Single shot fast spin echo long TE magnetic resonance cholangio-pancreatography

Objectives - To assess the accuracy and reproducibility of a new magnetic resonance cholangiopancreatography sequence (MRCP), using long echo time and "single shot" acquisition (providing high-contrast chick slices: 20 mm or more) in the morphological analysis of the biliary free and pancreatic ducts. Methods - Fifty four patients with biliary and/or pancreatic disease were investigated with MRCP "single shot" chick slices. Biliary ducts were explored with MRCP "single shot", coronal and oblique coronal 20 mm thick slices on a 256 x 256 matrix. Natives pictures were reviewed by three independent radiologists, from three different institutions. MRCP results were compared with reference examinations in 54 cases (direct biligraphy methods: 54, CT scan: 11, endoscopic ultrasonography: 6, surgery: 6). Results - For defection of bile duct dilatation, the agreement of MRCP "single shot" chick slices was more than 96% (Kappa > 0.92) and the inter-observer agreement was excellent (Kappa = 0.92). For detection of biliary tree and/or pancreatic duct obstruction, MRCP "single shot" chick slice sensitivity was above 89% and specificity was 75%. The malignant nature of the lesions was determined with a sensitivity of 100% and a specificity of 92%. MRCP "single shot" thick slices could not differentiate pancreatic carcinomas from distal main bile duct cholangiocarcinomas. MRCP single shot" thick slices did not defect small stones (less than or equal to 3 mm) of the the common bile duct. Conclusion - The excellent sensitivity specificity and infer-observer agreement of MRCP "single shot" thick slices can be used to limit invasive imaging methods in the diagnosis of extrahepatic cholestasis.