Imaging Techniques

  • Paolo Pavone
  • Roberto Passariello


Several imaging techniques, both invasive and noninvasive, are commonly used for evaluating biliopancreatic ducts: intravenous cholangiography, ultrasound, computed tomography (CT), magnetic resonance (MR), percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP). Intravenous cholangiography is limited by the major drawback, namely the lack of opacification of the biliary system, which occurs in 30%–40% of cases. Moreover, in a prospective study intravenous cholangiography was useful in detecting choledocholithiasis only in 1.5% of cases [1, 2]. Risks related to adverse reaction of contrast agent, the cost of the procedure, and the poor anatomical definition of the intra- and extrahepatic bile ducts should be considered if a cost-effectiveness analysis is performed [3]. Ultrasound, CT, and conventional MR are currently used in the initial evaluation of patients with symptoms and signs related to the pancreaticobiliary system. The diagnostic accuracy varies with the various pathologies, but each of the previous techniques, offering an indirect representation of the biliary ducts, is often insufficient to provide a correct diagnosis and basis for treatment of the biliary obstruction [4–6].


Maximum Intensity Projection Steady State Free Precession Fast Spin Percutaneous Transhepatic Cholangiography Magnetic resonanCe Cholangiography 
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  1. 1.
    Patel JC, Mclnnes GC, Bagley JS, Needham G, Krukowski ZH (1993) The Role of intravenous cholangiography in pre-operative assessment for laparoscopic cholecystectomy. Br J Radiol 66: 1125–1127PubMedCrossRefGoogle Scholar
  2. 2.
    Dawson P, Adam A, Benjamin IS (1993) Intravenous cholangiography revisited. Clin Radiol 47: 223–225PubMedCrossRefGoogle Scholar
  3. 3.
    Shehadi WH, Toniolo G (1980) Adverse reaction to contrast media. Diagn Radiol 137: 299–302Google Scholar
  4. 4.
    Thomas MJ, Pellegrini CA, Way LW (1982) Usefulness of diagnostic tests for biliary ob-struction. Am J Surg 114: 102–108CrossRefGoogle Scholar
  5. 5.
    Laing FC, Jeffrey RB, Wing VW, Nyberg DA (1986) Biliary dilatation: defining the level and-the cause by real-time US. Radiology 160: 39–42PubMedGoogle Scholar
  6. 6.
    Pasanen P, Partanen K, Pikkarainen P et al (1992) Ultrasonography, CT and ERCP in the diagnosis of choledocal stones. Acta Radiol 33: 53–56PubMedCrossRefGoogle Scholar
  7. 7.
    Kuilman E, Borch K, Tarpila E et al (1984) Endoscopie Retrograde Cholangiopancreatography ( ERCP) in patients with jaundice and suspected biliary obstruction. Acta Chir Scand 150: 657–663Google Scholar
  8. 8.
    Osnes M, Myren J (1975) ERCP in patients with Bilroth II partial gastrectomy. Endoscopy 7: 227–232CrossRefGoogle Scholar
  9. 9.
    Lotveit T, Skar V, Osnes M (1988) Juxtapapillary duodenal diverticula. Endoscopy 20: 175–178PubMedCrossRefGoogle Scholar
  10. 10.
    Buset M, Dunham F, Gulbisa A et al (1991) Complications tardive de l’endoscopie diagnostique et operatoire des voies bilio-pancreatique. Acta Gastroenterol Bel 44: 396–403Google Scholar
  11. 11.
    Hart R, Classen M (1990) Complications of diagnostic gastrointestinal endoscopy. Endoscopy 22: 219–223CrossRefGoogle Scholar
  12. 12.
    Lenriot J, Le Neel J, Hay J et al (1993) Cholangio-pancreatographie retrograde et sphincterotomie endoscopique pou lithiase biliare. Gastroenterol Clin Biol 17: 244–250PubMedCrossRefGoogle Scholar
  13. 13.
    Hamilton I, Lintott DJ, Rothwell J, Axon ATR (1983) Acute pancrzatitis following endoscopic retrograde cholangiopancreatography. Clin Radiol 34: 543–546PubMedCrossRefGoogle Scholar
  14. 14.
    Chien D, Edelman RR (1992) Fast magnetic resonance imaging. In: Higgins CB, Hricak H, Helms CA (eds) Magnetic resonance imaging of the body. Raven, New York, pp 175–198Google Scholar
  15. 15.
    Margosian P, Schmitt F, Purdy D (1986) Faster MR imaging: imaging with half the data. Health Care Instrum 1: 195–197Google Scholar
  16. 16.
    Haase A, Frahm J, Matthaei D et al (1986) FLASH imaging: rapid NMR imaging using low flip angle pulses. J Magn Reson 67: 258–266Google Scholar
  17. 17.
    Haacke EM, Tkach J (1990) A review of fast imaging techniques and applications. AJR 155 (5): 951–964PubMedCrossRefGoogle Scholar
