1
|
Marth AA, Auer TA, Walter-Rittel TC, Nevermann N, Krenzien F, Schmelzle M, Müller T, Kolck J, Wieners G, Geisel D, Gebauer B, Hamm B, Schöning W, Fehrenbach U. Gd-EOB-DTPA-MRCP to localize bile leakage after liver trauma and surgery: impact on treatment and outcome. Eur Radiol 2023; 33:5933-5942. [PMID: 37052657 PMCID: PMC10415430 DOI: 10.1007/s00330-023-09608-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 02/20/2023] [Accepted: 03/19/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES Bile leakage (BL) is a challenging complication after hepatobiliary surgery and liver trauma. Gadolinium ethoxybenzyl (Gd-EOB-DTPA)-enhanced magnetic resonance cholangiopancreatography (MRCP) is used to diagnose BL non-invasively. We assessed the value of Gd-EOB-DTPA-MRCP in the detection of postoperative and post-traumatic BL hypothesizing that exact identification of the leakage site is pivotal for treatment planning and outcome. METHODS We retrospectively enrolled 39 trauma and postoperative patients who underwent Gd-EOB-DTPA-MRCP for suspected BL. Three readers rated the presence of BL and leakage site (intraparenchymal, central, peripheral ± aberrant or disconnected ducts). Imaging findings were compared to subsequent interventional procedures and their complexity and outcome. RESULTS BL was detected in Gd-EOB-DTPA-MRCP in 25 of patients and was subsequently confirmed. Sites of BL differed significantly between postoperative (central [58%] and peripheral [42%]) and trauma patients (intraparenchymal [100%]; p < 0.001). Aberrant or disconnected ducts were diagnosed in 8%/26% of cases in the postoperative subgroup. Inter-rater agreement for the detection and localization of BL was almost perfect (Κ = 0.85 and 0.88; p < 0.001). Intraparenchymal BL required significantly less complex interventional procedures (p = 0.002), whereas hospitalization and mortality did not differ between the subgroups (p > 0.05). CONCLUSIONS Gd-EOB-DTPA-MRCP reliably detects and exactly locates BL in postoperative and trauma patients. Exact localization of biliary injuries enables specific treatment planning, as intraparenchymal leakages, which occur more frequently after trauma, require less complex interventions than central or peripheral leaks in the postoperative setting. As a result of specific treatment based on exact BL localization, there was no difference in the duration of hospitalization or mortality. CLINICAL RELEVANCE STATEMENT Gd-EOB-DTPA-MRCP is a reliable diagnostic tool for exactly localizing iatrogenic and post-traumatic biliary leakage. Its precise localization helps tailor local therapies for different injury patterns, resulting in comparable clinical outcomes despite varying treatments. KEY POINTS • Gd-EOB-DTPA-MRCP enables adequate detection and localization of bile leakages in both postoperative and post-traumatic patients. • The site of bile leakage significantly impacts the complexity of required additional interventions. • Intraparenchymal bile leakage is commonly seen in patients with a history of liver trauma and requires less complex interventions than postoperative central or peripheral bile leakages, while hospitalization and mortality are similar.
Collapse
Affiliation(s)
- Adrian A Marth
- Department of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Timo A Auer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thula C Walter-Rittel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Nora Nevermann
- Department of Surgery | CCM | CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of General, Visceral and Transplant Surgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Felix Krenzien
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Surgery | CCM | CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Schmelzle
- Department of Surgery | CCM | CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of General, Visceral and Transplant Surgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Tobias Müller
- Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Kolck
- Department of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Gero Wieners
- Department of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Dominik Geisel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bernhard Gebauer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Wenzel Schöning
- Department of Surgery | CCM | CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Uli Fehrenbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| |
Collapse
|
2
|
Vernuccio F, Mercante I, Tong XX, Crimì F, Cillo U, Quaia E. Biliary complications after liver transplantation: A computed tomography and magnetic resonance imaging pictorial review. World J Gastroenterol 2023; 29:3257-3268. [PMID: 37377585 PMCID: PMC10292145 DOI: 10.3748/wjg.v29.i21.3257] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/23/2023] [Accepted: 04/27/2023] [Indexed: 06/01/2023] Open
Abstract
Biliary complications are the most common complications after liver transplantation. Computed tomography (CT) and magnetic resonance imaging (MRI) are cornerstones for timely diagnosis of biliary complications after liver transplantation. The diagnosis of these complications by CT and MRI requires expertise, mainly with respect to identifying subtle early signs to avoid missed or incorrect diagnoses. For example, biliary strictures may be misdiagnosed on MRI due to size mismatch of the common ducts of the donor and recipient, postoperative edema, pneumobilia, or susceptibility artifacts caused by surgical clips. Proper and prompt diagnosis of biliary complications after transplantation allows the timely initiation of appropriate management. The aim of this pictorial review is to illustrate various CT and MRI findings related to biliary complications after liver transplantation, based on time of presentation after surgery and frequency of occurrence.
