Capabilities of magnetic resonance cholangiopancreatography in the diagnosis of acute cholangitis

Objective: to study the capabilities of Magnetic Resonance Cholangiopancreatography (MRCP) in the diagnosis of acute cholangitis.

Material and methods: the study included 53 patients who underwent MRCP. The protocol included T2 T2FS, T1 dual Echo 1-2 (IP OP), DWI b (0-1000-2000), using a 24 channels superficial abdominal coil. The field of view extended from the diaphragm to the lower segment of the kidneys (slice thickness 5 mm; FOV 450 mm). Findings were interpreted in conjunction with the corresponding T2 and T2 FS data.

Results: all 53 patients demonstrated areas of hypointensity within thickened bile‑duct walls on MRCP. The altered bile duct walls were visualized immediately caudal to the lower border of the dilated intra- or extrahepatic bile ducts. These altered duct walls were visualised immediately caudal to the inferior margin of the dilated intra- or extrahepatic ducts. Secondary cholangitis arose in the setting of prolonged cholestasis and infection, and in patients with hepaticojejunostomies or choledochoduodenal anastomoses owing to reflux of intestinal contents into the biliary tree. On fat-suppressed T2-weighted images, small (2-8 mm) hyperintense foci were identified along small-caliber intrahepatic bile ducts. DWI IP likewise revealed small foci of diffusion restriction against the background of dilated small-caliber bile ducts.

Conclusions: MRCP combined with post-processing that includes multiplanar and volumetric reconstructions, enhances visualization of biliary duct inflammation. The resulting images are of a higher quality and provide a model for virtual treatment planning.

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