  18. 18.
    Buxton RB, Fisel CR, Chien D, Brady TJ (1989) Signal intensity in fast imaging. J Magn Reson 83 (3): 576–585Google Scholar
  19. 19.
    Elster AD (1993) Gradient-echo MR imaging: techniques and acronyms. Radiology 186: 1–8PubMedGoogle Scholar
  20. 20.
    Wehrli FW (1990) Fast-scan magnetic resonance: principles and applications. Magn Reson Q 6: 165–236PubMedGoogle Scholar
  21. 21.
    Gyngell ML (1989) The steady-state signals in short-repetition-time sequences. J Magn Reson 81: 474–483Google Scholar
  22. 22.
    Zur Y, Wood ML, Neuringer LJ (1991) Spoiling of transverse magnetization in steady-state sequences. Magn Reson Med 21: 251–263PubMedCrossRefGoogle Scholar
  23. 23.
    Cohen MS, Weisskoff RM (1991) Ultra-fast imaging. Magn Reson Imaging 9: 1–37PubMedCrossRefGoogle Scholar
  24. 24.
    Chien D, Edelman RR (1991) Ultrafast imaging using gradient echoes. Magn Reson Q 1: 31–56Google Scholar
  25. 25.
    Haase A, Matthaei W, Bartkowski R, Duhmke E, Leibfritz D (1989) Inversion-recovery snapshot FLASH MR imaging. J Comput Assist Tomogr 13: 1036–1039PubMedCrossRefGoogle Scholar
  26. 26.
    Mugler JP III, Brookeman JR (1990) Three-dimensional magnetization-prepared rapid gradient-echo imaging. Magn Reson Med 15: 152–157PubMedCrossRefGoogle Scholar
  27. 27.
    Meiboom S, Gill D (1958) Modified spin-echo method for measuring nuclear relaxation times. Rev Sci Instrum 29: 688–691CrossRefGoogle Scholar
  28. 28.
    Jones KM, Mulkern RV, Schwartz RB et al (1992) Fast spin-echo imaging of the brain and spine: current concepts. AJR 158: 1313–1320PubMedCrossRefGoogle Scholar
  29. 29.
    Hennig J, Naureth A, Friedburg H (1986) RARE imaging: a fast imaging method for clinical MR. Magn Reson Med 3:823–833-Google Scholar
  30. 30.
    Listerud J, Einstein S, Outwater E, Kressel HY (1992) First principles of fast spin-echo. Magn Reson Q 4: 199–244Google Scholar
  31. 31.
    Nghiem HV, Herfkens RJ, Francis IR et al (1992) The pelvis: T2 weighted fast spin-echo MR imaging. Radiology 185: 213–217PubMedGoogle Scholar
  32. 32.
    Smith RC, Constable RT, Reinhold C et al (1994) Fast Spin echo STIR imaging. J Corn-put Assist Tomogr 18: 209–213CrossRefGoogle Scholar
  33. 33.
    Chan TW, Listerud J, Kressel HY (1991) Combined chemical-shift and phase-selective imaging for fat-suppression: theory and clinical experience. Radiology 181: 41–47PubMedGoogle Scholar
  34. 34.
    Axel L, Summers RM, Kressel HY, Charles C (1986) respiratory effects in two-dimensional Fourier transform MR imaging. Radiology 160: 795–801Google Scholar
  35. 35.
    Wood ML, Henkelman MR (1985) MR image artifacts from periodic motion. Med Phys 12: 143–151PubMedCrossRefGoogle Scholar
  36. 36.
    Wood ML, Runge VM, Henkelman MR (1988) Overcoming motion in abdominal MR imaging. AJR 150: 513–522PubMedCrossRefGoogle Scholar
  37. 37.
    Perman WH, Moran PR, Moran RA, Bernstein MA (1986) Artifacts from pulsatile flow in MR imaging. J Comput Assist Tomogr 10: 473–483PubMedGoogle Scholar
  38. 38.
    Ehman RL, Felmlee JP (1990) Flow artifact reduction in MRI: a review of the roles of gradient moment nulling and spatial presaturation. Magn Reson Med 14: 293–307PubMedCrossRefGoogle Scholar
  39. 39.
    Chernish SM, Maglinte DD (1990) Glucagon: common untoward reactions —review and recommendations. Radiology 177: 145–146PubMedGoogle Scholar
  40. 40.
    Tyrell RL, Gluckert K, Pathria M, Modic MT (1988) Fast three-dimensional MR imaging of the knee: comparison with arthroscopy. Radiology 166: 865–872Google Scholar
  41. 41.
    Adam G, Bohndorf K, Drobnitzky M, Guenther RW (1989) MR imaging of the knee: three-dimensional volume imaging combined with fast processing. J Comput Assist Tomogr 13 (6): 984–988PubMedCrossRefGoogle Scholar
  42. 42.
    Frahm J, Hasse A, Matthaei W (1986) rapid three-dimensional MR imaging using the FLASH technique. J Comput Assist Tomogr 10: 363–368Google Scholar
  43. 43.
    Wallner BK, Schumacher KA, Weidenmaier W, Friedrich JM (1991) Dilated biliary tract: evaluation with MR cholangiography with a T2-weighted contrast-enhanced fast sequence. Radiology 181: 805–808PubMedGoogle Scholar
  44. 44.