Collapse
Affiliation(s)
- Federica Vernuccio
- Department of Radiology, University Hospital of Padova, Padova 35128, Italy
| | - Irene Mercante
- Department of Radiology-DIMED, University of Padova, Padova 35128, Italy
| | - Xiao-Xiao Tong
- Department of Radiology-DIMED, University of Padova, Padova 35128, Italy
| | - Filippo Crimì
- Department of Radiology-DIMED, University of Padova, Padova 35128, Italy
| | - Umberto Cillo
- Department of Surgery, Hepatobiliary Surgery and Liver Transplant Center, Oncology and Gastroenterology (DISCOG), University of Padova, Padova 35128, Italy
| | - Emilio Quaia
- Department of Radiology-DIMED, University of Padova, Padova 35128, Italy
| |
Collapse
|
3
|
Argirò R, Sensi B, Siragusa L, Bellini L, Conte LE, Riccetti C, Del Vecchio Blanco G, Troncone E, Floris R, Salavracos M, Tisone G, Anselmo A. Liver-Specific Contrast-Enhanced Magnetic Resonance Cholangio-Pancreatography (Ce-MRCP) in Non-Invasive Diagnosis of Iatrogenic Biliary Leakage. Diagnostics (Basel) 2023; 13:diagnostics13101681. [PMID: 37238167 DOI: 10.3390/diagnostics13101681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Current non-invasive diagnostic modalities of iatrogenic bile leak (BL) are not particularly sensitive and often fail to localise the BL origin. Percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) are considered the gold standard, yet are invasive studies with potential complications. Ce-MRCP has been not comprehensively studied in this setting but may prove particularly helpful given its non-invasive nature and the anatomical dynamic detail. This paper reports a monocentric retrospective study of BL patients referred between January 2018 and November 2022 submitted to Ce-MRCP followed by PTC. The primary outcome was the accuracy of Ce-MRCP in detecting and localising BL compared to PTC and ERCP. Blood tests, coexisting cholangitis features and time for leak resolution were also investigated. Thirty-nine patients were included. Liver-specific contrast-enhanced MRCP detected BL in 69% of cases. The BL localisation was 100% accurate. Total bilirubin above 4 mg/dL was significantly associated with false negative results of Ce-MRCP. Ce-MRCP is highly accurate in detecting and localising BL, but sensitivity is significantly reduced by a high bilirubin level. Ce-MRCP may be very useful in early BL diagnosis and in accurate pre-treatment planning, but can only be reliably used in selected patients with TB < 4 mg/dL. Non-surgical techniques, both radiological and endoscopic, are proven to be effective in terms of leak resolution.
Collapse
Affiliation(s)
- Renato Argirò
- Interventional Radiology Unit, Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Bruno Sensi
- HPB and Transplant Unit, Department of Surgery, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Leandro Siragusa
- HPB and Transplant Unit, Department of Surgery, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Luigi Bellini
- Interventional Radiology Unit, Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Luigi Edoardo Conte
- HPB and Transplant Unit, Department of Surgery, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Camilla Riccetti
- HPB and Transplant Unit, Department of Surgery, Tor Vergata University of Rome, 00133 Rome, Italy
| | | | - Edoardo Troncone
- Gastroenterology Unit, Department of System medicine, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Roberto Floris
- Diagnostic Imaging, Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Mike Salavracos
- Department of Surgery, Cliniques Universitaires St-Luc, 1200 Brussels, Belgium
| | - Giuseppe Tisone
- HPB and Transplant Unit, Department of Surgery, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Alessandro Anselmo
- HPB and Transplant Unit, Department of Surgery, Tor Vergata University of Rome, 00133 Rome, Italy
| |
Collapse
|
4
|
Biliary-Colonic Fistula Associated With High-Grade Biliary Stenosis From Errant Surgical Clip During Previous Biliary Surgery: Diagnosis and Treatment By ERCP. ACG Case Rep J 2021; 8:e00617. [PMID: 34124279 PMCID: PMC8189637 DOI: 10.14309/crj.0000000000000617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
|
5
|
