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1
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Vascular evaluation using transabdominal ultrasound for gallbladder polyps. J Med Ultrason (2001) 2020; 48:159-173. [DOI: 10.1007/s10396-020-01008-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/21/2020] [Indexed: 12/17/2022]
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Kubo N, Shirabe K. Treatment strategy for isolated bile leakage after hepatectomy: Literature review. Ann Gastroenterol Surg 2020; 4:47-55. [PMID: 32021958 PMCID: PMC6992677 DOI: 10.1002/ags3.12303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/23/2019] [Accepted: 11/08/2019] [Indexed: 12/26/2022] Open
Abstract
Isolated bile leakage (IBL) after hepatectomy is intractable, and various treatment methods for it have been reported. This review aimed to clarify the treatment strategy for IBL by summarizing studies on IBL after hepatectomy without extrahepatic bile duct resection. Thirty-three cases of IBL were reported. The incidence of IBL is very low, accounting for 0.1%-1% of all hepatectomy cases. The risk factors for IBL are unclear; however, several reports mention that biliary anomaly is associated with a high risk of IBL, with preoperative and intraoperative confirmation of biliary tree anatomy being the most important preventive strategy. Treatment methods for IBL include liver resection, bilioenteric anastomosis, endoscopic treatment, bile duct ablation, percutaneous transhepatic portal vein embolization (PTPE), transcatheter arterial embolization, and use of fibrin glue. The therapeutic methods should be chosen depending on remnant liver function, amount of bile leakage, and the liver volume causing the bile leakage. When there is bile leakage from less than one segment, non-surgical treatment is recommended, whereas when there is bile leakage from one or more segments, surgical treatment can be recommended. Nevertheless, recently, non-surgical treatment such as PTPE, PTPE with bile duct ablation, and endoscopic methods have been considered as effective treatment approaches.
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Affiliation(s)
- Norio Kubo
- Department of Hepatobiliary and Pancreatic SurgeryGunma University Graduate School of MedicineMaebashiJapan
| | - Ken Shirabe
- Department of Hepatobiliary and Pancreatic SurgeryGunma University Graduate School of MedicineMaebashiJapan
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3
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Gadoxetate Disodium-Enhanced MR Cholangiography for Evaluation of Biliary-Enteric Anastomoses: Added Value Beyond Conventional T2-Weighted Images. AJR Am J Roentgenol 2019; 213:W123-W133. [PMID: 31063422 DOI: 10.2214/ajr.18.20626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The objective of our study was to evaluate image quality and reader confidence in MR cholangiography of bile ducts using conventional T2-weighted MR cholangiography alone in comparison with T2-weighted MR cholangiography and gadoxetate disodium-enhanced MR cholangiography in a series of patients with biliary-enteric anastomosis (BEA). SUBJECTS AND METHODS. Fifty patients with BEA and clinically and sonographically suspected complications underwent 1.5-T MRI. After acquisition of T1- and T2-weighted images, conventional MR cholangiography was performed using 3D fast relaxation fast spin-echo (FRFSE) and single-shot fast spin-echo (SSFSE) T2-weighted sequences (image set 1). In each patient, a 3D fat-suppressed Liver Acquisition with Volume Acceleration (LAVA) sequence was performed before and 15, 20, 25, 30, and 40 minutes after IV administration of 0.1 mL/kg of gadoxetate disodium (Primovist) (image set 2). Two radiologists in consensus evaluated image quality in the anatomic segments of the biliary tract and recorded diagnostic confidence scores for image set 1 alone and image sets 1 and 2 together. MRI findings were compared with postsurgical specimen if surgery was performed, conventional cholangiography, or 12 months of imaging follow-up. RESULTS. A significant improvement in image quality for visualization of all biliary segments was found using gadoxetate disodium-enhanced MR cholangiography in comparison with T2-weighted MR cholangiography alone. Readers judged diagnostic confidence of image set 1 alone and image sets 1 and 2 together as very confident in three and 37 cases, confident in 30 and 11, not confident in 14 and one, and not confident at all in three and 1, respectively. Concordance between image set 1 alone and image sets 1 and 2 together and the reference standard results was present in 23 of 50 cases (46%) and 47 of 50 cases (94%), respectively (p < 0.0001). CONCLUSION. Gadoxetate disodium-enhanced MR cholangiography can improve image quality for visualization of the biliary tract and further enhanced the diagnostic performance of conventional T2-weighted MR cholangiography in the evaluation of patients with BEA.
