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Magnetic resonance cholangiopancreatography at 5.0 T: quantitative and qualitative comparison with 3.0 T

Abstract

Background

This study aimed to assess the feasibility and performance of 5.0 T MRI in MR Cholangiopancreatography (MRCP) imaging compared to 3.0 T, focusing on detail visualization, signal-to-noise ratio (SNR), and image artifacts.

Methods

A prospective study from May to October 2023 involved 20 healthy subjects and 19 with biliary dilation. Both groups underwent MRCP using 3.0 T and 5.0 T scanners. The detail visualization capability of the biliary tree and the SNR of the images were quantitatively evaluated. Two experienced MRI diagnostic physicians assessed the image artifacts qualitatively on a scale of 1 to 5. The t-test or Wilcoxon signed-rank test compared the quantitative results of biliary visualization and SNR between 3.0 T and 5.0 T scanners, while the Wilcoxon signed-rank test was used for comparing the level of image artifacts between the two scanners. The inter reader consistency was tested using Kappa test.

Results

In both healthy subjects and those with biliary dilation, the 5.0 T group exhibited significantly higher numbers of biliary tree branches, along with greater total and maximum branch lengths, compared to the 3.0 T group (P<0.05). Although the maximum branch length was higher in the 5.0 T group among healthy subjects, this difference was not statistically significant (P = 0.053). No notable differences were observed in SNR and image artifact levels between the two groups across both field strengths (P>0.05).

Conclusions

MRCP at 5.0 T offers superior biliary tree visualization compared to 3.0 T. The performance regarding SNR and image artifacts between the two is relatively comparable.

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Background

Magnetic resonance cholangiopancreatography (MRCP), a noninvasive diagnostic tool for visualizing bile and pancreatic ducts, has advanced significantly over the past three decades [1,2,3]. Benefiting from advancements in MRI hardware and imaging sequences, MRCP is radiation-free and doesn’t require contrast agents. It has reached a diagnostic performance on par with the gold standard, ERCP [4], making it the preferred choice for diagnosing biliary tract diseases [5,6,7]. Despite this progress, MRCP’s effectiveness at different magnetic field strengths, particularly at ultra-high fields, remains a subject of ongoing research.

Currently, MRCP predominantly utilizes 1.5 or 3.0 T magnetic fields, employing T2-weighted (T2W) sequences that leverage the prolonged T2 relaxation times of static or slowly flowing fluids, using a respiratory-triggered 3D fast spin-echo technique [8]. The potential benefits of higher magnetic fields, such as improved signal-to-noise ratio (SNR), better spatial resolution, and enhanced tissue contrast, have sparked interest in using MRI at fields greater than 3.0 T [9,10,11]. Initial studies in ultra-high-field body MRI, particularly at 7.0 T, have shown promising results for abdominal imaging. For example, non-enhanced 3D FLASH imaging at 7.0 T demonstrated superior contrast and more detailed visualization of mesentery structures [12]. Additionally, a study with ten healthy volunteers highlighted the effectiveness of 7.0 T 3D FLASH in rapidly acquiring high-quality, non-enhanced images of renal vasculature [13].

Abdominal imaging with 7.0 T MRI faces several challenges [14]. The ultra-high field strength leads to uneven distribution of the RF field (B1), adversely impacting image quality due to the inhomogeneous B1 field. This results in more artifacts and lower image quality in 7.0 T MRI compared to 1.5 and 3.0 T [15]. Specifically, for biliary tract imaging, the T2W turbo spin-echo sequence at 7.0 T struggles with B1 field inhomogeneities, compromising image quality [16]. Similar challenges are observed in renal MRI at 7.0 T, as noted by Umutlu et al., where image quality is significantly affected [17].

Recent developments in 5.0 T MRI technology offer potential advantages for abdominal MRCP imaging, presenting a promising alternative to 7.0 T MRI [18]. Theoretically, 5.0 T MRI could provide images with higher SNR than 3.0 T MRI, while better managing image artifacts compared to 7.0 T MRI [19]. This increase in SNR might enhance biliary tree visualization. However, the specific advantages of 5.0 T MRI in MRCP remain to be fully understood. Therefore, this study aimed to assess the feasibility and efficacy of 5.0 T MRI for abdominal MRCP, comparing it quantitatively and qualitatively to 3.0 T MRI in aspects like detail visualization, SNR, image quality, and artifacts.

