Choledocolithiasis: diagnostic accuracy of MR cholangiopancreatography. Three-year experience

The purpose of this study was to evaluate the diagnostic accuracy of MR cholangiopancreatography (MRCP) in the detection of common bile duct stones. A series of 286 consecutive patients were referred for MRCP, that was performed with a 1.5 T MR unit, through a non-breath-hold, respiratory-triggered, fat-suppressed, two-dimensional, heavily T2-weighted fast spin-echo sequence in the coronal plane. Axial T1 and T2-weighted sequences were first obtained. Axial, coronal, and Maximum Intensity Projection images were evaluated by three independent readers, who were asked to determine whether stones were present or not inside the biliary tract. The findings of MRCP images were compared with endoscopic retrograde cholangiopancreatography, percutaneous trans-hepatic cholangiography, intra-operative cholangiography, surgical, or imaging follow-up findings. Two-hundred and seventy-eight out of 286 MRCP examinations were judged diagnostic by the three reviewers. Among the 278 patients included in our study group, biliary tract lithiasis was proved in 76 cases (27%). On the basis of reviewers' reading, MRCP had sensitivity 92-93%, specificity 97-98%, positive predictive value 91-93%, negative predictive value 97-98%, and the diagnostic accuracy ranged between 95% and 96% in the detection of calculi. Interobserver agreement was excellent (K = 0.84, kappa statistic). MRCP showed a high diagnostic accuracy and an excellent inter-observer agreement in the detection of common bile duct stones.     

Magnetic resonance cholangiopancreatography using a free-breathing T2-weighted turbo spin-echo sequence with navigator-triggered prospective acquisition correction

PURPOSE: The objective of this study was to evaluate the image quality of a respiratory-triggered T2-weighted (T2w) turbo spin-echo (TSE) sequence for magnetic resonance cholangiopancreatography (MRCP) using a new method for respiratory triggering by tracking the motion of the right diaphragm [prospective acquisition correction (PACE) technique]. MATERIALS AND METHODS: Fifty consecutive patients underwent MRCP imaging applying breath-hold half-Fourier single-shot TSE sequences and the respiratory-triggered T2w TSE sequence. Qualitative evaluation grading the depiction of eight segments of the pancreaticobiliary tree and the frequency of artifacts was performed. Quantitative evaluation included calculation of the relative contrast (RC) between fluid-filled ductal structures and organ parenchyma at four segments. RESULTS: A significantly higher (P<.01) RC was measured for the respiratory-triggered T2w TSE sequence [maximum intensity projection (MIP)] for all of the four investigated segments (one of four segments for the MIP) of the pancreaticobiliary tree, as well as a significant (P<.01) improvement of visualization of all ductal segments compared with the breath-hold sequences. The frequency of artifacts was significantly lower (P<.01) compared with the breath-hold sequences. CONCLUSION: Respiratory-triggered MRCP using a T2w TSE sequence with PACE significantly improves image quality and may be included into the routine MRCP sequence protocol.     

Usefulness of the navigator-echo triggering technique for free-breathing three-dimensional magnetic resonance cholangiopancreatography

Purpose

To prospectively compare the navigator-echo triggering technique (navigator technique) and the conventional respiratory triggering technique using bellows (bellows technique) for free-breathing three-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP) under clinical conditions.

Materials and methods

Forty patients referred for evaluation of biliary or pancreatic diseases underwent 3D MRCP examination using both navigator and bellows techniques. Two independent radiologists visually evaluated the image quality of 12 segments of the pancreaticobiliary tree in a blinded manner. In addition, the clarity of the lesion was compared between the two techniques in a side-by-side manner.

Result

MRCP images were successfully acquired using both techniques in all patients. No significant difference in acquisition time was found between the two techniques. The image quality was significantly better using the navigator technique than using the bellows technique for the following seven segments: the head, body, and tail of the pancreatic duct; right hepatic duct; anterior and posterior segments of the right hepatic duct; and cystic duct. The other segments (common hepatic and bile duct, left hepatic duct, medial and lateral segments of left hepatic duct, gallbladder) showed no significant difference. The clarity of lesion depiction was significantly better using the navigator technique than using the bellows technique.