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Schizas D, Papaconstantinou D, Moris D, Koliakos N, Tsilimigras DI, Bakopoulos A, Karaolanis G, Spartalis E, Dimitroulis D, Felekouras E. Management of Segmental Bile Duct Injuries After Cholecystectomy: a Systematic Review. J Gastrointest Surg 2019; 23:408-416. [PMID: 30402723 DOI: 10.1007/s11605-018-4027-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/22/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Injuries to segmental or aberrant bile ducts are encountered less commonly than their major bile duct counterparts and present a unique diagnostic and therapeutic challenge, since the nature of this injury involves a transected bile duct that loses its communication with the main ductal system. In this systematic review, we aim to pool available data on this particular type of biliary injury in an effort to outline available diagnostic and therapeutic modalities and evaluate their efficacy. MATERIALS AND METHODS An extensive literature search was performed on MEDLINE, Scopus, and Web of Science to identify isolated segmental or aberrant bile duct injuries. RESULTS A total of 21 studies were included in this systematic report. Ten studies reported non-operative management of patients, while 12 reported operative management of included patients. Outcomes of interest were the choice of treatment interventions and their success. Overall, 23 patients were managed non-operatively with a 91% success rate and 30 patients were managed operatively with a 90% success rate. CONCLUSION Non-operative management might be a viable alternative to surgery. Hepatobiliary surgeons should be encouraged to publish their results in treating these rare injuries to further elucidate the role and efficacy of such an approach.
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Affiliation(s)
- Dimitrios Schizas
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Papaconstantinou
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Moris
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Nikolaos Koliakos
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Diamantis I Tsilimigras
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anargyros Bakopoulos
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Karaolanis
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Spartalis
- 2nd Propedeutic Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Dimitroulis
- 2nd Propedeutic Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Felekouras
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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5
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Updates in hepatic oncology imaging. Surg Oncol 2017; 26:195-206. [DOI: 10.1016/j.suronc.2017.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/06/2017] [Accepted: 03/08/2017] [Indexed: 12/17/2022]
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Kul M, Erden A, Düşünceli Atman E. Diagnostic value of Gd-EOB-DTPA-enhanced MR cholangiography in non-invasive detection of postoperative bile leakage. Br J Radiol 2017; 90:20160847. [PMID: 28181823 DOI: 10.1259/bjr.20160847] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To assess the diagnostic value of dynamic T1 weighted (T1w) gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA)-enhanced MR cholangiography (MRC) for the detection of active bile leaks. METHODS A total of 28 patients with suspected biliary leakage who underwent routine T2 weighted (T2w) MRC and T1w GD-EOB-DTPA-enhanced MRC at our institution from February 2013 to June 2016 were included in this study. The image sets were retrospectively analyzed in consensus by three radiologists. T1w Gd-EOB-DTPA-enhanced MRC findings were correlated with clinical data, follow-up examinations and findings of invasive/surgical procedures. Patients with positive bile leak findings in Gd-EOB-DTPA-enhanced MRC were divided into hepatobiliary phase (HBP) (20-30 min) and delayed phase (DP) (60-390 min) group according to elapsed time between Gd-EOB-DTPA injection and initial bile leak findings in MRC images. These groups were compared in terms of laboratory test results (total bilirubin, liver enzymes) and the presence of bile duct dilatation in T2w MRC images. RESULTS In each patient, visualization of bile ducts was sufficient in the HBP. The accuracy, sensitivity and specificity of dynamic Gd-EOB-DTPA-enhanced T1w MRC in the detection of biliary leaks were 92.9%, 90.5% and 100%, respectively (p < 0.001). 19 of 28 patients had bile leak findings in T1w Gd-EOB-DTPA-enhanced MRC [HBP group: N = 7 (36.8%), DP group: N = 12 (63.2%)]. There was no statistically significant difference in terms of laboratory test results and the presence of bile duct dilatation between HBP and DP group (p > 0.05). Three patients, each of them in DP group, showed normal laboratory test results and bile duct diameters. CONCLUSION Dynamic T1w Gd-EOB-DTPA-enhanced MRC is a useful non-invasive diagnostic tool to detect bile leak. Advances in knowledge: Prolonged DP imaging may be required for bile leak detection even if visualization of biliary tree is sufficient in HBP and liver function tests, total bilirubin levels and bile duct diameters are normal.