Methods

Patients

This prospective study was approved by the Ethics Committee of Shandong Provincial Third Hospital (KYLL-2023064). All participants were informed about the study and provided written informed consent. From May to October 2023, a total of 40 participants were recruited, including healthy volunteers and volunteers with bile duct dilation caused by bile duct stones from the hospital’s outpatient population. Inclusion criteria were as follows: (a) age > 18 years with capacity for autonomous decision-making; (b) no contraindications for MRI examination (e.g., presence of cardiac pacemaker, history of neurological or psychiatric disorders, metal implants). Exclusion criteria were: (a) a history of abdominal surgery; (b) a history of biliary stent placement; (c) liver disease; (d) significant abdominal ascites; (e) a history of biliary tract tumors. Each volunteer underwent a 3D MRCP examination within 24Ā h, using 3.0 T and 5.0 T scanners, respectively.

MRI acquisitions

All participants underwent a minimum of 6Ā h of fasting prior to the examination. The 5.0 T MRI scan was conducted using the state-of-the-art ultra high field MRI system (uMR Jupiter, United Imaging Healthcare) equipped with a 24-channel body coil and a 48-channel spine coil. However, only 16-channel body coil and 16-channel spine coil were activated during scanning. Additionally, 3.0 T MRI scans were performed on the advanced MRI system (Ingenia, Philips Healthcare) utilizing a 16-channel body coil and a 16-channel spine coil. Respiratory triggering was employed to acquire long-echo heavy T2W sequences with fat suppression. A comprehensive description of the MR protocols is provided in TableĀ 1. The source images obtained through the 3D TSE sequence were reconstructed using a maximum intensity projection (MIP) technique.

Table 1 3D MRCP protocols parameters at 3.0 T and 5.0 T

Quantitative image analysis

Quantitative Image Analysis involved evaluating the bile duct tree branches in MRCP using a semi-automatic approach to compare visualization capabilities at two different field strengths. MIP images were reconstructed from multiple directions to ensure comprehensive visualization of the biliary tree. For quantitative analysis, the coronal MIP image orientation was selected for consistency. The process, depicted in Fig.Ā 1, included: converting the MRCP image to an 8-bit format while excluding the gallbladder region; applying skeletonization to the image; removing disconnected parts not linked to the main bile duct trunk; calculating the longest branch; and determining the branch count, total and maximum branch lengths of the skeletonized tree. ImageJ (1.53T, https://imagej.nih.gov/ij/) [20] was used for data processing. Specific terms used in the analysis are defined as follows: Longest Branch: The longest continuous path from the main duct to the farthest visible branch within the biliary tree. Branch Count: The total number of branches identified, encompassing primary, secondary, and any further branches within the skeletonized tree. Total Branch Length: The cumulative length of all branches in the skeletonized biliary tree. Maximum Branch Length: The length of the longest individual branch from the biliary tree root to the tip.

Fig. 1
figure 1

Flow chart for semi-automatic quantitative analysis of maximum branch length of the biliary tree. The red line represents the identified maximum branch length; the common bile duct and main pancreatic duct, when indistinguishable in the MIP image, will be collectively recognized as the maximum branch length, occurring at both 3T and 5T

Additionally, identically-sized regions of interest (ROIs) of 0.2Ā cm diameter were placed on the bile duct’s upper segment (at the level of the gallbladder duct opening), the proximal left and right hepatic ducts for signal intensity (SI) measurement. Quantitative analysis included primary and secondary branches of the bile duct tree, with ROIs placed on the 3D TSE source images for consistency in SNR calculation. The standard deviation (SD) of the background was measured around each ROI, free of artifacts and with the same diameter. SNRs for each ROI were calculated, and the final SNRmean of the images was determined as the mean SNR of these three ROIs. A radiologist (L.Y.) with 11 years of abdominal MR scan experience performed all measurements.

Qualitative image analysis

Bile duct visibility was qualitatively assessed using a skeletonized tree representation, capturing the branching structure’s visibility in detail. Two radiologists, L.L. (with 12 years of experience) and M.S. (with 9 years of experience), independently assessed the MRI images, blind to the acquisition technique and field strength. To minimize potential bias, the order of subjects was randomized, and 3T and 5T images were evaluated separately. Observers were allowed to adjust image contrast freely during the qualitative assessment, enabling individualized optimization for evaluating image clarity and artifact presence. They evaluated image artifacts including magnetic field inhomogeneity, chemical shift, distortion, and motion artifacts on a 5-point scale: 5 indicating severe impairment rendering the images non-diagnostic; 4 indicating strong impairment; 3 indicating moderate impairment; 2 indicating slight impairment; and 1 indicating no impairment.