Conclusion

Respiratory-triggered 3D MRCP using the navigator technique was shown to be feasible in routine clinical practice. The navigator technique improved the image quality of free-breathing 3D MRCP compared with the bellows technique. The clarity of lesion visualization was also better using the navigator technique than using the bellows technique.     

Respiratory variation of the extrahepatic bile duct: evaluation with deep inspiratory and expiratory MRCP

Purpose

The purpose of the study was to evaluate the respiratory variation of the extrahepatic bile duct in morphology including shape, length and duct diameter on the breath-hold magnetic resonance cholangiopancreatography (MRCP) obtained during deep inspiration and deep expiration in patients with or without biliary diseases.

Materials and Methods

This study included 102 patients with or without biliary diseases. Breath-hold MRCP was obtained twice during the end-inspiration and the end-expiration. MRCP images were evaluated for the length, maximal diameter and “bowing” of the extrahepatic bile duct.

Results

In the normal group, the mean maximal diameter of the extrahepatic bile duct was significantly larger on the end-inspiratory MRCP (8.0±2.0 mm) than on the end-expiratory MRCP (7.3±1.8 mm) (P<.0001), while it was not significantly different in the dilated group. In the normal group, 25 (39%) of 65 patients had an increase in the mean maximal diameter of more than 1 mm at the end-inspiration, whereas 4 (11%) of 37 patients in the dilated group had it. The bowing of the extrahepatic bile duct on the end-inspiratory MRCP was observed in 60 (92%) of 65 normal patients, while it was seen in 22 (60%) of 37 patients with biliary dilatation (P<.0001).

Conclusion

Deep inspiratory and expiratory MRCP demonstrated the respiratory variations of the extrahepatic bile duct in the shape (bowing), length and maximal duct diameter in patients with nondilated bile ducts. Awareness of this normal phenomenon will be important for the correct interpretation of MRCP in patients with or without biliary diseases.     

Magnetic resonance cholangiopancreatography: comparison between respiratory-triggered turbo spin echo and breath hold single-shot turbo spin echo sequences

The purpose of this study was to compare the relative conspicuity of the pancreaticobiliary tree on respiratory-triggered three-dimensional turbo spin echo (3D TSE RT) and breath hold single-shot turbo spin echo (SSTSE BH) acquisitions respectively in MRCP imaging. Both techniques were applied to 61 patients with clinically suspected pancreaticobiliary disease using a 1.0 T MR system. All images were reviewed blindly. Qualitative comparison was made by grading subjectively the conspicuity of extrahepatic, intrahepatic, and main pancreatic ducts. Quantitative comparison included calculations of signal-to-noise ratio of the common bile duct, main pancreatic duct, gallbladder, liver, and contrast-to-noise ratio, relative contrast between common bile duct, gallbladder, and liver. 3D TSE RT provided significantly higher signal-to-noise ratio of the common bile duct (mean value 163.19) and main pancreatic duct (mean value 95.37) compared to SSTSE BH (mean values 76.24 and 26.22, respectively). 3D TSE RT was inferior to SSTSE BH for the depiction of intrahepatic ducts and pancreatic duct (head portion). 3D TSE RT and SSTSE BH sequences provide complimentary information in the visualization of the biliary and pancreatic ducts. Further comparative clinical studies are needed to redefine the sensitivity, specificity, and accuracy of MRCP using both sequences.     