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Affiliation(s)
- Melahat Kul
- Department of Radiology, Ibni Sina Hospital, Ankara University Medical Faculty, Ankara, Turkey
| | - Ayşe Erden
- Department of Radiology, Ibni Sina Hospital, Ankara University Medical Faculty, Ankara, Turkey
| | - Ebru Düşünceli Atman
- Department of Radiology, Ibni Sina Hospital, Ankara University Medical Faculty, Ankara, Turkey
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Lewis S, Vasudevan P, Chatterji M, Besa C, Jajamovich G, Facciuto M, Taouli B. Comparison of gadoxetic acid to gadobenate dimeglumine for assessment of biliary anatomy of potential liver donors. Abdom Radiol (NY) 2016; 41:1300-9. [PMID: 26960727 DOI: 10.1007/s00261-016-0693-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To compare MRI using gadobenate dimeglumine (Gd-BOPTA) vs. gadoxetic acid disodium (Gd-EOB-DTPA) for the assessment of biliary anatomy of potential liver donors. METHODS 76 potential liver donors (39 M/37 F, mean 38 years) who underwent 1.5T MRI using Gd-BOPTA (n = 37) or Gd-EOB-DTPA (n = 39) were retrospectively evaluated. T2 cholangiogram (T2 MRC) and delayed hepatobiliary phase (HBP) T1 cholangiogram (T1 MRC) (performed during HBP 20 min after injection of Gd-EOB-DTPA and 1-2 h after Gd-BOPTA injection) were obtained in addition to MR angiogram/venogram. Two independent observers evaluated image quality (IQ) and conspicuity scores (CS) of the biliary system. Biliary anatomy was assessed in 3 reading sessions (T2 MRC, T1 MRC, and combined T2/T1 MRC). Reference standard consisted of consensus reading of two separate observers of all image sets, clinical/surgical information and intraoperative cholangiogram when available. Datasets were compared using the Mann-Whitney U test or Chi-squared test. RESULTS There was no difference in IQ for T1 MRC using either contrast agent or T2 MRC vs. T1 MRC for both observers (all p values >0.07). There was superior CS for T2 MRC vs. Gd-BOPTA T1 MRC for both observers and T2 MRC vs. Gd-EOB for one observer (p < 0.001). No difference was found for biliary variant detection for T1 MRC (with either contrast agent) vs. T2 MRC. Combined T2/T1 MRC demonstrated improved sensitivity for biliary variant detection using Gd-BOPTA for both observers (p < 0.004) and Gd-EOB-DTPA for one observer (p < 0.001). CONCLUSION Equivalent image quality was found for T1 MRC obtained with Gd-BOPTA or Gd-EOB-DTPA and T2 MRC. T1 MRC is equivalent to T2 MRC for detection of variant biliary anatomy, and the combination of sequences may have added value.
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Affiliation(s)
- Sara Lewis
- Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA.
| | - Prasanna Vasudevan
- Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Manjil Chatterji
- Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Cecilia Besa
- Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Guido Jajamovich
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Marcelo Facciuto
- Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Bachir Taouli
- Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
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Di Martino M, Rossi M, Mennini G, Melandro F, Anzidei M, De Vizio S, Koryukova K, Catalano C. Imaging follow-up after liver transplantation. Br J Radiol 2016; 89:20151025. [PMID: 27188846 DOI: 10.1259/bjr.20151025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Liver transplantation (LT) represents the best treatment for end-stage chronic liver disease, acute liver failure and early stages of hepatocellular carcinoma. Radiologists should be aware of surgical techniques to distinguish a normal appearance from pathological findings. Imaging modalities, such as ultrasound, CT and MR, provide for rapid and reliable detection of vascular and biliary complications after LT. The role of imaging in the evaluation of rejection and primary graft dysfunction is less defined. This article illustrates the main surgical anastomoses during LT, the normal appearance and complications of the liver parenchyma and vascular and biliary structures.
