MR cholangiopancreatography: value of axial and coronal fast Spin-Echo fat-suppressed T2-weighted sequences

Objective: To compare axial and coronal Fast Spin-Echo fat-suppressed T2-we ighted sequences with three-dimensional (3D) maximum intensity projection ( MIP) images in patients with suspected pancreaticobiliary obstruction. Mate rial and methods: MR cholangiopancreatography (MRCP) was performed in 108 c onsecutive patients with a non-breath-hold, fat-suppressed, 2D, heavily T2- weighted fast spin-echo sequence in coronal plane. Axial T1- and T2-weighte d images were previously obtained. In addition. 3D reconstructions of the c oronal images were analysed separately by using a MIP algorithm. Both two-d imensional (2D) (axial and coronal) and 3D MIP images were separately evalu ated by two readers in conference and their results were compared with that of endoscopic retrograde cholangiopancreatography, percutaneous trans-hepa tic cholangiography, surgery and:or imaging follow-up. Statistical analysis of 2D and 3D MRCP images in diagnosing the level and probable cause of pan creaticobiliary obstruction were separately calculated. Results: 106/108 of MRCP examinations were judged diagnostic by the two reviewers for adequacy of visualisation of the biliary and pancreatic ducts, Sensitivity, specifi city, positive predictive value, negative predictive value and global diagn ostic accuracy of 2D (axial and coronal) and 3D MRCP images in diagnosing t he pancreaticobiliary obstruction were 94 and 57%, 95 and 93%, 97 and 92%, 91 and 60%, 94 and 72%, respectively. Conclusion: Our results do indicate a higher global accuracy for axial and coronal fast Spin-Echo fat-suppressed T2-weighted sequences versus 3D MIP images in diagnosis of the level and p robable cause of pancreaticobiliary obstruction and stress the limitations of 3D images in depiction of small intraductal pathology such as calculi an d biliary neoplastic lesions. (C) 1999 Elsevier Science Ireland Ltd. All ri ghts reserved.