Prospective trial of a navigator setting under left hepatic lobe on magnetic resonance cholangiopancreatography using a free-breathing prospective acquisition correction technique

PURPOSE: To prospectively compare the image acquisition time and image quality obtained by navigator setting under the left hepatic lobe vs. on the right diaphragm on magnetic resonance cholangiopancreatography (MRCP) using a free-breathing navigator-triggered prospective acquisition correction technique (PACE). MATERIALS AND METHODS: Fifty consecutive patients prospectively underwent three-dimensional T2-weighted turbo spin-echo MRCP using PACE with the navigator randomly set either under the left hepatic lobe or on top of the right diaphragm. Image acquisition time and subjective image quality were compared on a five-point scale using Student's t-test and Mann-Whitney's U test, respectively. RESULTS: There was no significant difference for mean acquisition time (6.1+/-1.6 vs. 6.3+/-1.2 min, P=.689) between the left hepatic lobe group and right diaphragm group. Mean subjective image quality was significantly worse in the left hepatic lobe group than in the right diaphragm group (4.1 vs. 4.7, P=.044). CONCLUSION: Setting the navigator under the left hepatic lobe for MRCP using PACE causes the data processing to be more difficult. As well, under current circumstances, it does not contribute to reducing acquisition time or improving the image quality.     

Biliary cystadenocarcinoma: seven year follow-up and the role of MRI and MRCP.

Biliary cystadenomas and their malignant counterparts, biliary cystadenocarcinomas, are rare cystic tumors that arise from hepatobiliary epithelium. Ultrasound (US) and computed tomography (CT) are the initial imaging modalities used for the evaluation of biliary cystic tumors, but are not specific. MRI and MRCP, because of increased contrast and spatial resolution, may be a more specific imaging modality in the detection of biliary cystic neoplasms. We present a case of biliary cystadenocarcinoma imaged by MRI and MRCP in a 65 year-old man managed conservatively for 7 years.     

Temperature and velocity measurement of a 3-D thermal flow field using thermo-sensitive liquid crystals

It is an important challenge to analyze a three-dimensional thermal flow field in engineering, science, and agriculture. For such an analysis, it is essential to measure physical quantities such as temperature and velocity over the entire thermal flow field. This paper presents a measurement system based on color image processing for temperature and velocity vector distributions in a three-dimensional thermal flow field. Flow visualization is accomplished by the use of thermo-sensitive liquid crystal tracers. An algorithm for the color-to-temperature transformation using a multi-layer feed-forward neural network is applied to three-dimensional natural convection in a rotating cylindrical cell. Two-dimensional temperature distributions in a slit plane are obtained by using the algorithm. A three-dimensional temperature distribution is consequently constructed by interpolating the two-dimensional distributions using the B-spline function. In addition, the Spatio-Temporal correlation method is applied to the natural convection to obtain a three-dimensional velocity vector distribution.     

Diet and gastrointestinal signal on T1-weighted magnetic resonance imaging of mice

In magnetic resonance (MR) imaging of small animals, the gastrointestinal contents may give rise to intense signals on T1-weighted images. The aim of this study was to determine the optimal dietary preparation to reduce gastrointestinal signals in mice and to evaluate the usefulness of this approach. Images of the mouse trunk were obtained using a T1-weighted, three-dimensional fast low-angle shot sequence under various dietary conditions and were compared with respect to the gastrointestinal signals and image quality. The dietary preparation studied included giving alternative diets for 24 h, intestinal cleansing, and 6-h fasting. Mice with and without dietary preparation underwent MR lymphography using gadofluorine 8, and the visualization of abdominal lymph nodes was compared. In the absence of dietary preparation, hyperintense areas were conspicuous in the gastrointestinal system, whereas on the images taken from mice fed potato or sweet potato for 24 h before imaging, gastrointestinal hyperintensity was less prominent. This preparation also reduced artifactual signals and resulted in higher-quality images of the kidneys. Intestinal cleansing, which consisted of 24-h fasting and laxative intake, did not reduce the gastrointestinal signals and caused signal changes that were indicative of fatty liver development. Some of the abdominal lymph nodes of the mice that did not receive dietary preparation were visualized on MR lymphography source images but not on maximum intensity projection (MIP) images. In contrast, on the MIP images of mice fed potato, all the lymph nodes delineated on the source images were successfully visualized. In conclusion, feeding mice potato or sweet potato for 24 h before MR imaging reduces the gastrointestinal signals and image degradation due to artifacts. Appropriate dietary preparations facilitate the display of target structures on MIP images and are expected to enhance the capabilities of small animal MR imaging.     