Gadoxetate Disodium-Enhanced MR Cholangiography for Evaluation of Biliary-Enteric Anastomoses: Added Value Beyond Conventional T2-Weighted Images. AJR Am J Roentgenol 2019; 213:W123-W133. [PMID: 31063422 DOI: 10.2214/ajr.18.20626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The objective of our study was to evaluate image quality and reader confidence in MR cholangiography of bile ducts using conventional T2-weighted MR cholangiography alone in comparison with T2-weighted MR cholangiography and gadoxetate disodium-enhanced MR cholangiography in a series of patients with biliary-enteric anastomosis (BEA). SUBJECTS AND METHODS. Fifty patients with BEA and clinically and sonographically suspected complications underwent 1.5-T MRI. After acquisition of T1- and T2-weighted images, conventional MR cholangiography was performed using 3D fast relaxation fast spin-echo (FRFSE) and single-shot fast spin-echo (SSFSE) T2-weighted sequences (image set 1). In each patient, a 3D fat-suppressed Liver Acquisition with Volume Acceleration (LAVA) sequence was performed before and 15, 20, 25, 30, and 40 minutes after IV administration of 0.1 mL/kg of gadoxetate disodium (Primovist) (image set 2). Two radiologists in consensus evaluated image quality in the anatomic segments of the biliary tract and recorded diagnostic confidence scores for image set 1 alone and image sets 1 and 2 together. MRI findings were compared with postsurgical specimen if surgery was performed, conventional cholangiography, or 12 months of imaging follow-up. RESULTS. A significant improvement in image quality for visualization of all biliary segments was found using gadoxetate disodium-enhanced MR cholangiography in comparison with T2-weighted MR cholangiography alone. Readers judged diagnostic confidence of image set 1 alone and image sets 1 and 2 together as very confident in three and 37 cases, confident in 30 and 11, not confident in 14 and one, and not confident at all in three and 1, respectively. Concordance between image set 1 alone and image sets 1 and 2 together and the reference standard results was present in 23 of 50 cases (46%) and 47 of 50 cases (94%), respectively (p < 0.0001). CONCLUSION. Gadoxetate disodium-enhanced MR cholangiography can improve image quality for visualization of the biliary tract and further enhanced the diagnostic performance of conventional T2-weighted MR cholangiography in the evaluation of patients with BEA.
Collapse
|
6
|
The hepatoduodenal ligament revisited: cross-sectional imaging spectrum of non-neoplastic conditions. Abdom Radiol (NY) 2019; 44:1269-1294. [PMID: 30448917 DOI: 10.1007/s00261-018-1829-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The hepatoduodenal ligament is frequently involved by conditions affecting the portal triad and surrounding structures, including a vast array of non-neoplastic conditions. Due its unique location between the retroperitoneum and the peritoneal space, the hepatoduodenal ligament is also targeted by inflammatory conditions involving the retroperitoneum and the liver. Finally, the presence of lymphatics and of the biliary tracts makes the hepatoduodenal ligament a route of spread for a variety of infections. The purpose of this pictorial essay is twofold: to review the cross-sectional radiological anatomy and variants of the structures within the hepatoduodenal ligament, and to illustrate the non-neoplastic conditions that may arise within the hepatoduodenal ligament. CONCLUSION Familiarity with these specific entities and their cross-sectional imaging findings is fundamental for a more accurate diagnosis.
Collapse
|
7
|
Petrillo M, Ierardi AM, Tofanelli L, Maresca D, Angileri A, Patella F, Carrafiello G. Gd-EOB-DTP-enhanced MRC in the preoperative percutaneous management of intra and extrahepatic biliary leakages: does it matter? Gland Surg 2019; 8:174-183. [PMID: 31183327 DOI: 10.21037/gs.2019.03.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Postoperative bile leakage is a common complication of abdominal surgical procedures and a precise localization of is important to choose the best management. Many techniques are available to correctly identify bile leaks, including ultrasound (US), computed tomography (CT) or magnetic resonance imaging (MRI), being the latter the best to clearly depict "active" bile leakages. This paper presents the state of the art algorithm in the detection of biliary leakages in order to plan a percutaneous biliary drainage focusing on widely available and safe contrast agent, the Gb-EOB-DPA. We consider its pharmacokinetic properties and impact in biliary imaging explain current debates to optimize image quality. We report common sites of leakage after surgery with special considerations in cirrhotic liver to show what interventional radiologists should look to easily detect bile leaks.
