Variation in tube voltage for pediatric neck 64VCT: Effect on radiation dose and image quality.

Exposure to ionizing radiation can cause cancer, especially in children. In computed tomography (CT), a trade-off exists between the radiation dose and image quality. Few studies have investigated the effect of dose reduction on image quality in pediatric neck CT. We aimed to assess the effect of peak kilovoltage on the radiation dose and image quality in pediatric neck multidetector-row CT. Measurements were made using three phantoms representative of children aged 1, 5, and 10 years, with tube voltages of 80, 100, and 120 kilovoltage peak (kVp); tube current of 10, 40, 80, 120, 150, 200, and 250 mA; and exposure time = 0.5 s (pitch, 0.984:1). Radiation dose estimates were derived from the dose-length product with a 64-multidetector-row CT scanner. Images obtained from the control protocol (120 kVp) were compared with the 80- and 100-kVp protocols. The effective dose (ED) was determined for each protocol and compared with the 120-kVp protocol. Quantitative analysis entailed noise measurements by recording the standard deviation of attenuation for a circular 1-cm2 region of interest placed on homogeneous soft tissue structures in the phantom. The mean noise of the various kVp protocols was compared using the unpaired Student t-test. Reduction of ED was 37.58% and 68.58% for neck CT with 100 kVp and 80 kVp, respectively. The image noise level increased with the decrease in peak kilovoltage. Noise values were higher at 80 kVp at all neck levels, but did not increase at 100 kVp, compared to 120 kVp in the three phantoms. The measured noise difference was the greatest at 80 kVp (absolute increases<2.5 HU). The subjective image quality did not differ among the protocols. Thus, reducing voltage from 120 to 80 kVp for neck CT may achieve ED reduction of 68.58%, without compromising image quality.

DIAGNOSTIC REFERENCE LEVELS OF CARDIAC COMPUTED TOMOGRAPHY ANGIOGRAPHY IN A SINGLE MEDICAL CENTER IN TAIWAN: A 3-Y ANALYSIS.

This study aimed to establish the diagnostic reference levels (DRLs) for coronary computed tomography angiography (CCTA) and coronary arterial calcium score (CACS) owing to a large variability in patient radiation dose and the lack of dose recommendations in Taiwan. Volume computed tomography dose index (CTDIvol) and dose-length product (DLP) were obtained using CCTAs and the CACS of 445 patients over a 3-y period in a single medical center in Taiwan. CCTAs were performed using routine protocols and 256-detector CT scanners. Electrocardiogram gating was retrospective. The obtained data were analyzed using Prism 6 to determine the 25th, 50th (median) and 75th DRL percentiles for CTDIvol and DLP. These DRL results were compared with existing DRLs from seven countries. The DRLs for CCTA determined from this survey were similar to the existing data from other countries. Such DRLs could provide a useful tool for the optimization of radiation dose for CCTA in Taiwan.

Automatic current selection with iterative reconstruction reduces effective dose to less than 1 mSv in low-dose chest computed tomography in persons with normal BMI.

Most of the recent studies have used fixed tube current while few investigators use automatic current selection (ACS) with iterative reconstruction (IR) techniques to reduce effective dose (ED) to < 1 mSv in low-dose chest computed tomography (LDCCT). We investigated whether image quality of lungs as produced by a fixed tube current (FTC) of 35 mAs can be maintained with ED < 1 mSv produced by ACS with IR techniques in LDCCT. A total of 32 participants were included. The LDCCT was performed by a FTC 35 mAs (with a kilovoltage peak of 120 kVp) in 16 participants (Group A), and by a DoseRight ACS in 16 participants (Group B). Their images were improved by IR technique. The ED was estimated by multiplying the individual dose length product (DLP) by the dose conversion factor. The image quality was assessed by the CT number, noise levels, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of the regions of interest in the apex, upper lobe, and lower lobe of lung regions in the CT images. A t-test was used to evaluate the LDCCT image quality between the groups. The ED was significantly 49.2% lower in Group B than in Group A (0.71 ±â€Š0.05 mSv vs 1.40 ±â€Š0.02 mSv, P < .001). However, noise level, SNR, and CNR were not significantly different between Groups A and B, indicating the image quality was similar between two groups, or our setting parameters for DoseRight ACS with IR technique can achieve the image quality as good as obtained on the FTC 35 mAs with IR techniques. Our results suggest that the DoseRight ACS with IR technique reduces ED to lower than 1 mSv (averagely 0.71 mSv) yet maintains an image quality as good as produced by FTC 35 mAs with IR technique in normal BMI persons. The ACS setup thus is more preferable than the FTC to achieve the ALARA (as low as reasonably achievable) principle.

