Introduction
Acute and chronic abdominal pain is one of the most common causes of hospital admissions worldwide.
From an observational point of view, most biliary symptoms are usually caused by cholelithiasis or cholecystitis and are met by straightforward diagnosis and treatment. However, complex diseases like biliary and pancreatic neoplasms or congenital disorders require a sophisticated diagnostic work-up and a tailored therapeutic approach.
Endoscopic retrograde Cholangiopancreatography (ERCP), an endoluminal invasive technique, provides accurate diagnosis and offers therapeutic alternatives within the biliary tract. Still, it can never see beyond the wall into the surrounding tissue.
The differential diagnosis and staging of tumors inside or around the biliary tract require a comprehensive assessment. MRI is crucial in differential diagnosis and treatment follow-up due to its intrinsic soft tissue contrast.
Equipment
Imaging is performed on the Siemens Healthineers MAGNETOM Vida 3T MRI system equipped with BioMatrix™ Technology.
The protocols are optimized for image quality and acquisition time. In addition, the 18-channel body coil with the industry’s unique integrated BioMatrix™ Respiratory sensor is utilized for body imaging.
MR Techniques
MRI has an unparalleled ability to visualize the biliary tracts directly, relying on the physical properties of barely moving fluid with long T2-relaxation times.
The protocols we deploy at our department are:
- HASTE (half-Fourier acquisition single-shot turbo spin echo) axial and Coronal
- FLASH (Fast Low Angle Shot) T1 Acquisition Axial
- 3D-SPACE 3D MRCP
- HASTE T2 TSE Thick Slab
- 3D VIBE with CAIPIRINHA
- 3D SPACE T2
- Diffusion
Case Studies 1 - 6
Case Study 1
Clinical presentation
40-year-old male presenting with intermittent pain in the epigastrium radiating to the back, nausea and lack of appetite for 5 days.
Imaging
Distended gallbladder with edematous thickened walled and calculi - cholecystitis.
Dilated common bile duct with 4.9 x 4.4 mm sized calculus at the ampulla with proximal biliary ductal dilatation.
Follow up
ERCP: Stone removal; Cholecystectomy.
Contact
HOD and Specialist, Radiologist
NMC Royal Hospital Sharjah, UAE