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Endoscopy 3 prof lecture medicine lecture and pdf

1. MRCP

2. Indication MRCP can be used to evaluate various conditions of the pancreaticobiliary ductal syste identification of congenital anomalies of the cystic and hepatic ducts post-surgical biliary anatomy and complications pancreas divisum anomalous pancreaticobiliary junction choledocholithiasis biliary strictures chronic pancreatitis pancreatic cystic lesions biliary or pancreatic trauma

3. Physics The technique exploits the fluid which is present in the biliary and pancreatic ducts as an intrinsic contrast medium by acquiring the images using heavily T2-weighted sequences. Since the fluid-filled structures in the abdomen have a long T2 relaxation time as compared to the surrounding soft tissue, these structures appear hyperintense against the surrounding non-fluid-containing tissues on a heavily T2-weighted sequence and can easily be distinguished.

4. Techniques and protocol No exogenous contrast medium is administered to the patient. Fasting for 4 hours prior to the examination is required to reduce gastroduodenal secretions, reduce bowel peristalsis (and related motion artifact) and to promote distension of the gallbladder. MRCP is performed on a 1.5 T or higher field system, using a phased-array body coil. All protocols obtain heavily T2-weighted sequences. Most commonly obtained sequences are: RARE: rapid acquisition and relaxation enhancement FRFSE: fast-recovery fast spin-echo coronal oblique 3D respiratory triggered HASTE: half-Fourier acquisition single shot turbo spin echo-axial 2D breath hold sequence which provides superior images and can be performed in single breath hold (<20 s) and a fat-suppressed sequence an additional sequence that can be acquired to evaluate the duct wall is a fat suppressed T1 GRE sequence T1 sequences may also help differentiate biliary calculi from pneumobilia For optimal visualisation of ducts, acquired images are reformatted in different planes using multiplanar reconstruction (MPR) and maximum intensity projection (MIP). The advantage of FRFSE, as a 3D technique, is the ability to perform multiplanar reconstructions. However, despite respiratory triggering, this sequence is often prone to motion artifact.