Statistical analysis

The Shapiro-Wilk test assessed data normality. For data that was normally distributed, means and standard deviations were calculated. Conversely, for non-normally distributed data, medians and interquartile ranges were determined. The paired sample t-test were applied to normally distributed data, while Wilcoxon signed-rank tests were used for comparing SNR and quantitative measures at 3.0 T and 5.0 T in skewed distributions. The Kappa consistency test assessed the agreement level between the two radiologists in qualitative analysis, with values ranging from 0 to 0.2 indicating slight agreement, 0.21 to 0.4 indicating fair agreement, 0.41 to 0.60 indicating moderate agreement, 0.61 to 0.8 indicating substantial agreement, and values above 0.8 indicating excellent agreement. Lastly, the Wilcoxon signed-rank test compared the image artifact scores at 3.0 T and 5.0 T. All statistical procedures were executed using SPSS (version 26.0), and a P < 0.05 was considered indicative of statistical significance.ā€

Results

Subjects

Throughout the study, 21 healthy individuals and 19 patients with bile duct dilation were subjected to MRCP examinations. However, one healthy participant was excluded due to claustrophobia during the 3.0 T scan. Consequently, the study included 20 healthy subjects (9 females and 11 males, average age 33.2 ± 9.9 years) and 19 patients with bile duct dilation (7 females and 12 males, average age 57.3 ± 12.4 years). The patients with bile duct dilation had diagnoses of common bile duct stones (n = 12) or hilar bile duct stones (n = 7), confirmed by ultrasound or CT.

Visualization and quantitative assessment of the bile duct tree

In this study, the healthy volunteer group exhibited higher branch counts, total branch lengths, and maximum branch lengths in the biliary tree on 5.0 T MRCP images compared to 3.0 T, as detailed in TableĀ 2. The differences in branch count and total branch length were statistically significant (P < 0.05), while the difference in maximum branch length was not (P = 0.053). Similarly, for the group with biliary dilation, 5.0 T MRCP images showed significantly higher branch count, total branch length, and maximum branch length compared to 3.0 T (P < 0.05), as indicated in TableĀ 2. FiguresĀ 2 and 3 display comparative biliary tree images of volunteers with choledocholithiasis-induced intrahepatic and extrahepatic biliary dilation at both 3.0 T and 5.0 T.

Table 2 Quantitative image analysis for MRCP imaging at 3.0 T and 5.0 T
Fig. 2
figure 2

Taken from a subject with dilated bile ducts due to common bile duct stones, the MIP image of 5.0 T (A) demonstrates more detail of the bile duct tree (white arrows) than 3.0 T (B). C and D are skeletonized views of the dilated biliary tree at 5.0 T and 3.0 T

Fig. 3
figure 3

A healthy subject. Intrahepatic bile duct branches in the right lobe of the liver are better visualized at 5.0 T (A) than at 3.0 T (B) (white arrow). C and D are skeletonized views of the undilated biliary tree at 5.0 T and 3.0 T, showing that 5.0 T exhibits more branches and a greater maximum branch length compared to 3.0 T

Quantitative assessment of SNR

For the group with bile duct dilation, the SNRs for the 3.0 T and 5.0 T groups were recorded as 77.51 ± 25.68 and 91.24 ± 23.08, respectively. In the healthy group, the SNR values at 3.0 T and 5.0 T were 69.53 ± 30.68 and 80.75 ± 25.11, respectively. The difference in SNR between the two groups was not statistically significant (P > 0.05), as indicated in TableĀ 3.

Table 3 SNR of MRCP imaging at 3.0 T and 5.0 T

Analysis of image artifacts

Subjective evaluations of 3D MRCP pseudobleaching under the two field strengths were conducted, with results presented in TableĀ 4. The assessment showed excellent observer consistency in subjective image observations. There was no significant difference in pseudobleaching scores between the 5.0 T and 3.0 T images (P = 0.053).

Table 4 Score of image artifacts for MRCP imaging at 3.0 T and 5.0 T

Discussion

Enhanced detail resolution in MRCP images offers clearer and more precise visualization of anatomical variations in bile ducts, particularly useful for patients with bile duct calculus [21]. These images provide critical information on the location, size, and number of calculi, aiding in clinical decision-making. In this study, a semi-automated quantitative approach was used to compare bile duct branch visualization in 3.0 T and 5.0 T MRCP images. Cross-validation revealed that 5.0 T MRCP provided superior anatomical detail, especially in cases with bile duct dilation, exhibiting significantly better branch quantity, total length, and maximum length.