Extensive peritoneal calcification and small intestinal perforation in a peritoneal dialysis patient: a case report.

A 56-year-old woman was maintained on continuous ambulatory peritoneal dialysis (PD) for 12 years. The patient presented to our hospital with chief complaints of intermittent abdominal pain and frequent loose stool. Plain radiograph of abdomen revealed extensive peritoneal calcification. Computed tomography confirmed the extensive peritoneal calcification and revealed a large right ovarian cyst. Torsion of the right ovarian cyst was suspected. Right oophorectomy was performed. Small intestinal perforation developed 37 days after the operation. The patient expired because of peritonitis and sepsis. Extensive peritoneal calcification is a rare and serious complication after long-term PD. Intestinal perforation is a rare complication of PD. Pathognomic signs of imaging studies can be important in early diagnosis and treatment.

Use of two-dimensional multiple-slice magnetic resonance hydrography for diagnosis of hepatic hemangiomas and cysts.

BACKGROUND/PURPOSE: Although hepatic hemangiomas and cysts display very high signal intensities on conventional T2 images, their appearances are quite distinct using magnetic resonance hydrography (MRH). We examined the feasibility of using MRH in distinguishing hepatic cysts from hemangiomas. METHODS: We recruited 97 patients with hepatic hemangiomas and 65 with hepatic cysts. All patients underwent magnetic resonance imaging (including two-dimensional multiple slice MRH, TR/TE: 8000/800) and the results were reviewed independently by two radiologists. The signal intensities of the lesions were measured. For each lesion, the variation in signal to noise ratio between MRH and the fat-saturated T2-weighted images was calculated, and the results were validated using a receiver operating characteristic curve. RESULTS: There was a significant difference between the signal to noise ratio of hepatic hemangiomas and cysts using MRH (p < 0.001). This difference could be identified by visual inspection. The receiver operating characteristic curve revealed that the ideal cut-off value for the signal intensity reduction ratio between hepatic cysts and hemangiomas was -0.1. Using this ratio, the derived sensitivity was 95.4%, specificity 99.0%, and accuracy 99.7%. CONCLUSION: Hepatic hemangiomas and cysts have significantly different signal intensities on non-contrast two-dimensional multiple-slice MRH. This approach uses a non-invasive, reliable, and accurate imaging technique to differentiate the two diagnoses.

T2-weighted and T1-weighted dynamic superparamagnetic iron oxide (ferucarbotran) enhanced MRI of hepatocellular carcinoma and hyperplastic nodules.

BACKGROUND/PURPOSE: Iron oxide contrast medium (ferucarbotran) shortens both T1 and T2 relaxation time. We used the T2- and the T1-weighted dynamic ferucarbotran-enhanced magnetic resonance (MR) imaging to predict the histologic grade of hepatocellular carcinoma (HCC) and to distinguish HCC from hyperplastic nodules. METHODS: Forty-three patients with 48 representative hepatic lesions (13 well differentiated HCC, 19 moderately differentiated HCC, 4 poorly differentiated HCC, 12 hyperplastic nodules) were included in the study. T1-weighted image, T2-weighted turbo spin echo, and T2*EPI (echo-planar) images were obtained before and after ferucarbotran injection. The percentage T2 signal intensity loss (T2 PSIL) of the tumors was calculated at 5 minutes and 25 minutes after contrast injection. The enhancement in dynamic T1 images was interpreted by two independent radiologists. RESULTS: The T2 PSIL of well differentiated HCC was 39.5 +/- 8.23%, moderately differentiated HCC was 26.4 +/- 13.78%, poorly differentiated HCC was 4.4 +/- 9.42%, and hyperplastic nodules was 44.3 +/- 11.04%. Comparison of T2 PSIL showed significant differences in the three histologically graded HCCs (p < 0.001), but not between the well differentiated HCCs and hyperplastic nodules (p > 0.05). Delayed post-contrast (25 minutes) T2-weighted images were not necessary and shortened the examination time. In the post contrast dynamic T1 study, no significant differences between all the groups was seen. CONCLUSION: Ferucarbotran MR images help in differentiating the different histologic grades of HCC but T2 PSIL could not differentiate hyperplastic nodules from well differentiated HCC. Dynamic post contrast T1-weighted images provide no additional information.