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Affiliation(s)
- Michele Di Martino
- 1 Department of Radiological Sciences, Oncology and Anatomical Pathology, University of Rome "Sapienza", Rome, Italy
| | - Massimo Rossi
- 2 Department of General Surgery, Division of Organ Transplantation, University of Rome "Sapienza", Rome, Italy
| | - Gianluca Mennini
- 2 Department of General Surgery, Division of Organ Transplantation, University of Rome "Sapienza", Rome, Italy
| | - Fabio Melandro
- 2 Department of General Surgery, Division of Organ Transplantation, University of Rome "Sapienza", Rome, Italy
| | - Michele Anzidei
- 1 Department of Radiological Sciences, Oncology and Anatomical Pathology, University of Rome "Sapienza", Rome, Italy
| | - Silvia De Vizio
- 1 Department of Radiological Sciences, Oncology and Anatomical Pathology, University of Rome "Sapienza", Rome, Italy
| | - Kameliya Koryukova
- 1 Department of Radiological Sciences, Oncology and Anatomical Pathology, University of Rome "Sapienza", Rome, Italy
| | - Carlo Catalano
- 1 Department of Radiological Sciences, Oncology and Anatomical Pathology, University of Rome "Sapienza", Rome, Italy
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Boraschi P, Donati F, Gigoni R, Filipponi F. Biliary complications following orthotopic liver transplantation: May contrast-enhanced MR Cholangiography provide additional information? Eur J Radiol Open 2016; 3:108-16. [PMID: 27331082 PMCID: PMC4906040 DOI: 10.1016/j.ejro.2016.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/07/2016] [Accepted: 05/07/2016] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To assess whether contrast-enhanced T1-weighted MR Cholangiography may provide additional information in the evaluation of biliary complications in orthotopic liver transplant recipients. MATERIAL AND METHODS Eighty liver transplant patients with suspicion of biliary adverse events underwent MR imaging at 1.5 T scanner. After acquisition of axial T1-/T2-weighted images and conventional T2-weighted MR Cholangiography (image set 1), 3D gradient-echo T1-weighted fat-suppressed LAVA (Liver Acquisition with Volume Acceleration) sequences were obtained about 30 min after intravenous infusion of mangafodipir trisodium (Mn-DPDP,Teslascan(®)) (image set 2). The diagnostic value of mangafodipir trisodium-enhanced MR Cholangiography in the detection of biliary complications was tested by separate analysis results of image set 1 alone and image set 1 and 2 together. MRI results were correlated with direct cholangiography in 46 patients, surgery in 14 and/or clinical-radiological follow-up in the remaining 20 cases. RESULTS The level of confidence in the assessment of biliary adverse events was significantly increased by the administration of mangafodipir trisodium (p < 0.05). Particularly, contrast-enhanced T1-weighted LAVA sequences tended to out-perform conventional T2-weighted MR Cholangiography in the delineation of anastomotic and non-anastomotic biliary strictures and in the diagnosis of biliary leak. CONCLUSIONS Contrast-enhanced T1-weighted MR Cholangiography may improve the level of diagnostic confidence provided by conventional T2-weighted MR Cholangiography in the evaluation of biliary complications after orthotopic liver transplantation.
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Affiliation(s)
- Piero Boraschi
- 2nd Unit of Radiology, Department of Diagnostic Radiology, Vascular and Interventional Radiology, and Nuclear Medicine-Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Francescamaria Donati
- 2nd Unit of Radiology, Department of Diagnostic Radiology, Vascular and Interventional Radiology, and Nuclear Medicine-Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Roberto Gigoni
- 2nd Unit of Radiology, Department of Diagnostic Radiology, Vascular and Interventional Radiology, and Nuclear Medicine-Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Franco Filipponi
- Hepatobiliary Surgery and Liver Transplantation-Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
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10
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Montini KM, Tulchinsky M. Applied hepatobiliary scintigraphy in acute cholecystitis. APPLIED RADIOLOGY 2015:21-30. [DOI: 10.37549/ar2183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Affiliation(s)
| | - Mark Tulchinsky
- Pennsylvania State University, The Milton S. Hershey Medical Center
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11
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Abstract
Evaluation of acute abdominal and pelvic pain in pregnancy presents a diagnostic challenge for clinicians and radiologists alike. The differential diagnosis includes obstetric and nonobstetric conditions unique to pregnancy, in addition to causes of acute abdominal and pelvic pain unrelated to the pregnancy. The clinical presentation and course of disease may be altered in pregnancy, and several pathologies are exacerbated by pregnancy. Discriminating clinical features in the diagnosis of abdominal and pelvic pain are often confounded by expected anatomic and physiologic changes in pregnancy. Moreover, while diagnostic pathways may be altered in pregnancy, the necessity for a timely and accurate diagnosis must be underscored, as delay in treatment may result in an undesirable increase in morbidity and/or mortality for both the patient and fetus. Advances in magnetic resonance imaging (MRI) through faster acquisition and motion-insensitive techniques, coupled with increased awareness and education regarding the value of MRI in diagnosing a wide range of pathology, have established MRI as a valuable strategy in the investigation of acute abdominal and pelvic pain in the pregnant patient. This review presents a practical approach to common obstetric and nonobstetric causes of acute abdominal and pelvic pain during pregnancy, as well as safety considerations for performing MRI in this patient population.