面向开环扫描系统的超声图像畸变校正方法*

超声显微成像技术广泛应用于工业无损检测领域。相较于闭环、半闭环扫描系统硬件复杂、成本高,开环扫描系统结构简单、成本低,但由于无反馈机制会导致步进电机的非线性运动引起图像像素错位畸变。因此,消除非线性运动带来的错位畸变是采用开环扫描系统实现高质量超声成像的关键。该文提出集最大值投影法、最大类间方差法和中心坐标校正法于一体的MIP-Otsu-C³M方法,对开环扫描系统获得的硬币回波数据采用最大值投影法获取初始灰度图像,采用最大类间方差法获取感兴趣区域的B扫描图像边缘像素位置,并采用中心坐标校正法成功消除像素错位,解决了超声C扫描图像畸变问题。对消除错位畸变的回波数据进行飞行时间法和傅里叶变换法图像重建,直接获得了非畸变的三维图像和透视图像。该新颖算法也验证了最大值投影法可拓展至图像畸变校正应用。     

Visualization of scientific arts and some examples of applications

In this paper, implementation and visualization of scientific arts are described using some examples of application in subject research areas, such as sculpture, archeology, fine arts and information aesthetics, which have been discussed through the Scientific Art Session at FLUCOME9, Tallahassee, Florida, 2007–9. In the application to sculpture, stereo visualization techniques, such as anaglyph stereo visualization and integral imaging technique, are introduced to realize the three-dimensional geometry of sculpture to enhance visual impact on the art. The second application is the flow visualization technique for archeology, where the vortices behind the river stones are studied to understand the origin of patterns on Jomon pottery. Interestingly, such vortex patterns also appear in the paintings of fine arts. The third example is the visualization of information aesthetics, where the Web information, such as public media and stock market, are visualized through scientific techniques. These examples of visualization of scientific arts provide the present state of the art in interdisciplinary visualization.     

MR virtual endoscopy of the pancreaticobiliary tract

Purpose: To evaluate the feasibility of surface-rendered magnetic resonance virtual endoscopy (MRVE) of magnetic resonance cholangiopancreatography (MRCP) data sets. We retrospectively reviewed MR cholangiopancreatography data sets of 120 patients with biliary stone (n = 40), inflammatory ampullary stenosis (n = 12), pancreatic tumor (n = 8), cholangiocarcinoma (n = 7), stenosis of surgical bilio-enteric anastomosis (n = 4), extrinsic localized common bile duct stenosis (n = 2), ampullary carcinoma (n = 2), pancreatic duct stone (n = 1), tumor of the gallbladder (n = 1), and normal pancreaticobiliary tree (n = 43). MRVE views were generated with Navigator software. Segmentation of the acquired data sets was performed with a thresholding technique. Navigation sequences were simulated through the entire biliary tract. MRVE was obtained in 27 (63%) of the 43 normal patients. Endoscopic views were generated in all 77 patients with partial or complete obstruction of the pancreaticobiliary tree. Among these, three groups of patterns were identified: 36 (47%) endoluminal masses (polyp-like masses), 17 (22%) luminal stenoses, 24 (31%) luminal occlusion. In 29 cases, hole artifacts through the internal wall were observed and interpreted as mistakes of segmentation. MRVE proved to show the internal anatomy of the biliary tract and endoluminal changes due to pathological condition. Further investigations are needed to test the usefulness and the potentialities of this technique.     