Differentiation of soft tissue benign and malignant peripheral nerve sheath tumors with magnetic resonance imaging.

PURPOSE: The objective of this study was to differentiate the magnetic resonance (MR) imaging appearance of benign peripheral nerve sheath tumors (PNSTs) from that of malignant PNSTs. MATERIALS AND METHODS: Twenty-six patients who underwent MR imaging and had a histologic diagnosis of benign (schwannoma, n=16; neurofibroma, n=1) or malignant (n=9) PNST were retrospectively reviewed. The size, location, shape, margin, and signal intensities of the tumors on precontrast and gadolinium-enhanced MR imaging were analyzed. In each patient, the presence or absence of split fat, target, and fascicular signs was determined. RESULTS: The mean size of the benign PNSTs (3.4 cm, S.D.=2.5 cm) was significantly smaller than that of the malignant tumors (8.2 cm, S.D.=3.1 cm) (P<.001). Seventeen (65.4%) of the 26 tumors were spindle shaped or ovoid (12 benign and 5 malignant tumors). Contiguity with specific nerves was identified in 15 (88.2%) of the 17 benign PNSTs but in none of the malignant tumors (P<.05). Well-defined margins were noted in all 17 benign PNSTs but in only 3 (33.3%) of the 9 malignant tumors (P<.001). Five (55.6%) of the 9 malignant PNSTs but none of the benign tumors showed signal intensity change in adjacent soft tissue (P<.05). There was no significant difference in signal intensity between the benign and malignant tumors on T(1)-weighted, T(2)-weighted, and contrast-enhanced MR images. The split fat and target signs were present more frequently in the benign PNSTs than in the malignant PNSTs (P<.05). CONCLUSIONS: Benign and malignant PNSTs are often spindle shaped. Recognition of contiguity with adjacent nerves, a well-defined margin, and the presence of the split fat sign may suggest benignity. Imaging features suggestive of malignancy can be a larger size and an infiltrative margin.

Magnetic resonance imaging appearance of well-differentiated hepatocellular carcinoma.

OBJECTIVE: To investigate the magnetic resonance imaging (MRI) features of well-differentiated hepatocellular carcinoma (HCC). METHODS: We reviewed the MRI of 32 patients with 33 pathologically confirmed well-differentiated HCC. The MRI protocol included T2-weighted imaging with and without fat saturation, dual-phase T1-weighted imaging, and gadolinium-enhanced dynamic study. The signal intensity of each lesion was categorized as hyperintense, isointense, and hypointense with reference to the surrounding liver parenchyma. RESULTS: Thirty-one (93.9%) of 33 well-differentiated HCC were demonstrated on the MRI. The remaining 2 were isointense in all magnetic resonance sequences and, therefore, could not be identified. Most of them were hyperintense (n = 15 [45.4%]) or isointense (n = 16 [48.5%]) on T1-weighted imaging, and hyperintense (n = 12 [36.4%]) or isointense (n = 17 [51.5%]) on T2-weighted imaging. On the dynamic study, 17 lesions (51.5%) were enhanced. CONCLUSIONS: MRI may identify most well-differentiated HCC; however, the imaging appearance is diverse. Biopsy should be performed if magnetic resonance study is inconclusive.

Pseudomyxoma peritonei as a cause of culture-negative peritonitis for a patient undergoing peritoneal dialysis.

Culture-negative peritonitis accounts for up to 20% of all peritoneal dialysis-related peritonitis, the causes of which include culture-associated technical errors, prior use of antibiotics, infection caused by certain unusual or fastidious microorganisms, the development of abdominal or retroperitoneal organ inflammation, and the presence of malignancies. Here, we report a patient with end-stage renal disease receiving peritoneal dialysis who presented with culture-negative peritonitis and ultrafiltration failure caused by the rare pseudomyxoma peritonei. For cases of culture-negative peritonitis such as this, early imaging studies may help recognize intraperitoneal/retroperitoneal visceral inflammation and malignant conditions.

