title: Contrast-enhanced MRI combined with MR cholangiopancreatography for the evaluation of patients with biliary strictures: differentiation of malignant from benign bile duct strictures.
abstract: OBJECTIVE
  To determine imaging criteria for the combined use of contrast-enhanced (CE)-MRI and MR cholangiopancreatography (MRCP) to differentiate malignant from benign biliary strictures.
  
  
  METHODS
  A total of 44 patients with biliary stricture who had undergone unenhanced, MRCP, and dynamic MRI were identified from radiological and surgical databases. Two radiologists analyzed MR features for asymmetry, luminal irregularity, abrupt narrowing, outer margin, signal intensity (SI) on T2-weighted (T2W) images, and hyperenhancement relative to liver parenchyma during portal phase. The wall thickness and length of the narrowed segment were measured. MR findings relevant as predictors were identified using a Chi-square or Fisher's exact test and the odds ratio (OR).
  
  
  RESULTS
  The presence of hyperenhancement relative to liver parenchyma, length > 12 mm, wall thickness > 3 mm, indistinct outer margin, luminal irregularity, and asymmetry of strictured bile duct were significant factors for malignancy (P < 0.05). Malignant strictures were significantly thicker (5.0 +/- 2.0 mm) and longer (27.0 +/- 13.6 mm) than benign strictures. When any three or more of these six criteria were used in combination, we could identify 100% of malignant strictures and 87.0% of benign strictures.
  
  
  CONCLUSIONS
  The combined use of CE-MRI and MRCP helped to define the criteria for differentiating malignant from benign biliary strictures in our data.
authors.affiliation: Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Ji Yang
authors.initials: JY
authors.lastname: Kim
authors.forename: Jeong Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Joon Koo
authors.initials: JK
authors.lastname: Han
authors.forename: Se Hyung
authors.initials: SH
authors.lastname: Kim
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Soo Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Hyuck Jung
authors.initials: HJ
authors.lastname: Kim
authors.forename: Ki Hyeun
authors.initials: KH
authors.lastname: Kim
authors.forename: Byung Ihn
authors.initials: BI
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000175:diagnosis* / Q000473:pathology; D001652:Bile Ducts / Q000473:pathology*; D001660:Biliary Tract Diseases / Q000175:diagnosis* / Q000473:pathology; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods*; D002779:Cholestasis / Q000473:pathology; D003287:Contrast Media / Q000494:pharmacology; D005260:Female; D006801:Humans; D008099:Liver / Q000378:metabolism; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged
chemical_list: D003287:Contrast Media