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12
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Boraschi P, Donati F. Postoperative biliary adverse events following orthotopic liver transplantation: Assessment with magnetic resonance cholangiography. World J Gastroenterol 2014; 20:11080-11094. [PMID: 25170197 PMCID: PMC4145751 DOI: 10.3748/wjg.v20.i32.11080] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 03/24/2014] [Accepted: 05/26/2014] [Indexed: 02/06/2023] Open
Abstract
Biliary adverse events following orthotopic liver transplantation (OLT) are relatively common and continue to be serious causes of morbidity, mortality, and transplant dysfunction or failure. The development of these adverse events is heavily influenced by the type of anastomosis during surgery. The low specificity of clinical and biologic findings makes the diagnosis challenging. Moreover, direct cholangiographic procedures such as endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography present an inadmissible rate of adverse events to be utilized in clinically low suspected patients. Magnetic resonance (MR) maging with MR cholangiopancreatography is crucial in assessing abnormalities in the biliary system after liver surgery, including liver transplant. MR cholangiopancreatography is a safe, rapid, non-invasive, and effective diagnostic procedure for the evaluation of biliary adverse events after liver transplantation, since it plays an increasingly important role in the diagnosis and management of these events. On the basis of a recent systematic review of the literature the summary estimates of sensitivity and specificity of MR cholangiopancreatography for diagnosis of biliary adverse events following OLT were 0.95 and 0.92, respectively. It can provide a non-invasive method of imaging surgical reconstruction of the biliary anastomoses as well as adverse events including anastomotic and non-anastomotic strictures, biliary lithiasis and sphincter of Oddi dysfunction in liver transplant recipients. Nevertheless, conventional T2-weighted MR cholangiography can be implemented with T1-weighted contrast-enhanced MR cholangiography using hepatobiliary contrast agents (in particular using Gd-EOB-DTPA) in order to improve the diagnostic accuracy in the adverse events’ detection such as bile leakage and strictures, especially in selected patients with biliary-enteric anastomosis.
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Girometti R, Cereser L, Bazzocchi M, Zuiani C. Magnetic resonance cholangiography in the assessment and management of biliary complications after OLT. World J Radiol 2014; 6:424-436. [PMID: 25071883 PMCID: PMC4109094 DOI: 10.4329/wjr.v6.i7.424] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/05/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Despite advances in patient and graft management, biliary complications (BC) still represent a challenge both in the early and delayed period after orthotopic liver transplantation (OLT). Because of unspecific clinical presentation, imaging is often mandatory in order to diagnose BC. Among imaging modalities, magnetic resonance cholangiography (MRC) has gained widespread acceptance as a tool to represent the reconstructed biliary tree noninvasively, using both the conventional technique (based on heavily T2-weighted sequences) and contrast-enhanced MRC (based on the acquisition of T1-weighted sequences after the administration of hepatobiliary contrast agents). On this basis, MRC is generally indicated to: (1) avoid unnecessary procedures of direct cholangiography in patients with a negative examination and/or identify alternative complications; and (2) provide a road map for interventional procedures or surgery. As illustrated in the review, MRC is accurate in the diagnosis of different types of biliary complications, including anastomotic strictures, non-anastomotic strictures, leakage and stones.
