old man with intrahepatic bile duct stones. Coronal single-slab rapid acquisition with relaxation enhancement MRCP image (infinite/1200) shows intrahepatic stones (arrow) inadequately compared with B.

View larger version (136K): [in a new window]   Fig. 3A. —57-year-old woman with bile duct stones and biliary air. ERCP image obtained after injection of contrast material with balloon occlusion of duct (arrowhead) shows dilatation of intrahepatic and extrahepatic bile ducts and intrahepatic duct stones (arrow) in left lobe of liver.

View larger version (153K): [in a new window]   Fig. 3B. —57-year-old woman with bile duct stones and biliary air. Coronal single-slab rapid acquisition with relaxation enhancement (RARE) MR cholangiopancreatography image (TR/TE, infinite/1200) also shows intrahepatic duct stones in left lobe (open arrow). Poorly defined, hypointense lesion (solid arrow) is seen in proximal common duct.

View larger version (121K): [in a new window]   Fig. 3C. —57-year-old woman with bile duct stones and biliary air. Lateral single-slab RARE image (infinite/1200) produces air—fluid level (arrow) in proximal common duct, suggesting that lesion in proximal common duct is biliary air instead of stones.

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