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Biliary Dilatation: Differentiation of Benign from Malignant Causes-Value of Adding Conventional MR Imaging to MR Cholangiopancreatography¹

¹ From the Department of Radiology, Thomas Jefferson University Hospital, Rm 1096, Main Bldg, 132 S 10th St, Philadelphia, PA 19107-5244. Received February 24, 1999; revision requested April 23; revision received May 14; accepted August 23. Address reprint requests to D.G.M. (e-mail: donald.mitchell@mail.tju.edu).

PURPOSE: To determine the value of conventional T1- and T2-weighted images and gadolinium-enhanced dynamic magnetic resonance (MR) images as a supplement to MR cholangiopancreatographic (MRCP) images in differentiation of benign from malignant causes of biliary dilatation.

MATERIALS AND METHODS: MR studies in 62 patients with biliary dilatation with proved causes included conventional T1- and less heavily T2-weighted images, as well as gadolinium-enhanced dynamic images and heavily T2-weighted MRCP images. Two radiologists reviewed MRCP images alone, MRCP images with nonenhanced T1- and T2-weighted MR images, and MRCP images with nonenhanced and gadolinium-enhanced dynamic images.

RESULTS: For differentiation of benign from malignant causes of biliary dilatation, the area under the receiver operating characteristic curve (A_z) was significantly (P < .05) larger for MRCP images interpreted with T1- and T2-weighted images (0.9547 for reader 1, 0.8404 for reader 2) than for MRCP images alone (0.8144 for reader 1, 0.8122 for reader 2). The addition of gadolinium-enhanced dynamic MR images to MRCP images with nonenhanced T1- and T2-weighted images did not significantly increase accuracy (A_z = 0.9554 for reader 1 and 0.8650 for reader 2), but the level of confidence was increased in 17%–24% of cases.

CONCLUSION: Use of nonenhanced T1- and less heavily T2-weighted images with MRCP images significantly improved the diagnostic accuracy of MR examinations of pancreaticobiliary disease.

Index terms: Bile ducts, abnormalities, 76.28 • Bile ducts, calculi, 76.28 • Bile ducts, diseases, 76.28 • Bile ducts, stenosis or obstruction, 76.28 • Gastrointestinal tract, neoplasms, 70.30 • Magnetic resonance (MR), comparative studies, 76.121412, 76.121415, 76.12149 • Receiver operating characteristic (ROC) curve

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