Transcatheter arterial chemoembolization in patients with hepatocellular carcinoma and coexisting hepatic cavernous hemangioma.

We investigated the consequence of repeated transcatheter arterial chemoembolization (TACE) for coexisting small hepatic hemangioma in the treatment of patients with hepatocellular carcinomas and describe the imaging features of embolized hemangioma on the follow-up Lipiodol CT and MR. Six of 431 patients with biopsy-confirmed hepatocellular carcinomas, who underwent TACE, also had seven small hepatic cavernous hemangiomas (0.8 approximately 2.3 cm) in the same area of embolization. All six patients underwent repeated TACE All lesions were evaluated with CT and/or MR for the post-treatment follow-up. The outcomes and imaging features of these embolized hemangiomas were reviewed for the change of tumor size, Lipiodol deposition, enhancing pattern as well as embolization complications. Six of the seven hemangiomas did not depict changes in the size or enhancement pattern without being ablated. One hemangioma showed a decrease in size, but still persisted after TACE. All of the hemangiomas showed Lipiodol deposition for 2 approximately 15 months, in which five hemangiomas depicted irregular rim patterns. There is no complication caused by the procedures. The differentiation of small hepatic hemangiomas from viable HCC is important in the post-TACE follow-up to avoid unnecessary repeated embolization.

Peritumoral fat-spared area is well correlated with the presence of temporal peritumoral enhancement in hepatic hemangioma in fatty liver.

PURPOSE: To assess the relationship between temporal peritumoral enhancement and peritumoral focal fat sparing adjacent to hepatic hemangiomas. MATERIALS AND METHODS: On the basis of MRI and sonographic imaging follow-up, 51 hepatic hemangiomas were identified in 37 patients, who had both hepatic hemangiomas and focal fat-sparing areas in fatty liver. Among them, 36 tumors were associated with peritumoral focal fat spares. The association between the temporal peritumoral enhancement in the early arterial phase of dynamic MRI and peritumoral fat sparing in the same hemangioma was investigated. Furthermore, the configuration of the temporal peritumoral enhancement was correlated with that of the peritumoral focal fat-sparing area. We used Chi square and Fisher's exact test for statistic analysis. RESULTS: A total of 31 out of 36 hemangiomas (86.1%) showed both peritumoral focal fat spares and temporal peritumoral enhancement. The presence of temporal peritumoral enhancement is significantly related to that of peritumoral focal fat-sparing (P < 0.001). A total of 21 of the 31 tumors (67.7%) presented with similar configuration of the peritumoral focal fat-sparing area and temporal peritumoral enhancement area with respect to size and shape. The remaining 10 hemangiomas showed similar shape but slightly different size in these two imaging characteristics. CONCLUSION: Temporal peritumoral enhancement seen in hepatic hemangioma might be related to focal fatty sparing adjacent to the hemangiomas.

Metastases from gastric carcinoma to colon in the form of multiple flat elevated lesions: a case report.

Gastric carcinoma is a common malignancy worldwide. Advanced stages of the disease may result in metastases to many other organs of the body. However, colonic metastases are rare. We report a case of gastric carcinoma with symptoms of abdominal fullness and weight loss. The serum carcinoembryonic antigen level was elevated. Esophagogastroduodenoscopy revealed giant folds occupying the whole gastric body and poor expansion of the stomach. Histologic examination of biopsy specimens from the giant fold demonstrated poorly differentiated adenocarcinoma with signet ring-cell differentiation. Total colonoscopy revealed five or six discrete flat elevated lesions in the distal transverse, descending, and sigmoid colons. These lesions were characterized by a clear margin of 3-5 mm in diameter and erosions on the tips. Polypectomy specimens demonstrated signet ring-cell carcinoma, which was histologically similar to the specimens taken from the gastric lesion. We conclude that this was a rare case in which gastric signet ring-cell carcinoma had metastasized to the colon in the form of flat elevated lesions, combined with rapid and wide lymphatic spread to the thorax and abdomen in a clinical course as short as 46 days.

Relationship between vertebral bone marrow blood perfusion and common carotid intima-media thickness in aging adults.

