COMPARISON OF BREATH HOLD MULTI-SLICE HASTE MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY WITH ENDOSCOPIC CHOLANGIOPANCREATOGRAPHY: INITIAL EXPERIENCE

Abstract

OBJECTIVE : To compare in a prospective and double blinded fashion the accuracy of anew breath-hold multi-slice half Fourier acquisition single shot turbo spin-echo technique (HASTE) magnetic resonance cholangiopancreatography (BHHASTE MRCP) against endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of patients presenting with biliary and pancreatic pathology.

PATIENTS AND METHODS : A total of 20 patients had both breath-hold thin slice MRCP and ERCP. There was no preparation of these patients prior to the breath-hold multi-slice MRCP. The acquisition times for MRCP was 20 seconds. For the MRCP, both the source images and MIP images were evaluated. The results were reported independently by two radiologists. The presence of dilatation, stricture and intraductal abnormalities were recorded. The ERCP was used as the gold standard.

RESULTS : MRCP and ERCP finding concurred in all but one patient in whom ERCP failed. An accuracy of 100% (with a sensitivity and specificity of 100%). MRCP was able to show more dilated intrahepatic ducts than ERCP. The presence of fluid in the upper gastrointestinal tract did not obscure any pathology. There were three patients with subcapsular fluid noted. This finding on MRCP has not been previously reported.

CONCLUSION : BHHASTE MRCP is an excellent non-invasive technique to assess the biliary and pancreatic ducts and may be used to select those patients who require therapeutic ERCP. This may be done without the need for any oral preparation. This will reduce the cost as well as the complications. The additional ability to perform conventional axial MR images at the same sitting with not much extra scanning times makes this examination of choice as well as providing a “road map” for planning intervention. BHHASTE MRCP has overcome some of the problems of respiration and volume averaging.