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MR Cholangiography in Symptomatic Gallstones: Diagnostic Accuracy according to Clinical Risk Group¹

¹ From the Department of Diagnostic Radiology (J.H.K., M.J.K., S.I.P., J.J.C., H.S.Y., J.T.L., K.W.K.), BK21 Project for Medical Science (M.J.K.), Division of Gastroenterology, Department of Internal Medicine (S.Y.S.), and Department of Surgery (K.S.K.), Yonsei University College of Medicine, Seodaemun-ku Shinchon-dong 134, Seoul 120-752, Korea. Received July 19, 2001; revision requested September 11; revision received October 25; accepted December 10. Supported by Yonsei University Research Fund of 2001. Address correspondence to M.J.K. (e-mail: kimnex@yumc.yonsei.ac.kr).

View larger version (114K): [in a new window]   Figure 1. Coronal thick-section (/1,079 [effective]; 50-mm thickness) MR cholangiographic image obtained in a 57-year-old man with a high risk of CBD stones and an elevated bilirubin concentration (>1.5 mg/dL [>25.6 µmol/L]). Patient had a true-positive diagnosis of a CBD stone. Image shows a single stone (arrow) in the distal lumen of the CBD.

View larger version (113K): [in a new window]   Figure 2a. MR cholangiographic images obtained in a 57-year-old man with a high risk of CBD stones and a false-positive diagnosis of CBD stones. A small calculus (arrows) was observed on (a) coronal thick-section (/1004 [effective], 30-mm thickness) and (b) T2-weighted (/97 [effective]) images. However, the calculus was not demonstrated at ERC performed 4 days after MR cholangiography, and only bile sludge was found. The patient’s laboratory test abnormality had normalized by the time of ERC. Therefore, the calculus depicted at MR cholangiography was considered to have been passed at the time of ERC.

View larger version (134K): [in a new window]   Figure 2b. MR cholangiographic images obtained in a 57-year-old man with a high risk of CBD stones and a false-positive diagnosis of CBD stones. A small calculus (arrows) was observed on (a) coronal thick-section (/1004 [effective], 30-mm thickness) and (b) T2-weighted (/97 [effective]) images. However, the calculus was not demonstrated at ERC performed 4 days after MR cholangiography, and only bile sludge was found. The patient’s laboratory test abnormality had normalized by the time of ERC. Therefore, the calculus depicted at MR cholangiography was considered to have been passed at the time of ERC.

View larger version (109K): [in a new window]   Figure 3a. MR cholangiographic images obtained in a 72-year-old man with a high risk of CBD stones and a false-negative diagnosis of CBD stones. (a) Coronal thick-section (/1,088 [effective]; 30-mm thickness) and (b) thin-section T2-weighted (/100 [effective]) images showed no evidence of CBD stones. CBD stones were not found at ERC (images not shown). The patient underwent IOC, however, which revealed a calculus smaller than 3 mm.

View larger version (144K): [in a new window]   Figure 3b. MR cholangiographic images obtained in a 72-year-old man with a high risk of CBD stones and a false-negative diagnosis of CBD stones. (a) Coronal thick-section (/1,088 [effective]; 30-mm thickness) and (b) thin-section T2-weighted (/100 [effective]) images showed no evidence of CBD stones. CBD stones were not found at ERC (images not shown). The patient underwent IOC, however, which revealed a calculus smaller than 3 mm.

View larger version (113K): [in a new window]   Figure 4a. MR cholangiographic images obtained in a 58-year-old man with a moderate risk of CBD stones and a false-positive diagnosis of CBD stones. (a) Coronal (/66 [effective]) and (b) transverse (/66 [effective]) T2-weighted images showed a linear signal void (arrow) in the distal lumen of the CBD. (c) Although thick-section (/995 [effective]; 50-mm thickness) images did not depict the signal void, it was regarded as being a CBD stone at preoperative image interpretation. The patient underwent ERC 5 days after MR cholangiography, and no stone was found. Laparoscopic cholecystectomy was performed without IOC. There has been no recurrence of symptoms.

View larger version (135K): [in a new window]   Figure 4b. MR cholangiographic images obtained in a 58-year-old man with a moderate risk of CBD stones and a false-positive diagnosis of CBD stones. (a) Coronal (/66 [effective]) and (b) transverse (/66 [effective]) T2-weighted images showed a linear signal void (arrow) in the distal lumen of the CBD. (c) Although thick-section (/995 [effective]; 50-mm thickness) images did not depict the signal void, it was regarded as being a CBD stone at preoperative image interpretation. The patient underwent ERC 5 days after MR cholangiography, and no stone was found. Laparoscopic cholecystectomy was performed without IOC. There has been no recurrence of symptoms.

View larger version (124K): [in a new window]   Figure 4c. MR cholangiographic images obtained in a 58-year-old man with a moderate risk of CBD stones and a false-positive diagnosis of CBD stones. (a) Coronal (/66 [effective]) and (b) transverse (/66 [effective]) T2-weighted images showed a linear signal void (arrow) in the distal lumen of the CBD. (c) Although thick-section (/995 [effective]; 50-mm thickness) images did not depict the signal void, it was regarded as being a CBD stone at preoperative image interpretation. The patient underwent ERC 5 days after MR cholangiography, and no stone was found. Laparoscopic cholecystectomy was performed without IOC. There has been no recurrence of symptoms.

View larger version (122K): [in a new window]   Figure 5a. MR cholangiographic images obtained in an 87-year-old man with a low risk of CBD stones and a true-positive diagnosis of CBD stones. The (a) thick-slab (/1,217 [effective]; 30-mm thickness) and (b) thin-section T2-weighted (/100 [effective]) images showed a single small stone (arrows) in the distal lumen of the nondilated CBD.

View larger version (153K): [in a new window]   Figure 5b. MR cholangiographic images obtained in an 87-year-old man with a low risk of CBD stones and a true-positive diagnosis of CBD stones. The (a) thick-slab (/1,217 [effective]; 30-mm thickness) and (b) thin-section T2-weighted (/100 [effective]) images showed a single small stone (arrows) in the distal lumen of the nondilated CBD.

View larger version (122K): [in a new window]   Figure 6a. MR cholangiographic images obtained in a 30-year-old woman with a low risk of CBD stones and a false-positive diagnosis of CBD stones. A tiny area of nodular signal void (arrows) seen on (a) single thick-section (/1,217 [effective]; 30-mm thickness) and (b) T2-weighted (/100 [effective]) images was interpreted initially as being a CBD stone with minor confidence. Clinical, sonographic, and laboratory findings did not support the presumed diagnosis of a CBD stone. In the preoperative conference, the initial MR cholangiographic diagnosis was changed to negative for the presence of CBD stones. Laparoscopic surgery was performed without preoperative ERC or IOC. There has been no recurrence of symptoms.

View larger version (132K): [in a new window]   Figure 6b. MR cholangiographic images obtained in a 30-year-old woman with a low risk of CBD stones and a false-positive diagnosis of CBD stones. A tiny area of nodular signal void (arrows) seen on (a) single thick-section (/1,217 [effective]; 30-mm thickness) and (b) T2-weighted (/100 [effective]) images was interpreted initially as being a CBD stone with minor confidence. Clinical, sonographic, and laboratory findings did not support the presumed diagnosis of a CBD stone. In the preoperative conference, the initial MR cholangiographic diagnosis was changed to negative for the presence of CBD stones. Laparoscopic surgery was performed without preoperative ERC or IOC. There has been no recurrence of symptoms.