Comparative performance of non-contrast MRI with HASTE vs. contrast-enhanced MRI/3D-MRCP for possible choledocholithiasis in hospitalized patients.
To compare the performance of non-contrast MRI with half-Fourier acquisition single-shot turbo spin echo (HASTE) vs. contrast-enhanced MRI/3D-MRCP for assessment of suspected choledocholithiasis in hospitalized patients.



123 contrast-enhanced abdominal MRI/MRCP scans in the hospital setting for possible choledocholithiasis were retrospectively evaluated. Endoscopic retrograde cholangiopancreatography, intraoperative cholangiogram or documented clinical resolution served as the reference standard. Readers first evaluated the biliary tree using coronal and axial HASTE and other non-contrast sequences, and later reviewed the entire exam with post-contrast sequences and 3D-MRCP. Test performance for the image sets was compared for choledocholithiasis, acute hepatitis, cholangitis, and acute cholecystitis. Reader agreement, MRCP image quality, and confidence levels were also assessed. Clinical predictors of age and fever were tested for association with perceived need for contrast in biliary assessment.



There were 27 cases of choledocholithiasis, 31 cases of acute hepatitis, 37 cases of acute cholecystitis, and 3 clinically diagnosed cases of acute cholangitis. Both the abbreviated and full contrast-enhanced/MRCP image sets resulted in high accuracy for choledocholithiasis (91.1-94.3% vs. 91.9-92.7%). There was no difference in sensitivity or specificity for either reader for any diagnosis between image sets (p > 0.40). 1 reader showed improved confidence (p < 0.001) with inclusion of MRCP and contrast-enhanced images, but neither confidence nor MRCP quality scores were associated with diagnostic accuracy. Patient age and fever did not predict the need for contrast-enhanced images.



In hospitalized patients with suspected choledocholithiasis, performance of non-contrast abdominal MRI with HASTE is similar to contrast-enhanced MRI with 3D-MRCP, offering potential for decreased scanning time and improved patient tolerability.
Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY, 10016, USA. stella.kang@nyumc.org.|Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA. stella.kang@nyumc.org.
Stella K
0000-0003-2402-3787
SK
Kang
Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY, 10016, USA.
Laura
L
Heacock
Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY, 10016, USA.
Ankur M
AM
Doshi
Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY, 10016, USA.
Justin R
JR
Ream
NYU School of Medicine, 550 First Ave, New York, NY, 10016, USA.
Jeffrey
J
Sun
Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY, 10016, USA.
James S
JS
Babb
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods*; D042883:Choledocholithiasis / Q000000981:diagnostic imaging*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006760:Hospitalization; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D003287:Contrast Media; D019786:Gadolinium DTPA
Choledocholithiasis; Gallstone disease; HASTE; Magnetic resonance cholangiopancreatography