Cardiac-synchronized gadolinium-enhanced MR angiography: preliminary experience for the evaluation of the thoracic aorta

Gadolinium (Gd)-enhanced three-dimensional breath-hold magnetic resonance cardiac-synchronized angiography was performed in 13 patients suspected or known to have thoracic aortic disease. High-quality angiograms of the ascending/descending thoracic aorta and coronary arteries were obtained with this method. MR angiograms were compared with Gd-enhanced angiograms obtained without cardiac synchronization. Synchronized imaging showed significantly better aortic valve leaflet and proximal coronary artery depiction. Synchronization reduced motion artifacts, allowing better visualization of the aortic root and proximal coronary arteries.     

Improved phase-contrast flow quantification by three-dimensional vessel localization

In this paper, a method of three-dimensional (3D) vessel localization is presented to allow the identification of a vessel of interest, the selection of a vessel segment, and the determination of a slice orientation to improve the accuracy of phase-contrast magnetic resonance (PCMR) angiography. A marching-cube surface-rendering algorithm was used to reconstruct the 3D vasculature. Surface-rendering was obtained using an iso-surface value determined from a maximum intensity projection (MIP) image. This 3D vasculature was used to find a vessel of interest, select a vessel segment, and to determine the slice orientation perpendicular to the vessel axis. Volumetric flow rate (VFR) was obtained in a phantom model and in vivo using 3D localization with double oblique cine PCMR scanning. PCMR flow measurements in the phantom showed 5. 2% maximum error and a standard deviation of 9 mL/min during steady flow, 7.9% maximum error and a standard deviation of 13 mL/min during pulsatile flow compared with measurements using an ultrasonic transit-time flowmeter. PCMR VFR measurement error increased with misalignment at 10, 20, and 30 degrees oblique to the perpendicular slice in vitro and in vivo. The 3D localization technique allowed precise localization of the vessel of interest and optimal placement of the slice orientation for minimum error in flow measurements.     

Three-dimensional detonation cellular structures in rectangular ducts using an improved CESE scheme

The three-dimensional premixed H_2-O_2 detonation propagation in rectangular ducts is simulated using an in-house parallel detonation code based on the second-order space-time conservation element and solution element(CE/SE) scheme.The simulation reproduces three typical cellular structures by setting appropriate cross-sectional size and initial perturbation in square tubes.As the cross-sectional size decreases,critical cellular structures transforming the rectangular or diagonal mode into the spinning mode are obtained and discussed in the perspective of phase variation as well as decreasing of triple point lines.Furthermore,multiple cellular structures are observed through examples with typical aspect ratios.Utilizing the visualization of detailed three-dimensional structures,their formation mechanism is further analyzed.     

Identification of cholesterol gallstones using in vitro low-fluence laser-induced fluorescence spectroscopic analysis

Identifying the chemical composition of gallstones may be important in certain cases of calculus biliary disease when planning a dissolution therapy or a fragmentation of the calculi using pulsed lasers. The present study was conducted in vitro to evaluate the feasibility of distinguishing cholesterol gallstones from pigment stones. We propose an identification method in which the stone fluorescence spectrum, induced by a low fluence laser, is recorded using an optical multichannel analyser. Fluorescence spectra of twenty-two stones were recorded together with the fluorescence spectra of various pure compounds likely to compose the gallstones, using successively four different pump lasers (_p=308 nm, 337 nm, 423 nm, 469 nm). The fluorescence spectra of cholesterol gallstones are quite different from the pigment ones. Ratios of fluorescence intensities taken at three different wavelengths enable one to distinguish easily between cholesterol and pigment stones.     

Three-dimensional imaging and visualization of partially occluded objects using axially distributed stereo image sensing

In this Letter, we propose a multiperspective three-dimensional (3D) imaging system using axially distributed stereo image sensing. In this proposed method, the stereo camera is translated along its optical axis and multiple axial elemental image pairs for a 3D scene are collected. The captured elemental images are reconstructed in 3D using a computational reconstruction algorithm based on ray back-projection. The proposed method is applied to partially occluded object visualization. Optical experiments are performed to verify the approach.     

