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Recurrent Pyogenic Cholangitis: Comparison between MR Cholangiography and Direct Cholangiography¹

¹ From the Department of Diagnostic Radiology, the Research Institute of Radiological Science (M.S.P., J.S.Y., K.W.K., M.J.K., S.W.Y., J.J.C., J.T.L., H.S.Y.) and the Department of Internal Medicine (J.P.C.), Yonsei University College of Medicine, YongDong Severance Hospital, 146-92, Dokok-Dong, Kangnam-Ku, Seoul, 135-270, South Korea. From the 2000 RSNA scientific assembly. Received July 17, 2000; revision requested September 5; final revision received February 23, 2001; accepted February 26. Address correspondence to J.S.Y.

PURPOSE: To compare the accuracy of magnetic resonance (MR) cholangiography with that of direct cholangiography for the evaluation of recurrent pyogenic cholangitis.

MATERIALS AND METHODS: Twenty-four patients with recurrent pyogenic cholangitis underwent MR cholangiography before surgery, and 18 of these 24 also underwent direct cholangiography. Two reviewers evaluated MR cholangiograms and direct cholangiograms and focused on identifying intrahepatic ductal dilatation, stricture, and calculi, as well as coexistent parenchymal abnormalities, on the basis of the classification of the internal lobes and segments of the liver. These observations were compared with surgical findings.

RESULTS: According to examination results in the surgical specimens, 24 patients had 46 segmental abnormalities. MR cholangiography depicted all 46 (100%) segments with ductal dilatation, 22 (96%) of 23 segments with focal ductal stricture, and 43 (98%) of 44 segments with ductal calculi. Eighteen patients who underwent direct cholangiography had 32 segmental abnormalities according to examination results in the surgical specimens. Direct cholangiography depicted 15 (47%) of 32 segments with ductal dilatation, eight (44%) of 18 segments with focal ductal stricture, and 14 (45%) of 31 segments with ductal calculi.

CONCLUSION: MR cholangiography is superior to direct cholangiography for accurate topographic evaluation of recurrent pyogenic cholangitis because it is able to depict all of the biliary tree, despite obstruction or stenosis.

Index terms: Bile ducts, calculi, 768.289 • Bile ducts, stenosis or obstruction, 768.2886 • Bile ducts radiography, 768.1222, 768.1226 • Cholangitis, 768.288 • Magnetic resonance (MR), cholangiopancreatography, 768.121411

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