MR cholangiopancreatography in patients with primary sclerosing cholangitis: interobserver variability and comparison with endoscopic retrograde cholangiopancreatography.

OBJECTIVE: The purpose of our study was to determine the degree of interobserver variability and correlation between MR cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) for the presence of bile duct strictures in patients with primary sclerosing cholangitis. MATERIALS AND METHODS: For this retrospective study involving 26 patients with primary sclerosing cholangitis, 31 MR cholangiopancreatograms were compared with 30 endoscopic retrograde cholangiopancreatograms. The MR cholangiopancreatograms were independently interpreted by two abdominal radiologists in a blinded, randomized manner for overall image quality, extent of ductal visualization, and the presence and location of bile duct strictures. Unweighted multirater kappa coefficient values were estimated for each comparison. RESULTS: Visualization of more than 50% of the expected ductal length was possible in the extrahepatic, central intrahepatic, and peripheral intrahepatic bile ducts in 99%, 88%, and 69% of the MR cholangiopancreatograms and 100%, 86%, and 52% of the endoscopic retrograde cholangiopancreatograms, respectively. Strictures were detected in the extrahepatic, central, and peripheral ducts in 53%, 68%, and 87% of the MR cholangiopancreatograms and 73%, 67%, and 63% of the endoscopic retrograde cholangiopancreatograms, respectively. The interobserver agreement for stricture detection was 61% for MR cholangiopancreatography and 76% for ERCP. MR cholangiopancreatographic findings were consistent with ERCP findings for the presence of strictures in 69% of the cases. CONCLUSION: In patients with primary sclerosing cholangitis, MR cholangiopancreatography better shows the bile ducts and can depict more strictures, especially of the peripheral intrahepatic ducts, than ERCP. MR cholangiopancreatography can be used to noninvasively diagnose and follow up patients with primary sclerosing cholangitis.

Cirrhosis: spectrum of findings on unenhanced and dynamic gadolinium-enhanced MR imaging.

The appearance of the cirrhotic liver on computed tomography can be difficult to evaluate and can frustrate the radiologist distinguishing benign from malignant lesions. Hepatic edema, fibrosis, atrophy, and vascular abnormalities are common in the cirrhotic liver and produce derangements in morphology, attenuation, and perfusion, limiting the accurate characterization of hepatic masses. With the development of fast magnetic resonance (MR) sequences and dynamic postgadolinium-enhanced imaging, most hepatic lesions with uncertain etiology on computed tomography can be accurately characterized on MR imaging. We describe MR imaging techniques useful for imaging cirrhosis and its complications. We also illustrate the spectrum of findings in the cirrhotic liver on dynamic gadolinium-enhanced MR imaging, including reticular and confluent fibrosis, fatty infiltration, hemochromatosis, regenerating nodules, dysplastic nodules, hepatocellular carcinoma, and sequela of portal hypertension.

Web-based viewing of picture archiving and communications systems images--Part I: Optimal personal computer configuration.

Now that picture archiving and communications systems (PACS) has matured, our challenge is to make the images available to the referring physician and, in a teaching institution, to make these images available for conferences and rounding. One solution is the distribution of the images using web-based technology. We investigated a web-based add-on to our PACS to determine the characteristics of the personal computer that will make this technology useful and affordable. We found that images can be viewed easily through a web-based system. We found that the optimal system to view these images at a reasonable speed and a reasonable cost is on with a medium-range processor (200 to 300 MHz) and a large amount of inexpensive RAM, at least 64 Mb.

Web-based viewing of picture archiving and communications systems images--Part II: The effect of compression on speed of transmission.

Now that picture archiving and communications systems (PACS) has matured, our challenge is to make the images available to the referring physician and, in a teaching institution, to make these images available for conferences and rounding. One solution is the distribution of the images using web-based technology. We investigated a web-based add-on to our PACS to determine the characteristics of the personal computer that will make this technology useful and affordable. We found that images can be viewed easily through a web-based system. We found that the optimal system to view these images at a reasonable speed and a reasonable cost is on with a medium-range processor (200 to 300 MHz) and a large amount of inexpensive RAM, at least 64 Mb.