PURPOSE: To evaluate the relationship between vertebral marrow blood perfusion and common carotid intima-media thickness (IMT) in aging adults. MATERIALS AND METHODS: An age- and sex-matched case control study was conducted. Subjects were contacted and enrolled voluntarily according to a database containing 2,258 cases that received carotid ultrasonography examination at our hospital in the previous two years. Forty-three pairs of subjects (56 male, 30 female; aged 44-85 years, average 63 years) underwent dynamic contrast-enhanced magnetic resonance (MR) study of the lumbar spine. The average peak enhancement percentage of the second to fourth lumbar vertebrae was used to represent the vertebral marrow perfusion status for each subject. The common carotid IMT, presence of plaque, peak enhancement percentage, body mass index (BMI), systolic and diastolic blood pressure, serum total cholesterol, high-density lipoprotein (HDL), and triglycerol levels were acquired for statistical analysis. RESULTS: The average peak enhancement percentage was significantly lower in thickened IMT group compared to the normal IMT group (73 +/- 23 vs. 90 +/- 27, P=0.0023). The carotid IMT inversely correlated with vertebral peak enhancement percentage (r=-0.33, P=0.0018). The vertebral peak enhancement percentage was significantly lower in subjects with presence of any carotid plaque (P=0.032). Common carotid IMT was the only significant variable that was negatively associated with vertebral marrow perfusion after adjusting for the effect of sex, age, blood pressure, BMI, total cholesterol, HDL, and triglycerol level in linear regression model (P=0.008). CONCLUSION: Our data demonstrate the negative association between vertebral marrow blood perfusion and common carotid IMT. These results suggest that common carotid IMT may provide the information of tissue perfusion status of the vertebral bone marrow.

MRI of angiomatoid fibrous histiocytoma.

Angiomatoid fibrous histiocytoma is a rare soft tissue tumor of low-grade malignancy. We present the case of a 32-year-old man who complained of soreness and numbness over his left arm and hand over the previous 2 months and of having a palpable mass over his left upper back for 4 years. Magnetic resonance imaging (MRI) showed an intramuscular soft tissue mass in the left scapular region. The tumor mass was seen to have multiple cystic components with fluid-fluid levels. Histological examination showed multiple cystic spaces filled with blood lakes and hemosiderin deposits in the solid part of the tumor. After the initial surgery, the patient had local recurrences over 2.5 years. The immunohistochemical study at the second surgery showed that the recurrent tumor was strongly positive for the histiocytic marker CD68, and the myoid trait desmin. Histological diagnosis was compatible with angiomatoid fibrous histiocytoma.

Spontaneous regression of hepatocellular carcinoma: a case report and literature review.

A case of spontaneous regression of hepatocellular carcinoma is reported and compared with the reports published in the English literature. Spontaneous regression of a histologically proven hepatocellular carcinoma was observed in a 42-year-old male patient with chronic hepatitis B. The patient refused to receive any medical therapy. The tumor subsequently regressed without specific treatment, as demonstrated radiologically by computed tomography 22 months and ultrasonography 24 months after initial diagnosis. We review 27 case reports of apparently spontaneous regression of hepatocellular carcinoma that have been published in the English literature from 1982 to 2002. In this report, we present our unusual case and discuss possible causes of spontaneous total necrosis or regression of hepatocellular carcinoma.

Temporal peritumoral enhancement of hepatic cavernous hemangioma: findings at multiphase dynamic magnetic resonance imaging.

OBJECTIVE: To evaluate the occurrence rate of temporal peritumoral enhancement associated with hepatic cavernous hemangiomas and to correlate that with the speed of intratumoral contrast enhancement and tumor volume. METHODS: Dynamic magnetic resonance imaging (MRI) of 69 consecutive patients with 136 hemangiomas was reviewed for peritumoral enhancement. Tumor volume was estimated by the largest diameter on T2-weighted images. Speed of intratumoral contrast enhancement was determined by portal phase image and was categorized as rapid (>75% of tumor volume), intermediate (25%-75% of tumor volume), or slow (<25% of tumor volume). RESULTS: Temporal peritumoral enhancement was found in 37 (26.6%) of 136 hemangiomas. It was more common in hemangiomas with rapid enhancement (30 of 67 cases [44.8%]) than in those with intermediate (3 of 22 cases [13.6%]) and slow (4 of 47 cases [8.5%]) enhancement (P < 0.05). There was no statistically significant relation between lesion size and presence of temporal peritumoral enhancement (P > 0.05). CONCLUSIONS: Temporal peritumoral enhancement is not uncommonly seen in hepatic cavernous hemangiomas at dynamic MRI. It is most commonly encountered in rapidly enhancing small lesions. There is no statistically significant relation between temporal peritumoral enhancement and tumor volume, however.

