Comparative performance of non-contrast MRI with HASTE vs. contrast-enhanced MRI/3D-MRCP for possible choledocholithiasis in hospitalized patients

Abstract

Purpose: To compare the performance of non-contrast MRI with half-Fourier acquisition single-shot turbo spin echo (HASTE) vs. contrast-enhanced MRI/3D-MRCP for assessment of suspected choledocholithiasis in hospitalized patients.

Methods and materials: 123 contrast-enhanced abdominal MRI/MRCP scans in the hospital setting for possible choledocholithiasis were retrospectively evaluated. Endoscopic retrograde cholangiopancreatography, intraoperative cholangiogram or documented clinical resolution served as the reference standard. Readers first evaluated the biliary tree using coronal and axial HASTE and other non-contrast sequences, and later reviewed the entire exam with post-contrast sequences and 3D-MRCP. Test performance for the image sets was compared for choledocholithiasis, acute hepatitis, cholangitis, and acute cholecystitis. Reader agreement, MRCP image quality, and confidence levels were also assessed. Clinical predictors of age and fever were tested for association with perceived need for contrast in biliary assessment.

Results: There were 27 cases of choledocholithiasis, 31 cases of acute hepatitis, 37 cases of acute cholecystitis, and 3 clinically diagnosed cases of acute cholangitis. Both the abbreviated and full contrast-enhanced/MRCP image sets resulted in high accuracy for choledocholithiasis (91.1-94.3% vs. 91.9-92.7%). There was no difference in sensitivity or specificity for either reader for any diagnosis between image sets (p > 0.40). 1 reader showed improved confidence (p < 0.001) with inclusion of MRCP and contrast-enhanced images, but neither confidence nor MRCP quality scores were associated with diagnostic accuracy. Patient age and fever did not predict the need for contrast-enhanced images.

Conclusion: In hospitalized patients with suspected choledocholithiasis, performance of non-contrast abdominal MRI with HASTE is similar to contrast-enhanced MRI with 3D-MRCP, offering potential for decreased scanning time and improved patient tolerability.

Keywords: Choledocholithiasis; Gallstone disease; HASTE; Magnetic resonance cholangiopancreatography.

Fig. 1

A 90-year-old woman with right abdominal pain for one day and history of gallstones. Axial HASTE (A, arrow) and axial T2-fat saturated (B, arrow) sequences show a gallstone at the level of the ampulla in the presence of common bile duct dilatation. Both readers assigned the MRCP, including MRCP PACE (C), with a quality score of 5, indicating excellent visualization of entire biliary tree including choledocholithiasis in this case (arrow). The diagnosis was correctly made by both readers using abbreviated as well as the full image set

Fig. 1

A 90-year-old woman with right abdominal pain for one day and history of gallstones. Axial HASTE (A, arrow) and axial T2-fat saturated (B, arrow) sequences show a gallstone at the level of the ampulla in the presence of common bile duct dilatation. Both readers assigned the MRCP, including MRCP PACE (C), with a quality score of 5, indicating excellent visualization of entire biliary tree including choledocholithiasis in this case (arrow). The diagnosis was correctly made by both readers using abbreviated as well as the full image set

Fig. 1

A 90-year-old woman with right abdominal pain for one day and history of gallstones. Axial HASTE (A, arrow) and axial T2-fat saturated (B, arrow) sequences show a gallstone at the level of the ampulla in the presence of common bile duct dilatation. Both readers assigned the MRCP, including MRCP PACE (C), with a quality score of 5, indicating excellent visualization of entire biliary tree including choledocholithiasis in this case (arrow). The diagnosis was correctly made by both readers using abbreviated as well as the full image set

Fig. 2

A 72-year-old man with severe right upper quadrant pain for one day and abnormal liver function tests. Axial HASTE (A, arrow) and axial T2-fat saturated (B, arrow) sequences show a gallstone in the distal common bile duct with dilatation of the bile duct, as correctly interpreted by both readers using the abbreviated image set. Both readers assigned the MRCP, including MRCP PACE (C), with a low quality score of 2, indicating minimal information provided as the images depicted a dilated common bile duct but otherwise poor visualization of the biliary tree secondary to breathing motion

Fig. 2

A 72-year-old man with severe right upper quadrant pain for one day and abnormal liver function tests. Axial HASTE (A, arrow) and axial T2-fat saturated (B, arrow) sequences show a gallstone in the distal common bile duct with dilatation of the bile duct, as correctly interpreted by both readers using the abbreviated image set. Both readers assigned the MRCP, including MRCP PACE (C), with a low quality score of 2, indicating minimal information provided as the images depicted a dilated common bile duct but otherwise poor visualization of the biliary tree secondary to breathing motion

Fig. 2

A 72-year-old man with severe right upper quadrant pain for one day and abnormal liver function tests. Axial HASTE (A, arrow) and axial T2-fat saturated (B, arrow) sequences show a gallstone in the distal common bile duct with dilatation of the bile duct, as correctly interpreted by both readers using the abbreviated image set. Both readers assigned the MRCP, including MRCP PACE (C), with a low quality score of 2, indicating minimal information provided as the images depicted a dilated common bile duct but otherwise poor visualization of the biliary tree secondary to breathing motion

Fig. 3

A 25-year-old woman with severe right upper quadrant pain, gallstones and elevated bilirubin. Coronal HASTE image shows marked gallbladder edema (arrow) and periportal edema (arrowhead) (A), with mildly elevated T2 signal intensity of the liver parenchyma (B) leading to the diagnosis of acute hepatitis on noncontrast MRI by both readers using the abbreviated image set, also confirmed clinically. There was also heterogeneous arterial-phase enhancement on axial fat-suppressed 3D GRE T1-weighted image after injection of gadopentetate dimeglumine (C, arrow)

Fig. 3

A 25-year-old woman with severe right upper quadrant pain, gallstones and elevated bilirubin. Coronal HASTE image shows marked gallbladder edema (arrow) and periportal edema (arrowhead) (A), with mildly elevated T2 signal intensity of the liver parenchyma (B) leading to the diagnosis of acute hepatitis on noncontrast MRI by both readers using the abbreviated image set, also confirmed clinically. There was also heterogeneous arterial-phase enhancement on axial fat-suppressed 3D GRE T1-weighted image after injection of gadopentetate dimeglumine (C, arrow)

Fig. 3

A 25-year-old woman with severe right upper quadrant pain, gallstones and elevated bilirubin. Coronal HASTE image shows marked gallbladder edema (arrow) and periportal edema (arrowhead) (A), with mildly elevated T2 signal intensity of the liver parenchyma (B) leading to the diagnosis of acute hepatitis on noncontrast MRI by both readers using the abbreviated image set, also confirmed clinically. There was also heterogeneous arterial-phase enhancement on axial fat-suppressed 3D GRE T1-weighted image after injection of gadopentetate dimeglumine (C, arrow)