Virtual cisternoscopy of intracranial vessels: a novel visualization technique using virtual reality

This paper introduces a different visualization method which we call “virtual cisternoscopy” using 3D MRA data sets. Virtual cisternoscopy uses well known tools, such as perspective volume rendering (pVR), fly-through techniques, and interactive visualization and combines them to a new approach featuring motion to resolve spatial relationships of intracranial vessels and vascular malformations. With a dedicated flight protocol extraluminal topography of intracranial arteries was analyzed using pVR. For evaluation of difficult vascular malformations extraluminal views are necessary. Therefore, movies of pVR views were produced simulating virtual tracks of neurosurgical flexible endoscopes, by flying around the intracranial vessels and vascular malformations within the cisterns. Endoluminal views were acquired additionally for precise evaluation of cases with complex vessel topography. Two healthy volunteers and three patients were examined. Comparing MIP and pVR images relevant advantages of pVR were found, such as depth information, perspective, lighting, and color. In contrast to MIP and source images of the MRA data set, virtual cisternoscopy of an aneurysm of the left middle cerebral artery demonstrated clearly an early origin of an artery in the region of the aneurysm neck/sac. In this case only virtual cisternoscopy led to the correct therapeutical decision. In a newborn, the type of a vein of Galen aneurysmal malformation could only be evaluated reliably by means of virtual cisternoscopy. The third case of a patient with a clipped aneurysm was evaluated more easily with virtual cisternoscopy than with DSA. In conclusion, virtual cisternoscopy may improve the pretherapeutical visualization of intracranial vascular malformations.     

MR image reconstruction of sparsely sampled 3D k-space data by projection-onto-convex sets

In many rapid three-dimensional (3D) magnetic resonance (MR) imaging applications, such as when following a contrast bolus in the vasculature using a moving table technique, the desired k-space data cannot be fully acquired due to scan time limitations. One solution to this problem is to sparsely sample the data space. Typically, the central zone of k-space is fully sampled, but the peripheral zone is partially sampled. We have experimentally evaluated the application of the projection-onto-convex sets (POCS) and zero-filling (ZF) algorithms for the reconstruction of sparsely sampled 3D k-space data. Both a subjective assessment (by direct image visualization) and an objective analysis [using standard image quality parameters such as global and local performance error and signal-to-noise ratio (SNR)] were employed. Compared to ZF, the POCS algorithm was found to be a powerful and robust method for reconstructing images from sparsely sampled 3D k-space data, a practical strategy for greatly reducing scan time. The POCS algorithm reconstructed a faithful representation of the true image and improved image quality with regard to global and local performance error, with respect to the ZF images. SNR, however, was superior to ZF only when more than 20% of the data were sparsely sampled. POCS-based methods show potential for reconstructing fast 3D MR images obtained by sparse sampling.     

Modeling of fluid flow in a biological reactor of rotational type

The technology using for the replacement of damaged tissues the own cells of the patient, which are placed in a three-dimensional frame - scaffold, is promising for solving the problem of the bone tissue regeneration. A new biological reactor of the rotational type, in which the scaffold tissue rotates in a medium for cultivating the cells, was designed for the development of this technique. A numerical algorithm based on the ANSYS program was developed, which enables one to estimate in a new bioreactor the level of the mechanical load on the cells, which affects their pro-perties. The algorithm enables the computation of the values of the shear stress and static pressure acting on the scaf-fold surface. The computations have shown that the necessary shear stress is reached in the proposed rotational biore-actor on the outer side of the inner cylinder (0.002?0.1 Pa) in the range of rotation frequencies 0.083 < f < 0.233 Hz. At the same time, computational results have revealed the presence of an inhomogeneity in the mechanical action distribution along the scaffold tissue, which is due to the appearance of two Taylor vortices with opposite rotation directions in the gap between the cylinders. The experiments on the flow field visualization inside the rotational bio-logical reactor have shown a qualitative agreement of the flow character with computational results. The proposed numerical algorithm may simulate with sufficient accuracy the fluid flow in a real system. The obtained dependencies can be used in practice for creating an optimal microenvironment of the cells cultivated in the biological reactor.