TÀI LIỆU HỘI NGHỊ KỸ THUẬT ĐIỆN QUANG VÀ Y HỌC HẠT NHÂN VIỆT NAM LẦN 7 (2019) Nguồn: https://hinhanhykhoa.com/

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MR CHOLANGIOPANCREATOGRAPHY
IN COLEDOCHAL CYSTS AT THE VIET NAMIN COLEDOCHAL CYSTS AT THE VIET NAM
NATIONAL CHILDREN’S HOSPITAL
LÊ MINH TIẾN. RAD
RADIOLOGY DEPARTMENT
I.BACKGROUND
• Choledochal cysts represent congenital cystic dilatation of the biliary tree ≥
1cm
• In pediatric , the disease is usually bile cyst type I and IV
• Most Choledochal cysts are detected before age 10
• Less common in adultsLess common in adults
• Ultrasound is the first diagnostic method
• MRCP scanning is very valuable
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No x-rays
Can perform
il
noninvasive
No side effects
Images exactly
easily
o s de e ects
WHY DO YOU NEED TO SCAN MRCP
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PURPOSE
• Evalutaion of MR image quality in choledochal cyst
• Factors affecting to MR image quality and fix the factors affecting
image quality
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II.MATERIALS AND METHOD
• 20 children diagnosed with choledochal cysts with postoperative
results and MRI were performed in 2 consecutive month from 5/2019
to 7/2019
• Perform scan MRCP according to the protocol
• Factors that affect images qualityFactors that affect images quality
• Evaluate image quality ( specialist )
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NECESSARY DEVICES
MR CAMERA
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MONITOR COIL
PATIENT POSITION AND LOCALIZATION
• Supine position
• Head first
• Coil set
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ẢNH MINH HỌA
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• Set the laser beam

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PROTOCOL
1. Localiser
2. T2_haste_cor_p2_trig_(non trig)
3. T2_blade_tra_p2_fs_(non fs )
4. T2_space_cor_p2_trig_iso
5. T1_vibe_tra_Dixon_p2
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LOCALISER_HASTE_18S
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T2_HASTE_COR_P2_TRIG ( NON TRIG) 2MIN
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TR TE Flip Nex Slice Matrix FOV Phase Oversample Trigger
1300 93 180 1 3 – 4 mm 256x256 280 H>F 50%-70% Yes
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T2_BLADE_TRA_FS_P2 (3MIN)
TR TE Flip Nex Slice Matrix FOV Phase Oversample Trigger
2500 76 160 1 3 – 4 mm 320x320 250 R>L 37.5% Yes
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T2_SPACE_COR_ISO_TRIG (5MIN)
TR TE Flip Nex Slice Matrix FOV Phase Oversample
2500 705 140 1.5 1mm 353x384 300 H>F 30%
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T1_VIBE_TRA_DIXON ( 48S )
TR TE Flip Nex Slice Matrix FOV Phase Oversample Trigger
6.98 2.39 10 1 3mm 260x320 250 A>P 30% NO
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III. RESULTS AND DISCUSSION
1.AGE
Over 6 year
old
[PERCENTA
Under 6 year
old
[PERCENTA
GE]
[
GE]
19
AVG age Youngest age Oldest age N
3.9 year olg 2 months 12 year old 20
III. RESULTS AND DISCUSSION
2.GENDER
[CATEGORY
NAME]
[PERCENTA
GE]
female
65%
 Male :35%
 Female :65%
No statictical significance
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III. RESULTS AND DISCUSSION
3.TYPES PERCENTAGE ACCORDING TO TODANI
Type % N
Type I 75% 15
Type II 0% 0
Type III 0% 0
Type IV 25% 5yp
Type V 0% 0
Tổng 20
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III.RESULTS AND DISCUSSION
4.EVALUATION CRITERIA
Good Medium Bad
Images are clear and sharp Images are not clear and sharp Images are too blurry
Reveal all the biliary ducts Reveal all the biliary ducts Cannot reveal all the biliary ducts
Can see the broder between the
cyst and the biliary duct clearly
Can see the broder between the
cyst and the biliary duct clearly
Cannot see the border between
the cyst and the biliary duct
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III.RESULTS AND DISCUSSION
5.IMAGE QUALITY
70
80
79
30
40
50
60
70
53
61 60
21
47
39 40
0
10
20
T2_Haste_Cor_Trig T2_Blade_tra_fs T2_Space_Cor_trig_iso T1_Vibe_Dixon
0 0 0 0
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III.RESULTS AND DISCUSSION
6.FACTORS AFFECTING
Factor affecting % N Age Weight
Patient
Sedated 75% 15
2 months - 6
years old
4kg-24kg
Patient years old
Co-operate 25% 5 6 -12 years old 24kg-45kg
Technical
specifications
FOV
250-300 80% 16
2 months - 6
years old
4kg-24kg
300-400 20% 4 6 -12 years old 24kg-45kg
Slice 3-4mm 100% 20 Depending on the size
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Matrix
256x256 -
320x320
100% 20
Depending on FOV and
pulse sepuence
Other factors
Contrast in the gastrointestinal tract
Set the respiratory navigation box to the wrong position
Coil is not close to the body
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2525
NAVIGATION BOX COIL SET ERROR
• Patient 1 :
- Sedated
- Regularly breath
• Patient 2:
- Older children
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- Co-operate
- Holdbreath well

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III.RESULTS AND DISCUSSION
T2_BLADE_TRA_FS
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FEMALE , 9 YEAR OLD MALE , 6 YEAR OLD
III.RESULTS AND DISCUSSION
T2_SPACE_COR_ISO_TRIG
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FEMALE, 2 YEAR OLDMALE, 6 YEAR OLD MALE , 7 YEAR OLD
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LIMITATION
• Pediatric abdomen
• Adjust parameter ( FOV , MATRIX , OVERSAMLING …)
• Imperfect signals
• Long time scanning
• Need extra medical workers
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CONCLUSION
• MRCP scanning is an effective diagnostic method and have good
image quality in choledochal cysts
• There are many affecting factors to image quality: sedation, patient’s
co-operation, parameter techniques, etc. Pay attention to know and fix
affecting factors
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SOURCES
1. http://radiographics.rsna.org/content/26/3/715.full#sec-15
2. https://radiopaedia.org/articles/todani-classification-of-bile-duct-cysts
3. https://mrimaster.com/PLAN%20MRCP.html
4. Nguyễn Thanh Liêm , Mark D. Stern and Hock Lim Tam
5. Choledochal cyst pediatric.surgery,7th
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