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14
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Boraschi P, Donati F. Biliary-enteric anastomoses: spectrum of findings on Gd-EOB-DTPA-enhanced MR cholangiography. ACTA ACUST UNITED AC 2014; 38:1351-9. [PMID: 23820693 DOI: 10.1007/s00261-013-0007-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Biliary-enteric anastomosis is a common surgical procedure performed for the management of a variety of benign and malignant diseases. This procedure presents a high risk of developing complications such as anastomotic leak, hemorrhage, cholangitis, stones, stricture formation, that have been reported as ranging from 3 % to 43 %. Because the endoscopic approach of the biliary tract is generally precluded in this setting, there is clearly a role for a non-invasive imaging technique to follow up these patients and to detect the possible complications. T2-weighted MR cholangiography has been shown to be effective in the evaluation of patients with biliary-enteric anastomosis. Some of these patients may have mild duct dilatation in spite of a patent anastomosis, and stenosis should be considered only when duct dilatation is associated with narrowing of the anastomotic site. T2-weighted MRC depicts the site of biliary-enteric anastomosis, the cause of obstruction, and the status of the biliary ducts upstream. However, the disadvantages of conventional MRC are that it lacks functional information and so, differentiation between obstructive and non-obstructive dilatation of the bile ducts is often extremely difficult. T1-weighted contrast-enhanced MR cholangiography using Gd-EOB-DTPA is a recently emerging technique that is useful for delineating the anatomy of biliary-enteric anastomoses and detecting complications such as strictures, intraductal stones, and biliary leaks; besides, this technique can provide functional information that are extremely promising in the grading of biliary obstruction. We present the spectrum of findings of biliary-enteric anastomoses on Gd-EOB-DTPA-enhanced MR cholangiography focusing on the main clinical applications.
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Affiliation(s)
- Piero Boraschi
- 2nd Unit of Radiology, Department of Diagnostic Radiology, Vascular and Interventional Radiology, and Nuclear Medicine, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy,
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15
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Ogul H, Kantarci M, Pirimoglu B, Karaca L, Aydinli B, Okur A, Ozturk G, Kizrak Y. The efficiency of Gd-EOB-DTPA-enhanced magnetic resonance cholangiography in living donor liver transplantation: a preliminary study. Clin Transplant 2014; 28:354-60. [PMID: 24506817 DOI: 10.1111/ctr.12320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 01/13/2023]
Abstract
The aim of this study was to evaluate utility of gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance cholangiography (MRC) for the detection of biliary complications after living donor liver transplantation (LDLT). A total of 18 patients with suspected biliary complications underwent MRC. T2-weighted MRC and contrast-enhanced MRC (CE-MRC) were used to identify the biliary complications. MRC included routine breath-hold T2-weighted MRC using half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences and Gd-EOB-DTPA-enhanced MRC T1-weighted volumetric interpolated breath-hold examination (VIBE) sequences. Before confirming the biliary complications, one observer reviewed the MRC images and the CE-MRC images separately. The verification procedures and MRC findings were compared, and the sensitivity, specificity, and accuracy of both techniques were calculated for the identification of biliary complications. The observer found six of seven biliary complications using CE-MRC. The sensitivity was 85.7% and the accuracy was 94.4%. Using MRC alone, sensitivity was 57.1% and accuracy was 55.5%. The accuracy of Gd-EOB-DTPA-enhanced MRC was superior to MRC in locating biliary leaks (p < 0.05). The usage of Gd-EOB-DTPA-enhanced MRC yields information that complements the MRC findings that improve the identification of biliary complications. We recommend the use of MRC in addition to Gd-EOB-DTPA-enhanced MRC to increase the preoperative accuracy when assessing the biliary complications after LDLT.
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Affiliation(s)
- Hayri Ogul
- Department of Radiology, School of Medicine, Atatürk University, Erzurum, Turkey
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Can biliary–cyst communication be predicted by Gd-EOB-DTPA-enhanced MR cholangiography before treatment for hepatic hydatid disease? Clin Radiol 2014; 69:52-8. [PMID: 24156798 DOI: 10.1016/j.crad.2013.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 07/31/2013] [Accepted: 08/07/2013] [Indexed: 01/07/2023]
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Karam AR, Kim YH, Corwin MT. Gadoxetate disodium-enhanced liver MRI: gallbladder opacification patterns during hepatobiliary phase. Clin Imaging 2013; 38:42-9. [PMID: 24139834 DOI: 10.1016/j.clinimag.2013.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 08/14/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE(S) To describe the different patterns of gallbladder lumen opacification on gadoxetate disodium-enhanced liver magnetic resonance imaging (MRI). METHODS One hundred eighty-seven MRI examinations were reviewed by two abdominal imaging radiologists who described the different patterns of gallbladder opacification, based on comparing the post-contrast to the pre-contrast images. RESULTS Four patterns of gallbladder opacification were identified, all based on the anti-dependent distribution of the excreted biliary contrast inside the gallbladder lumen. Contrast was identified at the level of the gallbladder neck, anti-dependant wall, and gallbladder fundus. One gallbladder completely filled with contrast. CONCLUSION(S) The opacification of the gallbladder lumen follows a distinctive anti-dependent distribution.
