Detection of choledocholithiasis with MR cholangiography: comparison of three-dimensional fast spin-echo and single- and multisection half-Fourier rapid acquisition with relaxation enhancement sequences.
OBJECTIVE
To compare the performance of three pulse sequences commonly used at magnetic resonance (MR) cholangiography in the diagnosis of choledocholithiasis.


METHODS
MR cholangiography was performed in 57 patients who were suspected of having choledocholithiasis and referred for endoscopic retrograde cholangiography. Non-breath-hold three-dimensional fast spin-echo, breath-hold single-section half-Fourier rapid acquisition with relaxation enhancement (RARE), and breath-hold multisection half-Fourier RARE sequences were compared. Two radiologists independently interpreted the MR cholangiograms. Evaluated diagnostic performance parameters included sensitivity, specificity, receiver operating characteristic (ROC) curves, and interobserver agreement (kappa statistics). Endoscopic retrograde cholangiography was the standard of reference.


RESULTS
Eight patients were excluded because of incomplete MR examinations (n = 4) or failure in the cannulation of the bile duct at retrograde cholangiography (n = 4). In 49 patients, the three MR cholangiographic sequences were completed successfully. In 24 (49%) of these patients, retrograde cholangiography demonstrated stones. Sensitivity and specificity of MR cholangiography exceeded 90%, and the area under the ROC curve was greater than 0.95 for both radiologists and for the three sequences. Interobserver agreement for presence of bile duct stones was at least 0.80 (very good) for the three sequences.


CONCLUSIONS
The three MR cholangiographic sequences had similarly high sensitivities and specificities for the detection of choledocholithiasis.
Soto
J A
JA
Departments of Radiology, Universidad de Antioquia, Hospital Universitario San Vicente de Paúl, Medellín, Colombia. JorgeASoto@aol.com
Barish
M A
MA
Alvarez
O
O
Medina
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods / Q000706:statistics & numerical data; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005583:Fourier Analysis; D042882:Gallstones / Q000175:diagnosis*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity