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Pseudo-obstruction of the Extrahepatic Bile Duct Due to Artifact from Arterial Pulsatile Compression: A Diagnostic Pitfall of MR Cholangiopancreatography¹

¹ From the Department of Radiology, Kurashiki Central Hospital, Kurashiki 710-8602, Japan. From the 1997 RSNA scientific assembly. Received January 6, 1999; revision requested March 5; final revision received June 21; accepted July 21. Address reprint requests to Y.W. (e-mail: yw5904@kchnet.or.jp).

PURPOSE: To evaluate the frequency of artifact from arterial pulsatile compression as the cause of pseudo-obstruction of the extrahepatic bile duct at magnetic resonance (MR) cholangiopancreatography (MRCP) and specify the causative vessels.

MATERIALS AND METHODS: In 234 patients (102 men, 132 women; age range, 25–80 years), MRCP images obtained by using a single-shot turbo spin-echo sequence were reviewed to assess pseudo-obstruction of the extrahepatic bile duct caused by vascular compression. Dual-phase spiral computed tomography, contrast material–enhanced three-dimensional MR angiography, and/or digital subtraction angiography also were performed to determine the vessel that caused the pseudo-obstruction.

RESULTS: Thirty-six pseudo-obstructions due to vascular compression were found in 33 (14%) patients. The common hepatic duct (27 [75%] sites) was the most common pseudo-obstruction site, followed by the left hepatic duct (four [11%] sites), proximal common bile duct (three [8%] sites), and right hepatic duct (two [6%] sites). The causative vessels were identified as the right hepatic artery at 24 (67%) sites; gastroduodenal artery, two (6%) sites; cystic artery, two (6%) sites; proper hepatic artery, one (3%) site; and an unspecified branch of the common hepatic artery, seven (19%) sites.

CONCLUSION: At MRCP, pseudo-obstruction of the extrahepatic bile duct can be caused by pulsatile vascular compression of the hepatic and gastroduodenal arteries, and it should not be misdiagnosed as a bile duct tumor or biliary stone.

Index terms: Bile ducts, abnormalities, 768.288, 768.291, 768.31, 768.32 • Bile ducts, MR, 768.121411, 768.121416, 768.12142, 768.12143 • Computed tomography (CT), comparative studies, 76.1211 • Hepatic arteries • Magnetic resonance (MR), artifact, 768.121411, 768.121416, 768.12142, 768.12143 • Magnetic resonance (MR), comparative studies, 76.1214

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