The signal intensity of the same tissue exhibits a positive correlation with the B0 field strength, allowing higher field strength MRI to yield images with increased SNR [22]. Previous studies confirm this, showing improved differentiation of choledochal and periductal tissues, as well as overall image quality, when upgrading the MRI device’s B0 field from 1.5 T to 3.0 T [23].

The contrast in MR images at different magnetic field strengths is influenced by variations in the T1 and T2 relaxation times of each organ or tissue. Generally, T1 relaxation times are longer and T2 relaxation times shorter at 5.0 T than at 3.0 T, but this varies across different tissues [24]. While our images showed a tendency for higher SNR at 5.0 T compared to 3.0 T, this disparity was not statistically significant (P > 0.05). This contrasts with a recent 5.0 T MRI study of the pancreas involving 18 healthy volunteers, which showed superior SNR and satisfactory image quality in T2W and diffusion-weighted imaging at 5.0 T compared to 3.0 T [25]. MRCP imaging, based on the long T2 relaxation time of fluid in the biliopancreatic ducts, opts for fast acquisition of relaxation-enhanced sequences for heavy T2W imaging, making it more susceptible to B1-field inhomogeneity than normal abdominal organ imaging [3, 26]. Additionally, B1 field inhomogeneity amplifies image noise [27], reducing liquid signal strength when scanning protocols are optimized for background noise.

Although 5.0 T MRI has shown advantages of high SNR in cranial and cardiovascular imaging compared to 3.0 T [19, 28, 29], further studies in abdominal imaging are necessary to confirm its potential. Zheng L et al. found significantly better image quality of renal veins and arteries with comparable artifact levels in T1-weighted images at 5.0 T compared to 3.0 T, and on T2W images, the image quality was similar for both field strengths, but higher artifact levels were observed at 5.0 T [30]. Scanning protocols for heavy T2W water imaging in 5.0 T MRI systems still require optimization.

With increasing field strength, the Larmor wavelength decreases, leading to noticeable B1 inhomogeneity in larger anatomical regions at 7.0 T [16]. Hence, 5.0 T may have advantages in artifact control over 7.0 T. Despite potential drawbacks associated with ultra-high fields, such as dielectric effects and susceptibility artifacts, this study shows 5.0 T is comparable to 3.0 T in artifact control, enabling whole-body scans at ultra-high fields.

There are several limitations to this study. The primary concern is the small sample size, which might affect the reliability of the results. Future studies with larger cohorts are planned to bolster the findings’ credibility. Additionally, the study focused exclusively on the 3D TSE protocol triggered by respiration, omitting the 3D GRASE imaging during a single breath-hold, equally vital for diagnosing pancreatic and biliary diseases [31]. Furthermore, the use of scanners and phased array coils from different manufacturers could introduce variability. However, this was mitigated by using identical scanning parameters and activating the same number of coil channels for all scans.

Conclusions

In summary, this study demonstrates that 5.0 T MRCP offers improved anatomical detailing of the biliary tree over 3.0 T, while maintaining comparable SNR and image artifact levels. The enhanced detail provided by 5.0T MRCP facilitates clearer visualization of biliary structures, offering a foundation for future studies on its potential in identifying small biliary stones within minor intrahepatic branches.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

MRI:

Magnetic resonance imaging

MRCP:

Magnetic resonance cholangiopancreatography

SNR:

Signal-to-noise ratio

ERCP:

Endoscopic retrograde cholangiopancreatography

RF:

Radio-frequency

3D TSE:

Three dimensional turbo spin echo

3D GRASE:

Three dimensional gradientrecalled and spin echo

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Acknowledgements

Not applicable.

Funding

This study was supported by Outstanding Young Talents Fund of Shandong Provincial Third Hospital (jqrc007). The funding body played no role in the design of the study and collection, analysis, interpretation of data, and in writing the manuscript.

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Authors and Affiliations

Authors

Contributions

All authors contributed to this paper. YL and LZZ: Writing original draft, Data collection, Data analysis. SMY: Data analysis, Visualization. LZC and TBW: MRI scanning, Data collection. YL: Statistical analysis, Conceptualization, Methodology. GJ and YD: Conceptualization, Supervision, Project administration, Writing review and editing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jie Gan.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This prospective study was approved by the Ethics Committee of Shandong Provincial Third Hospital (KYLL-2023064). All participants were informed about the study and provided written informed consent.

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Yin, L., Li, Z., Shang, M. et al. Magnetic resonance cholangiopancreatography at 5.0 T: quantitative and qualitative comparison with 3.0 T. BMC Med Imaging 24, 331 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12880-024-01512-0

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