Copyright ©2013 Baishideng Publishing Group Co.
World J Hepatol. Dec 27, 2013; 5(12): 654-665
Published online Dec 27, 2013. doi: 10.4254/wjh.v5.i12.654
Table 1 Characteristics of magnetic resonance of each diseaseson
MR characteristicsDifferential diagnosisComparison to other modalitiesSensitivity and specificityPitfall of MRI
PSCDiffuse stricture and/or beaded appearance of the bile duct on MRCPCholangitis, CholangiocarcinomaERCP is considered the standard method. MRCP is considered being sufficient for diagnosis of PSCHigh sensitivity and very high specificityIt is often difficult to differentiate malignant tumors from PSC
Cholan- giocarci- nomaMRI with MRCP is usually considered the modality of choice in the diagnosis of cholangiocarcinomaDiagnosis of biliary stenosis by MRCP is high sensitivity and specificity. The ability of differentiation between benign obstruction and malignant is lowMinimal invasion along the mucosa and in the perineural space is difficult to diagnose
Intrahepatic cholangio- carcinomaThe tumor shows an irregular shaped solid mass with peripheral rim enhancement and incomplete concentric pooling of contrast material on dynamic studyMetastasis, Mixed HCC, cholangiocellular carcinoma
Extrahepatic cholangio- carcinomaThe most common pattern of the tumor growth is focal infiltration of the ductal wall or the periductal-infiltrating type, resulting in focal stricturesPSC, cholangitis (IgG4, infection, AIDS), sarcoidosis
Gallbladder carcinomaIn the diffusely infiltrative type, the tumor appears as a large solid mass in the gallbladder fossa In the polypoid and mural thickening types, lesion more than 10 mm in diameter or which enhance after intravenous contrast material, are usually malignantPolyp, adenomyomatosis, xanthogranulomatous cholecystitis, chronic cholecystitisUsually, US is used as an initial diagnostic modality As a second step, CT, MRI with MRCP, and /or traditional cholangiography is often used for obtaining additional informationConventional MRI showed 74% of sensitivity and 68%-83% specificity, while DWI set added to conventional MRI showed high sensitivity and specificityIt is often difficult malignant from benign tumors
Ampullary carcinomaIt is difficult to diagnose because of the small tumor on MRI. DWI has the potential for differentiating malignant from benign ampullary tumorsCholangiocarcinoma, Pancreas cancer, adenoma, inflammatory diseases, carcinoidMRI with MRCP is more accurate than CT in differentiating between malignant and benign lesionsHigh sensitivity (100%) and low specificity (59.1%-63.6%). Adding of DWI to conventional MRI improve specificityIt is often difficult to diagnose because of the small tumor