BACKGROUND: To determine
where magnetic resonance (MR) cholangiography can accurately demonstrate
the presence, extent, and type of choledochal cysts. METHODS: Ten patients
with sonographically suspected choledochal cysts were evaluated with a
non-breath-hold MR cholangiography technique. The presence, extent, and
type of choledochal cyst were determined. Visualization of the pancreatobiliary
junction was recorded. MR cholangiographic findings were correlated with
the gold standard of surgery in six patients, endoscopic retrograde cholangiography
in two, and a 99mTc hepatobiliary scintigram in one. Three patients underwent
intraoperative cholangiography. RESULTS: All MR cholangiograms were correlated
with findings at surgery, endoscopic retrograde cholangiography, or 99mTc
hepatobiliary scintigraphy. There were seven Todani type 1 and two Todani
type 5 choledochal cysts (Caroli's disease). The extent of involvement
was correctly demonstrated on all MR cholangiograms. The pancreatobiliary
junction could not be identified in any of the cases. Calculi and sludge
were correctly identified on the MR cross-sectional images in three patients
but were not seen on MR cholangiograms in two. In one patient with an initially
misinterpreted choledochal cyst, MR sectional images showed the typical
appearance of a hydatid cyst, which was confirmed at surgery. CONCLUSION:
MR cholangiography can be used to confirm the diagnosis of choledochal
cysts and define the extent of involvement preoperatively. The pancreatobiliary
junction, however, is difficult to visualize. Non-biliary cysts such as
a hydatid cyst can mimic a choledochal cyst on the MR cholangiogram and
should be correlated with the MR cross-sectional images to avoid misinterpretation.
Brine DR; Soulen RL Pancreaticobiliary
carcinoma associated with a large choledochal cyst: role of MRI and MR
cholangiopancreatography in diagnosis and preoperative assessment. Abdom
Imaging 1999 May-Jun;24(3):292-4
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