title: Magnetic resonance cholangiopancreatography: image quality, ductal morphology, and value of additional T2- and T1-weighted sequences for the assessment of suspected pancreatic cancer.
abstract: OBJECTIVE
  To assess image quality and duct morphology on magnetic resonance cholangiopancreatography (MRCP) and also the value of additional T2- and T1-weighted sequences for differentiation of benignity and malignancy in patients with suspected pancreatic tumors.
  
  
  METHODS
  One-hundred-and-fourteen patients received MRCP and unenhanced and contrast material-enhanced MR imaging. MR results were analyzed independently by two blinded readers, and subsequently correlated with the results from surgery, biopsy, and follow-up. Assessment included the evaluation of image quality, duct visualization and morphology, and the differentiation of pancreatic lesion status (benign versus malignant).
  
  
  RESULTS
  Overall, 49 patients had benign final diagnoses, while 65 had a malignant diagnosis. Image quality of single-shot thick-slab MRCP was rated significantly better than the MIP images of multisection MRCP. With MRCP alone, the two readers' accuracy in the assessment of pancreatic lesion status was 72% (95% CI, 64% to 83%) and 69% (95% CI, 56% to 77%), respectively; with the addition of T2- and T1-weighted images the accuracy significantly improved to 89% (95% CI, 82% to 95%) and 84% (95% CI, 77% to 92%) for readers 1 and 2, respectively.
  
  
  CONCLUSIONS
  Single-shot thick-slab MRCP and multisection MRCP provide complementary results; however, single-shot MRCP had superior image quality. Moreover, assessment of ductal morphology with MRCP alone facilitated the diagnosis of different pathologic conditions of the pancreatobiliary system in the majority of patients. However, with the addition of T2- and T1-weighted sequences the overall diagnostic accuracy was significantly improved and thus we consider that a comprehensive MR approach should comprise both MRCP techniques and parenchymal sequences.
authors.affiliation: Klinik für Strahlenheilkunde, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany. elh@charite.de
authors.forename: E Lopez
authors.initials: EL
authors.lastname: Hänninen
authors.forename: J
authors.initials: J
authors.lastname: Ricke
authors.forename: H
authors.initials: H
authors.lastname: Amthauer
authors.forename: R
authors.initials: R
authors.lastname: Röttgen
authors.forename: M
authors.initials: M
authors.lastname: Böhmig
authors.forename: J
authors.initials: J
authors.lastname: Langrehr
authors.forename: M
authors.initials: M
authors.lastname: Pech
authors.forename: T
authors.initials: T
authors.lastname: Denecke
authors.forename: S
authors.initials: S
authors.lastname: Rosewicz
authors.forename: R
authors.initials: R
authors.lastname: Felix
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000473:pathology*; D002277:Carcinoma / Q000473:pathology*; D049448:Cholangiopancreatography, Magnetic Resonance; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity