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Value of Adding T1-Weighted Image to MR Cholangiopancreatography for Detecting Intrahepatic Biliary Stones

Young Kon Kim1, Chong Soo Kim1, Jeong Min Lee2, Seog Wan Ko1, Gyung Ho Chung1, Seung Ok Lee3, Young Min Han1 and Sang Yong Lee1

1 Department of Diagnostic Radioology, Chonbuk National University Medical School and Hospital, 634-18 Keumam dong, Jeonju, Chonbuk, South Korea.
2 Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, South Korea.
3 Department of Internal Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Chonbuk, South Korea.


Figure 1
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  		Fig. 1A —55-year-old man with multiple common duct stones. Axial fat-suppressed T1-weighted image with fast low-angle shot (FLASH) sequence (TR/TE, 159/2.6; flip angle, 70°) shows bright high signal intensities of stones in distal common duct (arrow).

 

Figure 2
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  		Fig. 1B —55-year-old man with multiple common duct stones. Axial HASTE image (TR/TE, infinite/85) shows low signal intensity of stone in high signal intensities of common duct (arrow).

 

Figure 3
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  		Fig. 1C —55-year-old man with multiple common duct stones. Coronal single-projection thick-section RARE MR cholangiopancreatography (TR/TE, infinite/1,100) reveals multiple low signal intensities of stones in common duct (arrows). Superior filling defect appears linear but was more nodular on axial image.

 

Figure 4
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  		Fig. 2A —48-year-old man with bilateral multiple intrahepatic bile duct stones. Axial fat-suppressed T1-weighted image with fast low-angle shot (FLASH) sequence (TR/TE, 159/2.6; flip angle, 70°) shows multiple bright high signal intensities of stones in both right and left intrahepatic bile ducts (arrows).

 

Figure 5
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  		Fig. 2B —48-year-old man with bilateral multiple intrahepatic bile duct stones. Axial HASTE image (TR/TE, infinite/85) shows no definitive intrahepatic bile duct stone; only irregularly dilated intrahepatic bile ducts with multifocal stricture are shown.

 

Figure 6
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  		Fig. 2C —48-year-old man with bilateral multiple intrahepatic bile duct stones. Coronal multisection half-Fourier RARE MR cholangiopancreatography (TR/TE, infinite/84) shows only suspicious tiny bile duct stone (arrow) within irregularly dilated intrahepatic bile duct.

 

Figure 7
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  		Fig. 2D —48-year-old man with bilateral multiple intrahepatic bile duct stones. Coronal single-projection thick-section RARE MR cholangiography (TR/TE, infinite/1,100), shows only irregularly dilated intrahepatic bile duct with stricture.

 

Figure 8
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  		Fig. 3A —68-year-old man with right intrahepatic bile duct stone and common duct stones. Axial fat-suppressed T1-weighted image with fast low-angle shot (FLASH) sequence (TR/TE, 159/2.6; flip angle, 70°) shows bright high signal intensity of stone in right intrahepatic bile duct (arrow).

 

Figure 9
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  		Fig. 3B —68-year-old man with right intrahepatic bile duct stone and common duct stones. Axial HASTE image (TR/TE, infinite/85) at same level as A, shows mild bile duct dilatation without definitive stone.

 

Figure 10
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  		Fig. 3C —68-year-old man with right intrahepatic bile duct stone and common duct stones. Coronal multisection half-Fourier RARE MR cholangiopancreatography (TR/TE, infinite/84) shows no definitive bile duct stones within irregularly dilated intrahepatic bile duct.

 

Figure 11
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  		Fig. 3D —68-year-old man with right intrahepatic bile duct stone and common duct stones. Coronal single-projection thick-section RARE MR cholangiography (TR/TE, infinite/1,100) shows irregularly dilated intrahepatic bile duct with only suspicious filling defect (arrow). Multiple common duct stones are also shown.

 

Figure 12
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  		Fig. 3E —68-year-old man with right intrahepatic bile duct stone and common duct stones. Operative cholangiography reveals filling defect in proximal right intrahepatic bile duct (arrow).

 

Figure 13
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  		Fig. 4 —57-year-old man with mild biliary dilatation. The axial fat-suppressed T1-weighted image with fast low-angle shot (FLASH) sequence (TR/TE, 159/2.6; flip angle, 70°) shows bright high signal intensity in distal common duct (wide arrow), which was misdiagnosed as bile duct stone by one reviewer. This high signal intensity in distal common duct was caused by reflux of orally administered superparamagnetic iron oxide agent that had high signal intensity on T1-weighted images and low signal intensity on T2-weighted images. High signal intensity (thin arrows) in gastric lumen is also noted.

 

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