Clinical Utility of Respiratory-Triggered 3D Turbo Spin-Echo Sequence with Improved Motion-Sensitized Driven Equilibrium for Magnetic Resonance Cholangiopancreatography: A Prospective Comparative Study

Background: Conventional magnetic resonance cholangiopancreatography (MRCP) is often limited by moderate signal intensity from hepatic vessels, which may obscure visualization of the pancreatobiliary ducts. This study aimed to compare the clinical feasibility and image quality of a respiratory-triggered 3-dimensional (3D) turbo spin-echo sequence combined with improved motion-sensitized driven equilibrium (RT-3D TSE iMSDE) for pancreatobiliary imaging. Methods: This prospective study enrolled 53 patients (19 men and 34 women; mean age, 51.3 ± 15.5 years) with suspected pancreatobiliary disorders between September 2024 and February 2025. All patients underwent both RT-3D TSE iMSDE MRCP and conventional RT-3D TSE MRCP at 3.0 T MRI. Two radiologists independently scored the overall image quality, background suppression, and visibility of 15 pancreaticobiliary segments using a 5-point Likert scale. Qualitative scores and quantitative parameters—signal-to-noise ratio (SNR), contrast ratio (CR), and contrast-to-noise ratio (CNR)—were compared using Wilcoxon signed-rank tests. Interobserver agreement was analyzed using weighted kappa statistics. Wilcoxon signed-rank tests were used for pairwise comparisons, and Kendall's tau-b correlation analysis and the Mann–Whitney U test were applied to evaluate the correlation between age, sex, body mass index (BMI), and subjective image scores. Results: Interobserver agreement was good for all subjective image quality assessments. Compared with conventional RT-3D TSE MRCP, RT-3D TSE iMSDE MRCP sequence demonstrated notably higher scores for overall image quality, background suppression, and visualization of all 15 pancreatobiliary segments (all p <.05). Quantitative analysis revealed significantly higher SNR, CR, and CNR values for the iMSDE sequence: SNR: 22.77 vs. 16.39; CR: 0.95 vs. 0.91; CNR: 29.47 vs. 19.95 (all p <.05). No significant correlations were observed between age, sex, or BMI and overall MRCP image quality scores in either group (all p > .05). Conclusion: RT-3D TSE iMSDE MRCP improves duct-to-background contrast through vascular signal suppression, enabling clearer delineation of pancreatobiliary anatomy than conventional MRCP and enhancing diagnostic confidence. Trial registration: Clinical trial number: not applicable.