<Original> MR cholangiopancreatography; Predicting imaging findings for differentiation of malignant bile ductal obstruction versus benign lesion

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[Abstract] The purpose of the current study was to evaluate the use of magnetic resonance imaging (MRI) in conjunction with a scoring system to differentiate between malignant and benign strictures of the common bile duct. MRI scans of 54 patients with indeterminate biliary strictures on prior imaging were reviewed, and non-enhanced MRI, magnetic resonance cholangiopancreatography (MRCP), and diffusion-weighted imaging were analyzed. Eight radiologic parameters were significantly associated with malignancy; luminal irregularity, high signal intensity on diffusion-weighted MRI, luminal stenosis asymmetry, T2-weighted MRI signal intensity, abrupt stenosis,bile duct dilatation ≥ 12.5 mm, stenosis length ≥ 10.5 mm, and wall thickness ≥ 4.5 mm. A simple system scoring based on statistically significant findings was developed, where each of the above findings counts for one point. A score of 6 or higher was found only in patients with a malignant stricture of the common bile duct; 60% of patients with a benign stenosis had a score of 1,or 2, and all patients with benign lesions had scores of less than 5. This MRI scoring system can assist in the differential diagnosis of common bile duct stricture with high accuracy; to be widely applicable, the MRI score needs to be validated in a prospective patient population.

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