Preliminary Experience of Multidetector Computed Tomography(MDCT) Cholangiography using Thin-Slab Minimum Intensity Projection (MinIP) and Multiplanar Reformation(MPR) in the Evaluation of Patients with Biliary Obstruction

ABSTRACT

PURPOSE: The development of MDCT and associated software has enabled us to obtain clear biliary images. This study aimed to investigate the preliminary experience and use of MDCT cholangiography using MinIP and MPR for preoperative planning. METHODS: We reviewed MDCT cholangiographies of 11 patients who underwent surgery due to a biliary obstruction in our hospital between May 2004 and July 2005. The CT scan used 16 channels. The axial images were routinely reconstructed at 5 mm intervals. If the bile ducts were dilated as seen on the axial images, portal phase raw data (with a collimation of 0.75 mm) were reconstructed at 0.5 mm intervals for MDCT cholangiography using MinIP and MPR. We analyzed the images and compared them with the surgical findings. RESULTS: Of 11 patients, 8 patients underwent a pylorus preserving pancreaticoduodenctomy, one patient underwent a hepatopancreaticoduodenectomy, one patient had a segmental resection of the bile duct, and one patient received a pancreatic head resection and segmental duodenectomy. MDCT cholangiographies showed an enhancement of wall thickening in the lesion of the bile duct, especially with extrahepatic bile duct cancer. The MDCT cholangiographies were able to provide the correct level and range of the biliary obstruction and were useful for preoperative planning. CONCLUSION: MDCT cholangiography using thin-slab MinIP and MPRprovided useful information for the diagnosis of patients with malignant biliary obstruction and was well correlated with other cholangiographies. With technical advances in MDCT and three dimensional projection techniques, CT cholangiography may supplant other procedures such as diagnostic endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC) and magnetic resonance cholangiopancreatography (MRCP) because of its superior resolution and ability to provide pertinent information for the evaluation of the biliary tract and the surrounding structures.