Collapse
Affiliation(s)
- Mario Petrillo
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Laura Tofanelli
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Duilia Maresca
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Alessio Angileri
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Francesca Patella
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| |
Collapse
|
8
|
Kinner S, Schubert TB, Said A, Mezrich JD, Reeder SB. Added value of gadoxetic acid-enhanced T1-weighted magnetic resonance cholangiography for the diagnosis of post-transplant biliary complications. Eur Radiol 2017; 27:4415-4425. [PMID: 28409358 DOI: 10.1007/s00330-017-4797-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/18/2017] [Accepted: 03/07/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Biliary complications after liver transplantation (LT) are common. This study aimed to ascertain the value of gadoxetic acid-enhanced T1-weighted (T1w) magnetic resonance cholangiography (MRC) to evaluate anastomotic strictures (AS), non-anastomotic strictures (NAS) and biliary casts (BC). METHODS Sixty liver-transplanted patients with suspicion of biliary complications and T2w-MRCP and T1w-MRC followed by endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) were analysed. Two readers reviewed the MRCs and rated image quality (IQ) and likelihood for AS/NAS/BC on Likert scales. Sensitivity, specificity and predictive values were calculated, ROC curve analysis performed, and inter-reader variability assessed. The subjective added value of T1w-MRC was rated. RESULTS IQ was high for all sequences without significant differences (2.83-2.88). In 39 patients ERCP/PTC detected a complication. Sensitivity and specificity for AS were 64-96 using T2w-MRCP, increasing to 79-100 using all sequences. Use of all sequences increased the sensitivity of detecting NAS/BC from 72-92% to 88-100% and 67-89% to 72-94%, respectively. Kappa values were substantial (0.45-0.62). T1w-MRC was found to be helpful in 75-83.3%. CONCLUSIONS Combining T1w-MRC and T2w-MRCP increased sensitivity and specificity and diagnostic confidence in patients after LT with suspected biliary complications. T1w-MRC is a valuable tool for evaluating post-transplant biliary complications. KEY POINTS • T1w-MRC is a valuable tool for evaluating post-transplant biliary complications. • Adding T1w-MRC to T2w-MRC increases diagnostic confidence for detection of biliary complications. • A combination of T1w-MRC and T2w-MRCP leads to the best results.
Collapse
Affiliation(s)
- Sonja Kinner
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave., Madison, WI, 53792-3252, USA. .,Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
| | - Tilman B Schubert
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave., Madison, WI, 53792-3252, USA.,Clinic of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland
| | - Adnan Said
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Joshua D Mezrich
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave., Madison, WI, 53792-3252, USA.,Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.,Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
9
|
Contrast-Enhanced Magnetic Resonance Cholangiography: Practical Tips and Clinical Indications for Biliary Disease Management. Gastroenterol Res Pract 2017; 2017:2403012. [PMID: 28348578 PMCID: PMC5350537 DOI: 10.1155/2017/2403012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 01/15/2017] [Indexed: 02/07/2023] Open
Abstract
Since its introduction, MRCP has been improved over the years due to the introduction of several technical advances and innovations. It consists of a noninvasive method for biliary tree representation, based on heavily T2-weighted images. Conventionally, its protocol includes two-dimensional single-shot fast spin-echo images, acquired with thin sections or with multiple thick slabs. In recent years, three-dimensional T2-weighted fast-recovery fast spin-echo images have been added to the conventional protocol, increasing the possibility of biliary anatomy demonstration and leading to a significant benefit over conventional 2D imaging. A significant innovation has been reached with the introduction of hepatobiliary contrasts, represented by gadoxetic acid and gadobenate dimeglumine: they are excreted into the bile canaliculi, allowing the opacification of the biliary tree. Recently, 3D interpolated T1-weighted spoiled gradient echo images have been proposed for the evaluation of the biliary tree, obtaining images after hepatobiliary contrast agent administration. Thus, the acquisition of these excretory phases improves the diagnostic capability of conventional MRCP—based on T2 acquisitions. In this paper, technical features of contrast-enhanced magnetic resonance cholangiography are briefly discussed; main diagnostic tips of hepatobiliary phase are showed, emphasizing the benefit of enhanced cholangiography in comparison with conventional MRCP.
Collapse
|
10
|
Abstract
Interpreting body MRI cases can seem overwhelming to an uninitiated radiologist. The standard study includes a variety of pulse sequences, the names of which vary depending on the MR vendor. Pulse sequences may be displayed haphazardly on the picture archiving and communication system (PACS), frequently not synchronized with the imaging protocol. Adding to the complexity is the use of different gadolinium-based contrast agents, which may affect the timing and diagnostic yield of each sequence. The following introductory primer for interpreting body MRI cases is meant to create a basic framework for efficiently reviewing body MRI cases to provide high quality interpretations, fully utilizing the diagnostic information of the modality. There are 4 components that need to be mastered when interpreting body MRI cases including: (1) recognizing the key sequences in a basic body MRI protocol, (2) learning how to best display the key pulse sequences on PACS, (3) understanding the technique and clinical utility of each sequence and learning how to utilize sequences to be an "MR Pathologist", and (4) understanding the key features of the different gadolinium based contrast agents.
Collapse
|