Modified breath-hold compressed-sensing 3D MR cholangiopancreatography with a small field-of-view and high resolution acquisition: Clinical feasibility in biliary and pancreatic disorders.

BACKGROUND

Compressed-sensing (CS) accelerated 3D MR cholangiopancreatography (MRCP) could be acquired in both navigator-triggered (NT) and breath-hold (BH) mode, but the latter has been considered inferior in depicting pancreatic duct and diagnosing pancreatic duct-related diseases.

PURPOSE: To prospectively evaluate the clinical feasibility of a modified 3D BH-CS-MRCP prototype protocol with small field-of-view (FOV) and higher spatial resolution, and to compare its performance to the original BH-CS-MRCP and NT-CS-MRCP.

STUDY TYPE: Prospective cohort study.

POPULATION: Eighty-two patients with suspected pancreaticobiliary diseases (46 male, median age, 55 years, range, 16-79 years), including seven noncooperative patients.

FIELD STRENGTH/SEQUENCE: 3T, CS-MRCP.

ASSESSMENT: Three protocols were performed in random order in each patient. Acquisition time of each protocol was recorded. Image quality, background suppression, duct visibility, and diagnostic confidence with duct anatomic variations and duct-related pathologies were rated on a 5-point scale by two blinded radiologists independently.

STATISTICAL TESTS: The Wilcoxon signed-rank test was used to compare the intraindividual difference. Interobserver agreement was determined using kappa coefficients. The diagnostic performance was calculated using receiver operating characteristic curves.

RESULTS

Acquisition time was 17 seconds for both BH-CS-MRCP protocols, and 127.5 ± 36.9 seconds for NT-CS-MRCP. In 75 cooperative patients, the incidence of major artifacts was low for all protocols (5.3-8.0%). Background suppression was similar with the two BH-CS-MRCP protocols (3.67 ± 0.77 for original BH-CS-MRCP and 3.70 ± 0. 57 for modified BH-CS-MRCP, respectively), both inferior to the NT-CS-MRCP protocol (4.41 ± 0.68, P < 0.001 for both). Modified BH-CS-MRCP and NT-CS-MRCP depicted pancreatic duct and second-level branches of biliary duct better than original BH-CS-MRCP (all P < 0.01). The diagnostic performance for detecting bile duct abnormalities was similar for all protocols (P = 0.53-0.87), whereas for detecting pancreatic duct abnormalities, modified BH-CS-MRCP and NT-CS-MRCP had significantly better performance compared to original BH-CS-MRCP (both P < 0.01). In seven noncooperative patients, NT-CS-MRCP had superior image quality than both BH protocols (both P < 0.01).

DATA

CONCLUSION

Modified BH-CS-MRCP is feasible for pancreatic and biliary disorders. NT-CS-MRCP might be more useful in noncooperative patients.

LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1389-1399.