Carbon dioxide-enhanced sonographically guided percutaneous ethanol injection: treatment of patients with viable and recurrent hepatocellular carcinoma.

OBJECTIVE: Viable portions of tumors can persist and recurrent tumors sometimes appear in patients with hepatocellular carcinoma who have undergone transcatheter arterial chemoembolization, percutaneous ethanol injection, or a combination of the two. Some of these tumors are difficult to treat or do not respond to additional treatment using the same protocol. In this article, we examine the use of carbon dioxide (CO(2))-enhanced sonographically guided percutaneous ethanol injection to treat patients with such tumors. SUBJECTS AND METHODS. Our study population was 44 patients with 53 viable portions of tumors or recurrent hepatocellular carcinomas that had developed after the initial treatment of the primary tumor. The tumors were treated with CO(2)-enhanced sonographically guided percutaneous ethanol injection via the catheter that had been placed in the hepatic artery for angiography. Thirty-seven (84.1%) of the 44 patients had cirrhosis. Of these 37 patients, 23 had Child-Pugh class A cirrhosis, and 14 had Child-Pugh class B. RESULTS: Overall, thirty-four (64.2%) of the 53 tumors showed complete necrosis after treatment, eight (15.1%) of the 53 showed partial necrosis, and 11 (20.8%) of the 53 showed no response. The cumulative survival rates of patients who underwent CO(2)-enhanced sonographically guided percutaneous ethanol injection were 81%, 71%, and 44% for 1, 2, and 3 years, respectively. The small tumors were more responsive to the treatment. The tumor recurrence rate was 56.8%. In 9.1% of these cases, carcinoma had metastasized to other organs. CONCLUSION: CO(2)-enhanced sonographically guided percutaneous ethanol injection is effective for patients with viable portions of a treated tumor or new tumors who have undergone transcatheter arterial chemoembolization, percutaneous ethanol injection, or a combination of the two treatments. This finding is especially true of patients who are not good candidates for repeated treatments.

MR cholangiopancreatography: prospective comparison of 3-dimensional turbo spin echo and single-shot turbo spin echo with ERCP.

BACKGROUND AND PURPOSE: Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive technique for examination of the biliopancreatic tract. Respiratory-triggered 3-dimensional turbo spin echo (3DTSE RT) and breath-hold thick slab single-shot turbo spin echo (ssTSE BH) are both useful MRCP techniques. The purpose of this study was to compare these 2 sequences with endoscopic retrograde cholangiopancreatography (ERCP) in patients with biliary tract disease. METHODS: Forty four patients with suspected biliary obstruction were recruited to receive MRCP within 3 days before ERCP. MRCP was performed using both 3DTSE RT with maximum intensity projection images and ssTSE BH. ERCP was performed and assessed by 2 endoscopists. RESULTS: MRCP was successfully performed in all patients, whereas ERCP failed in 6 patients (13.6%). MRCP was effective in detecting the presence of choledocholithiasis in 13 of 14 patients, ERCP in 12 of 12, and 2 failed ERCP. MRCP was effective in detecting benign biliary obstruction in 18 of 19 patients, and ERCP in 15 of 15, but 4 patients failed ERCP and choledocholithiasis was misdiagnosed by MRCP in 1 patient. Both MRCP and ERCP correctly diagnosed malignant bile duct obstruction in 10 of 11 patients, and both misdiagnosed that condition as benign obstruction in 1 patient. There was no significant difference between MRCP and successful ERCP in detecting lesions. MRCP was significantly better than ERCP when both successful and failed ERCP were encountered (p = 0.0498). Both 3DTSE RT and ssTSE BH produced the same results in depicting the biliary ducts and lesions in 37 patients (84.1%). Four patients (9.1%) showed better images on 3DTSE RT, whereas 3 patients (6.8%) showed better images on ssTSE BH. CONCLUSIONS: 3DTSE RT and the ssTSE BH were complementary to each other in MRCP studies. Using these 2 techniques, MRCP has a high successful rate and diagnostic accuracy when compared with ERCP in detecting bile duct disease.