ARRS 2022 Abstracts

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E2089. What Radiologists Should Know: Benign and Malignant Biliary Strictures at MRI
Authors
  1. Pardeep Mittal; Medical College of Georgia
  2. Man Dai; Medical College of Georgia
  3. Thomas Estes ; Medical College of Georgia
  4. Manohar Roda; University of Mississippi Medical Center
  5. Abdul Abualruz; Medical College of Georgia
Background
The purpose of this exhibit is to describe imaging characteristics of combined contrast enhanced MRI (CE-MRI) and MRCP to differentiate malignant from benign biliary strictures along with histopathological findings such as cholangiocarcinoma, pancreatic adenocarcinoma, IgG4 cholangiopathy, ischemic strictures, and others. CE-MRI and MRCP are noninvasive methods for evaluation of patients with obstructive jaundice without ionizing radiation. ERCP with tissue biopsy or surgery is needed for definite diagnosis of biliary strictures, but certain MRI characteristics are helpful in narrowing the differential diagnosis. Various causes of bile duct strictures and other characteristics are important for diagnosis and management.

Educational Goals / Teaching Points
This exhibit aims to determine various causes of benign and malignant biliary strictures and their MRI characteristics; understand the role of combined CE-MRI and MRCP in the evaluation of bile ducts in patients with obstructive jaundice; and demonstrate important elements in the assessment and management of benign and malignant biliary strictures.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A wide spectrum of hepatobiliary and pancreatic diseases can lead to development of benign and malignant biliary strictures such as cholangiocarcinoma, pancreatic adenocarcinoma, ampullary carcinoma, PSC, autoimmune pancreatitis, ischemic strictures, post cholecystectomy, and trauma These along with histopathological findings will be discussed. MRI characteristics of malignant features such as length, location, wall thickness, asymmetry, luminal regularity, and enhancement will be discussed. MRI protocol and advantages over other modalities will be discussed in addition to treatment planning and management.

Conclusion
Combined CE-MRI and MRCP play a key role in characterization of benign and malignant biliary stricture such as CCA, pancreatic adenocarcinoma, PSC, autoimmune pancreatitis, and AIDS MRI helps to reach a specific diagnosis and narrow the differential diagnosis, which is of utmost importance for management and treatment planning.