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MR Cholangiopancreatography Versus Endoscopic Sonography in Suspected Common Bile Duct Lithiasis: A Prospective, Comparative Study

Christophe Aubé1, Benoit Delorme1, Thierry Yzet2, Pascal Burtin3, Jérome Lebigot1, Patrick Pessaux4, Catherine Gondry-Jouet5, Jean Boyer3 and Christine Caron1

1 Department of Radiology, University Hospital of Angers, 4, rue Larrey, Angers, France 49933.
2 Department of Hepatogastroenterology, University Hospital of Amiens, Amiens, France 80080.
3 Department of Hepatogastroenterology, University Hospital of Angers, Angers, France 49933.
4 Department of Visceral Surgery, University Hospital of Angers, Angers, France 49933.
5 Department of Radiology, Amiens University, Amiens, France 80080.



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  		Fig. 1A. —71-year-old woman with common bile duct stone, in whom sonography detected cholestasis associated with dilatation of bile ducts. Heavily T2-weighted single-shot fast spin-echo MR cholangiopancreatography sequence (coronal oblique slice 20 mm thick; TEeff = 920 msec) shows marked dilatation of common bile duct (star) and of intrahepatic bile ducts (thin arrow). Regular lacuna is seen because of 7-mm stone impacted in lower common bile duct (thick arrow).

 


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  		Fig. 1B. —71-year-old woman with common bile duct stone, in whom sonography detected cholestasis associated with dilatation of bile ducts. Endoscopic sonogram shows calculus (thin arrow) and its shadow.

 


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  		Fig. 2. —73-year-old man with multiple stones in common bile duct, clinical picture of cholangitis, and sonographically detected dilatation of bile ducts. Heavily T2-weighted single-shot fast spin-echo MR cholangiopancreatography sequence (coronal oblique slice 20 mm thick; TEeff = 1,070 msec) shows dilatation of common bile duct (star) and of intrahepatic bile ducts. Multiple regular lacunae are seen, the largest being due to a 13-mm stone impacted in the lower common bile duct (thick arrow). Gallbladder lithiasis (thin arrow) was not revealed by sonography.

 


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  		Fig. 3A. —34-year-old woman with microlithiasis of common bile duct, clinical indications of cholangitis associated with bile duct dilatation, and sonographically detected gallbladder lithiasis. T2-weighted single-shot fast spin-echo MR cholangiopancreatography sequence (coronal oblique slice 20 mm thick; TEeff = 944 msec [A], and axial slice 5 mm thick; TEeff = 101 msec [B]) shows dilatation of common bile duct (star) and of intrahepatic bile ducts. Small, regular downward-sloping lacuna (thin arrow) in lower part of common bile duct is better visualized in axial slices. Gallbladder stones of centimeter size are seen (thick arrow, A).

 


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  		Fig. 3B. —34-year-old woman with microlithiasis of common bile duct, clinical indications of cholangitis associated with bile duct dilatation, and sonographically detected gallbladder lithiasis. T2-weighted single-shot fast spin-echo MR cholangiopancreatography sequence (coronal oblique slice 20 mm thick; TEeff = 944 msec [A], and axial slice 5 mm thick; TEeff = 101 msec [B]) shows dilatation of common bile duct (star) and of intrahepatic bile ducts. Small, regular downward-sloping lacuna (thin arrow) in lower part of common bile duct is better visualized in axial slices. Gallbladder stones of centimeter size are seen (thick arrow, A).

 


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  		Fig. 4. —55-year-old man with small stone in common bile duct, acute pancreatitis associated with moderate dilatation of bile ducts, and no gallbladder stone detected by sonography. Heavily T2-weighted single-shot fast spin-echo MR cholangiopancreatography sequence (coronal oblique slice 20 mm thick; TEeff = 980 msec) shows dilatation of common bile duct (star). Regular lacuna is seen because of 4-mm stone impacted in lower common bile duct (arrow).

 


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  		Fig. 5. —83-year-old woman with bile duct stone, clinical indications of cholangitis, and false-positive MR cholangiopancreatography result. Heavily T2-weighted single-shot fast spin-echo MR cholangiopancreatography sequence (coronal oblique slice 5 mm thick; TEeff = 1,300 msec) shows dilatation of common bile duct (star) and 4-mm lacuna, typical of stone in lower third of common bile duct (arrow). Endoscopic sonography and ERCP, performed 48 hr later, found bile duct dilatation but no bile duct stone, but ERCP only showed papillary edema, which could suggest stone migration.

 

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