The Evaluation Of Magnetic Resonance Imaging In The Diagnosis Of Bile Duct Stone And Suppurative Cholecystitis

PartⅠ：Comparison of Magnetic Resonance Imaging with Ultrasonography in the Diagnosis of Bile Duct StoneObjective: To compare the value of magnetic resonance imaging (MRI)with that of ultrasonography (US) in the diagnosis of bile duct stone (BDS).Materials and Methods: A total of 136 consecutive patients withsuspected BDS were recruited from May 2010 to February 2011. They hadperformed both abdominal MRI and US at the same period before surgery.The sensitivity, specificity and accuracy of MRI and US based on surgerywere analyzed. The area under receiver operating characteristic (ROC) wereanalyzed for comparing MRI with US in the diagnosis of BDS.Results: In the 136 patients, 82 patients performed surgery and wereconfirmed with BDS. Of the 82 patients with BDS, 43 patients hadintrahepatic lithiasis (IHL), 73 patients (34 patients coexisted with IHL) hadextrahepatic lithiasis (EHL). The sensitivity, specificity and accuracy of USand MRI in detecting IHL were, respectively, 79.1%, 94.9% and 86.6%, and93.0%, 94.9% and 93.9%. The sensitivity, specificity and accuracy of US andMRI in detecting IHL were, respectively, 65.8%, 66.7% and 65.9%, and93.2%, 77.8% and 91.5%. The area under ROC curve for MRI and US and indetecting IHL were 0.971 and 0.964 respectively (P>0.05), and in diagnosingEHL were 0.855 and 0.776 respectively (P<0.05).Conclusion: MRI and US have a similar value in detecting IHL. However, MRI is superior to US in detecting EHL. PartⅡ：MRI Findings of Suppurative Cholecystitis: Comparison with Surgry and PathologyObjective: The aim of this study is describe and illustrate the MRfindings of suppurative cholecystitis.Materials and Methods: A total of 24 patients with suppurativecholecystitis (SCC) confirmed by surgry and pathology were recruited fromJuly 2010 to August 2011. They underwent MR imaging before surgery. Twoabdominal radiologists reviewed the images in these patients and comparedwith the surgry and pathology, then observed and summarized thecharacteristic of the MR findings of the suppurative cholecystitisretrospectively.Results: In the 24 patients with SCC confirmed by surgery andpathology results, there were 8 patients with gangrene of gallbladde, 5patients with perforation of gallbladder, 2 patients coexisted with acutepyogenic cholangitis, 3 patients coexisted with pericholecystic abscess, 19patients coexisted with cholecystolithiasis (CCL), 9 patients coexisted withcholangiolithiasis (CAL), 6 patients coexisted with CCL and CAL. 22 of 24patients showed wall thickening and edematous, 21patients hadpericholecystic fat stranding, 8 patients had pericholecystic fuid, 19 patients shoiwed gallbladder distension, 21 patients showed bile turbidness. Thesuppurative bile showed some or all hyperintense on GRE-T1WI andheterogeneous or all hypointense on FRFSE-T2WI, and hyperintense on bothIP and OP in dual-SPGR T1WI. 5 patients had perforation of gallbladder, 3patients were complicated with pericholecystic abscess, 1 patient wascomplicated with hepatic abscess. For the total of 8 patients underwentenhancement scanning, all of them showed gallbladder wall enhancedobviously in delayed phase, hyperintense of adjacent liver parenchyma duryarterial phase on contrast-enhanced fat-saturated T1-weighted images.Conclusion: Signs of SCC on MRI include wall thickening, edema andenhanced in the delayed phase on the enhancement scanning, gallbladderdistention, pericholecystic fluid, and pericholecystic tissue stranding,gallstones, pericholecystic adjacent liver parenchyma enhancement on arterialphase, the bile turbidness, and show some or all hyperintense on GRE-T1WIand heterogeneous or all hypointense on FRFSE-T2WI, and hyperintenseboth on IP and OP in dual-SPGR T1WI. The gall wall enhanced in thedelayed phase on the enhancement scanning and the change of the bile werethe characteristic findings.