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(Radiology. 2000;214:856-860.)
© RSNA, 2000

Gastrointestinal Imaging

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

Yuji Watanabe, MD, Masako Dohke, MD, Takayoshi Ishimori, MD, Yoshiki Amoh, MD, Akira Okumura, MD, Kazushige Oda, MD, Takafumi Hayashi, MD, Atsuto Hiyama, MD and Yoshihiro Dodo, MD

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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