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MRCP: technique and interpretation “10 rules in MRCP” Lieven Van Hoe MD PhD OLV Hospital Group Aalst - Belgium

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Presentation on theme: "MRCP: technique and interpretation “10 rules in MRCP” Lieven Van Hoe MD PhD OLV Hospital Group Aalst - Belgium"— Presentation transcript:

1 MRCP: technique and interpretation “10 rules in MRCP” Lieven Van Hoe MD PhD OLV Hospital Group Aalst - Belgium

2 Procedure Axial and coronal double echo HASTE (5mm) NON-FATSAT TE 60TE 360

3 10% of your patients has focal liver lesions Double echo HASTE: lesion characterizarion SI TE 60 SI TE cyst++ / +++as bright as CSF hemangioma+ / ++not as bright as CSF solid± / +± isointense

4 60 msec 360 msec solid hemangioma

5 Axial and coronal double echo HASTE (5mm) Thin-section MRCP Scout for breath-hold single-slice MRCP

6 Procedure Single-slice MRCP - RARE sequence – slice thickness 3 cm, TE 1100 – 3 sec / image – breath hold = overview images

7 Procedure Axial non-FATSAT turboFLASH T1 = magic tool for detection of pancreatic cancer and focal liver lesions Liver white Pancreas white Tumor dark

8 Procedure Multiphase contrast-enhanced VIBE Problem-solving tool Pancreatic lesions Only if required T P

9 Rule N° 1 Never use MRCP without cross- sectional imaging

10 Man, 43-year, elevated liver enzymes, previously papillotomy for biliary stone disease. Stone?

11 Aerobilia Always correlate with axial T2- weighted images !! Air-fluid level Extensive air may make MRCP nondiagnostic

12 Liver function abnormalities

13 Missed pancreatic carcinoma Never perform MRCP without cross-sectional imaging never, never, never TFLASH: 700 msec/slice – HASTE: 400 msec / slice

14 Rule N° 2 Use dynamic (repetitive) MRCP

15 May 13, hr:12min:15sec May 13, hr:12min:23sec

16 Temporal variability in shape of the sphincter of Oddi It works ! Only possible with breath-hold single- slice MRCP

17 Rule N° 3 Use the correct slice thickness Not 10 cm !

18 10cm5cm 2cm3cm

19 Rule N° 5 Be aware of biliary flow phenomena on axial images

20 Flow void in common bile duct Compare with single-slice MRCP Believe single-slice MRCP if results are different axial T2

21 Rule N° 6 Be aware of the pseudo-calculus sign

22 Pseudocalculus sign 30 sec later

23

24 Rule N° 7 Small stones not surrounded by fluid are invisible

25 Not included in slice Does the patient has stones in distal CBD ?? Normal size

26 Impacted stone May be difficult diagnosis ! No surrounding fluid Repetitive imaging useful

27

28 Rule N° 8 Anticipate differences between MRCP and ERCP images

29 MRCP : - imaging in the physiologic state (no ductal distention) - limitations in spatial resolution Low-grade stenoses can be missed The length of stenoses can be overestimated (physiologic collapse) Small polypoid ductal lesions can be missed

30 MRCP – ERCP The same things look different !! (distention)

31 Aberrant right posterior duct

32

33 Rule N° 9 For lesion characterization, use all information available (T1, T2, MRCP, multiphase contrast-enhanced images)

34 Cirrhosis. Incidental finding.

35 The double duct sign can be caused by chronic pancreatitis with pseudomass. Refer to axial T1- and T2-weighted images for differentiation with carcinoma.

36 Rule N° 10 Be aware of susceptibility artifact

37 Watanabe et al. RadioGraphics :

38 Susceptibility artifact air metal

39 Thank you !!

40 The double duct sign can be caused by chronic pancreatitis with pseudomass. Refer to axial T1- and T2-weighted images for differentiation with carcinoma.

41 Rule N° 4 Be careful with MIP images

42 The patient recently underwent laparoscopic gallbladder surgery and now suffers from jaundice. Injury to CBD?

43 MIP Projects 3D reality on 2D image Pathology may be masked


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