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Magnetic resonnance cholangiography (MRC): comparaison of two and three - dimensional sequences for assessment of biliary anomalies. A.Daghfous *, F. AbidI *, K. Bouzaid **, M. Maarouf *, L. Rezgui Marhoul *.

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Magneticresonnancecholangiography (MRC): comparaison of two and three-dimensionalsequences for assessment of biliary anomalies

A.Daghfous*, F. AbidI*, K. Bouzaid**, M. Maarouf*, L. RezguiMarhoul*

Radiology services in Trauma Center*, Tunisia and TaherMaamouri’shospital**, Nabeul

GI29

introduction
INTRODUCTION
  • Three-dimensional (3D) imaging has become a popular

modality because of its ability to provide 3D views of the

patient's anatomy. It also does not have many of the

inherent shortcomings of two-dimensional (2D) imaging.

  • Two-dimensional images make interpretation more difficult by forcing the reader to restructure the 2D images mentally in order to appreciate the true form of the disease or organ. Three-dimensional images, on the other hand, provide easier-to-understand information, while being more efficient, accurate, objective, and reproducible
slide3

OBJECTIVES

The purposewas to retrospectively compare two-dimensional (2D) magneticresonnance cholangiography (MRC) includingbreath-hold single-shotrapid acquisition with relaxation enhancement (RARE) and multislicehalf-fourrier RARE versus 3D-RARE MRC in the evaluation of biliary anomalies.

slide4

MATERIALSANDMETHODS

  • Retrospectivestudy
  • 20 adult patients whounderwent MRC
  • for pancreatic or bile ductabnormalitiesdetected by ultra
  • sound or CT-scan.
  • Our protocolincludesconventionnalsequences and
  • systematicsequences 2D and 3D-MRC thin sections.
slide5

RESULTS

  • MRC findingsincluding lithiasis (n=11), biliarymalignancy
  • (n=5), gallbladercarcinoma (n=1), ampullary cancer (n=2),
  • congenitalabnormality of bilaryduct (n=1).
  • All of these bile tract abnormalitieswere visible on the 2D
  • sequences, however, with the 3D sequences, the picture
  • qualitywasmuchhigherwithbetter spatial resolution
slide6

Example 1

A

B

C

D

Cholangio-MRI: 2D (A and B) and 3D séquences (Cet D)

Choledolithiasis ( ) and galdbladdercalculi ( )

slide7

Ax T1 gado

Example 2

MRC 2D

MRC 3D

Dilatation of intra hepatic bile ductsecondary to hilarcholangiocarcinoma ( )

without dilatation of the wirsung ( ) and the main bile duct ( )

slide8

Example 3

AX T2

MRC 2D

MRC 3D

Cystic dilatation of pancreaticducts( ) relevant to TIPMP

slide9

Example 4

T1G

T2

MRC 2D

MRC 2D

MRC 3D

Hilarcholangiocarcinoma ( )

MR cholangiography demonstrates dilatation of intra hepatic bile ducts( )

Withoutvisualization of the main bile duct

slide10

Example 5

MRC 2D

MRC 3D

Ax T2

Carolidisease

MRC demonstratescystic dilatation of main bile duct and intra hepaticducts relevant to Carolidisease

slide11

Example 6

Ax T2

Ax T2

MRC 3D

MRC demonstrates dilatation of main bile duct and intra hepaticductssecondary to ampullomavaterien ( )

MRC 2D

slide12

DISCUSSION

*In our study, 2D-MRC and 3D-MRC showed Similar diagnostic

accuracy in patients with biliary diseases. Although 3D-MRC

had the tendency to show higher accuracy compared with 2D

MRC: it did display superior image quality and ductal

conspicuity compared with 2DMRC.

*Magneticresonnance (MR) cholangiography has emerged as

an accurate, non invasive alternative to diagnostic endoscopic

retrogradecholangiography (ERC) in the evaluation of disease of

the biliary tract.

slide13

DISCUSSION

* Two-dimensionalthick-section single-shotRARE and multislice

thin-section half-Fourier RARE techniques are the most

commonly used techniques for MRC. The 2D thick-section

technique has the major advantage of allowing a quick

acquisition of an image giving an overview of the ductal

anatomy.

* The limitation of the thick-section technique, however,

is the lack of postprocessing, preventing the evaluation of

individual tomographic sections. Therefore, thick-section

technique alone is not suitable for the evaluation of

complex anatomical structures like the hepatic hilum.

slide14

* Currently, most institutes perform MRC using a combination

of thicksection imaging to provide an anatomical overview

and thin-section imaging to provide finer detail.

* The major advantage of 3D-MRC is that it provides isotropic

MIP images without distortion allowing its usage as a

complementary sequence tostandard 2D-MRC in the

evaluation of the biliary tree.

* Three-dimensional acquisition is appealing for MRC because it provides contiguous thin sections (approximately1 mm in all three dimensions) that may be used to reconstruct images in any plane.

slide15

* Volumetric acquisition of 3D-MRC has been used to improve

the quality of MIP reconstruction using a variety of software to

depict complexbiliaryductalrelationships

* 3D-MRC has a higher technical and overall image quality

than 2D-MRC,there is still a limitation in improving the

diagnostic performance for evaluating all biliary diseases.

Nevertheless, high quality MIP reconstructions are very

useful because they improve theunderstanding of complex

anatomical structures such as the hepatic hilum by

selecting the optimal viewing angle.

* Two major disadvantages of 3D-MRC are its long acquisition

time and high level of background suppression which lead to

low anatomical information regarding underlyingparenchymal

organs

slide16

CONCLUSION

  • 3D-MRC has superior image quality to 2D-MRC.
  • 3D-MRC showed no difference in accuracy compared with
  • 2D-MRC for evaluating the biliary diseases.
  • 3D-MRC should be a complementary sequence to
  • conventional 2D-MRC for the accurate evaluation of the
  • biliarytree.