Quantitative MRCP Imaging: Accuracy, Repeatability, Reproducibility, and Cohort‐Derived Normative Ranges. Issue 3 (8th March 2020) - Goldfinger, Marc H.
Abstract : Background: Magnetic resonance cholangiopancreatography (MRCP) is an important tool for noninvasive imaging of biliary disease, however, its assessment is currently subjective, resulting in the need for objective biomarkers. Purpose: To investigate the accuracy, scan/rescan repeatability, and cross‐scanner reproducibility of a novel quantitative MRCP tool on phantoms and in vivo. Additionally, to report normative ranges derived from the healthy cohort for duct measurements and tree‐level summary metrics. Study Type: Prospective. Phantoms/Subjects: Phantoms: two bespoke designs, one with varying tube‐width, curvature, and orientation, and one exhibiting a complex structure based on a real biliary tree. Subjects Twenty healthy volunteers, 10 patients with biliary disease, and 10 with nonbiliary liver disease. Sequence/Field Strength: MRCP data were acquired using heavily T2 ‐weighted 3D multishot fast/turbo spin echo acquisitions at 1.5T and 3T. Assessment: Digital instances of the phantoms were synthesized with varying resolution and signal‐to‐noise ratio. Physical 3D‐printed phantoms were scanned across six scanners (two field strengths for each of three manufacturers). Human subjects were imaged on four scanners (two fieldstrengths for each of two manufacturers). Statistical Tests: Bland–Altman analysis and repeatability coefficient (RC). Results: Accuracy of the diameter measurement approximated the scanning resolution, with 95% limits of agreement (LoA) from –1.1 to 1.0 mm. Excellent phantom repeatability was observed, with LoA from –0.4 to 0.4 mm. Good reproducibility was observed across the six scanners for both phantoms, with a range of LoA from –1.1 to 0.5 mm. Inter‐ and intraobserver agreement was high. Quantitative MRCP detected strictures and dilatations in the phantom with 76.6% and 85.9% sensitivity and 100% specificity in both. Patients and healthy volunteers exhibited significant differences in metrics including common bile duct (CBD) maximum diameter (7.6 mm vs. 5.2 mm P = 0.002), and overall biliary tree volume 12.36 mL vs. 4.61 mL, P = 0.0026). Data Conclusion: The results indicate that quantitative MRCP provides accurate, repeatable, and reproducible measurements capable of objectively assessing cholangiopathic change. Evidence Level: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;52:807–820.