    Morimoto K, Shimoi M, Shirakawa T et al (1992) Biliary obstruction: evaluation with three-dimensional MR cholangiography. Radiology 183: 578–580PubMedGoogle Scholar
  45. 45.
    Ishizaki Y, Wakayama T, Okada Y, Kobayashi T (1993) Magnetic resonance cholangiography for evaluation of obstructive jaundice. Am J Gastroenterol 88: 2072–2077PubMedGoogle Scholar
  46. 46.
    Hall-Craggs MA, Allen CM, Owens CM et al (1993) MR cholangiography: clinical evaluation in 40 cases. Radiology 189: 423–427PubMedGoogle Scholar
  47. 47.
    Reinhold C, Guibaud L, Genin G, Bret PM (1995) MR cholangiopancreatography: comparison between two-dimensional fast spin-echo and three-dimensional gradient-echo pulse sequences. JMRI 4: 379–384CrossRefGoogle Scholar
  48. 48.
    Outwater EK (1993) MR cholangiography with a fast spin-echo sequence. JMRI 3: 131CrossRefGoogle Scholar
  49. 49.
    Meakem TJ, Holland GA, Mc Dermott VGM et al (1993) Fast spin echo multicoil magnetic resonance cholangiography: initial experience. In: Society of Magnetic Resonance Imaging Abstract Book, P 47Google Scholar
  50. 50.
    Takehara Y, Ichijo K, Tooyama N et al (1994) Breath-hold MR cholangiopancreatography with a long-echo-train fast spin-echo sequence and a surface coil in chronic pancreatitis. Radiology 192: 73–78PubMedGoogle Scholar
  51. 51.
    Guibaud L, Bret PM, Reinhold C, Atri M, Barkun ANG (1994) Diagnosis of choledocho-lithiasis: value of MR cholangiography. AJR 163: 847–850PubMedCrossRefGoogle Scholar
  52. 52.
    Shiono T, Iwasaki N (1995) MR cholangiography with fast imaging scheme. In: Society of Magnetic Resonance Imaging abstract book, p1454Google Scholar
  53. 53.
    Laubenberger J, Buchert M, Schneider B, Blum U, Hennig J, Langer M (1995) Breath-Hold projection magnetic resonance cholangiopancreatography (MRCP): a new method for examination of the bile and pancreatic ducts. Magn Reson Med 33: 18–23PubMedCrossRefGoogle Scholar
  54. 54.
    Zuo C, Buff B, Wielopolski P, Clouse M (1995) MR cholangiography with fast imaging scheme. In: Society of Magnetic Resonance Imaging abstract book, pl445Google Scholar
  55. 55.
    Wielopolski P, Zuo C, Clouse M, Buff B (1995) Breath-hold 3D cholangiography using RARE and segmented echo planar imaging readouts. In: Society of Magnetic Resonance Imaging abstract book, P1448Google Scholar
  56. 56.
    Sananes JC, Bonnet M, Lecesne R et al (1995) Magnetic resonance cholangiography using HASTE sequence. Optimization and clinical evaluation in extrahepatic cholestasis. In: Society of Magnetic Resonance Imaging abstract book,. pl453Google Scholar
  57. 57.
    Macaulay SE, Schulte SJ, Sekijima JH et al (1995) Evaluation of a non-breath-hold MR cholangiography technique. Radiology 196: 227–232PubMedGoogle Scholar
  58. 58.
    Barish MA, Yucel EK, Soto JA, Chuttani R, Ferrucci JT (1995) MR cholangiopancreatography: efficacy of three-dimensional turbo spin-echo technique. AJR 165: 295–300PubMedCrossRefGoogle Scholar
  59. 58.
    Barish MA, Yucel EK, Soto JA, Chuttani R, Ferrucci JT (1995) MR cholangiopancreatography: efficacy of three-dimensional turbo spin-echo technique. AJR 165: 295–300PubMedCrossRefGoogle Scholar
  60. 60.
    Laghi A, Pavone P, Catalano C et al (1996) Non-breath-hold 3D MR-cholangiography at 0. 5T: technique optimization and clinical results. Presented at SMR Annual Meeting, April-May, 1995, New YorkGoogle Scholar
  61. 61.
    Brown DG, Riederer SJ (1992) Contrast-to-noise ratios in maximum intensity projection images. Magn Reson Med 23: 130–139PubMedCrossRefGoogle Scholar
  62. 62.
    Anderson CM, Saloner D, Tsuruda JS et al (1990) artifacts in maximum-intensity pro-jection display of MR angiograms. AJR 154: 623–629Google Scholar
  63. 63.
    Drebin RA, Carpenter L, Hanrahan P (1988) Volume rendering. Comput Graphics 22: 65–74CrossRefGoogle Scholar
  64. 64.
    Cline HE, Dumoulin CL, Lorensen WE et al (1991) Volume rendering and connectivity algorithms for MR angiography. Magn Reson Med 18: 384–394PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1997

Authors and Affiliations

  • Paolo Pavone
    • 1
  • Roberto Passariello
    • 1
  1. 1.Istituto di Radiologia, Cattedra IIUniversità degli Studi di Roma “La Sapienza”RomeItaly

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