The authors present their US findings in 24 patients with proved complicated midgut malrotation: volvulus in 18 and occlusive Ladd's bands in 6. All the 24 patients have had US examination prior to surgery. Contrast examinations were performed in only 9 patients, always after US and before surgery. The sonographic "whirlpool" pattern of the superior mesenteric vein and mesentery around the superior mesenteric artery was detected in 15 of the 18 patients with midgut volvulus, and was best seen using Doppler color. Embryological signification of midgut malrotation is discussed.

Percutaneous choledochoscopy can be used routinely, provided that strict techniques are adhered to. This procedure should be reserved for only a small subset of biliary diseases.

The purpose of our study was to perform a prospective comparative analysis of three-dimensional (3D) steady-state free precession (SSFP) and two-dimensional (2D) fast spin-echo (FSE) imaging in the evaluation of 26 patients with suspected bile duct obstruction. SSFP and highly T2-weighted FSE sequences were obtained for each patient in multiple planes. Both sequences were reviewed independently and results were compared with findings from direct cholangiography (n = 17) or from a combination of sonography and CT (n = 9). The extrahepatic bile duct [EHBD] and intrahepatic bile duct [IHBD] were dilated in 32% and 54% of patients, respectively. The EHBDs were visualized in 44% of patients with SSFP, versus in 96% with FSE. One or more IHBD segments were seen in 42% of the SSFP sequences and in 100% of the FSE sequences. A portion of, or the entire, pancreatic duct was seen in 23% of the SSFP sequences and in 65% of the FSE sequences. Our findings lead us to conclude that T2-weighted FSE sequences are superior to SSFP sequences in visualizing the biliary tree and pancreatic duct and that they should replace gradient-echo sequences in MR cholangiopancreatography.

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