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Affiliation(s)
- Adib R Karam
- University of Massachusetts Medical School, Radiology Department, 55 Lake Avenue North, Worcester, MA01655.
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MRI assessment of biliary ductal obstruction: is there added value of T1-weighted gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced MR cholangiography? AJR Am J Roentgenol 2013; 201:W49-56. [PMID: 23789696 DOI: 10.2214/ajr.12.9332] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The goal of the present study was to determine the added value of gadolium-ethoxybenzyl-diethylenetriamine pentaacetic acid (gadoxetate disodium)-enhanced magnetic resonance cholangiography (MRC) to standard liver MRI including T2-weighted MRCP in assessment of biliary ductal obstruction. MATERIALS AND METHODS Thirty-eight patients (mean age, 48.1 ± 16.7 years) (40 total examinations) who underwent liver MRI (including T2-weighted MRCP and gadoxetate disodium-enhanced MRC) for suspicion of biliary disease were included in this institutional review board-approved, HIPAA-compliant retrospective study. Three blinded radiologists first evaluated MR images without gadoxetate disodium-enhanced MRC for presence and significance of biliary obstruction, underlying cause for obstruction, and confidence in final diagnosis. After inclusion of gadoxetate disodium-enhanced MRC, readers again determined presence and significance of biliary obstruction and confidence in final diagnosis. Reference standard was established using MRI along with ERCP, percutaneous transhepatic cholangiography, intraoperative cholangiography, or a combination thereof. RESULTS Overall sensitivity across all readers in diagnosing significance of obstruction was 60% without gadoxetate disodium-enhanced MRC and 91% with gadoxetate disodium- enhanced MRC (p < 0.001). Across all readers, assessment of significance of obstruction was changed when adding gadoxetate disodium-enhanced MRC in 40 of 120 cases (33%); significance of obstruction was correctly changed in 35 of 40 cases (87.5%). Biliary obstruction was graded of unknown significance in 27 of 120 cases (22.5%) across all readers when gadoxetate disodium-enhanced MRC was not reviewed. Significance of biliary obstruction was classified correctly after adding gadoxetate disodium-enhanced MRC in 25 of these 27 cases (93%). Confidence in final diagnosis was significantly higher with addition of gadoxetate di-sodium-enhanced MRC for two of three readers (p < 0.003). CONCLUSION Addition of gadoxetate disodium-enhanced MRC to liver MRI significantly improves sensitivity in assessing significance of biliary obstruction and can improve reader confidence in establishing a final diagnosis. This added information could have a substantial impact in the determination of the most appropriate therapeutic options.
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Burke C, Alexander Grant L, Goh V, Griffin N. The role of hepatocyte-specific contrast agents in hepatobiliary magnetic resonance imaging. Semin Ultrasound CT MR 2013; 34:44-53. [PMID: 23395317 DOI: 10.1053/j.sult.2012.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hepatocyte-specific contrast agents have been made available in the last 15 years for magnetic resonance imaging of the liver. These agents are differentially taken up by functioning hepatocytes and excreted in the biliary system. They can help distinguish focal liver lesions of hepatocellular origin from lesions of nonhepatocellular origin, and can also be used in the evaluation of the biliary tree. The purpose of this review is to summarize the different types of hepatocyte-specific contrast agents presently available, their use in the characterization of focal liver lesions, their role in the evaluation of biliary pathology, and their potential future applications.
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Affiliation(s)
- Chistopher Burke
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, UK
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Kantarcı M, Pirimoglu B, Karabulut N, Bayraktutan U, Ogul H, Ozturk G, Aydinli B, Kizrak Y, Eren S, Yilmaz S. Non-invasive detection of biliary leaks using Gd-EOB-DTPA-enhanced MR cholangiography: comparison with T2-weighted MR cholangiography. Eur Radiol 2013; 23:2713-22. [PMID: 23695221 PMCID: PMC3769590 DOI: 10.1007/s00330-013-2880-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/20/2013] [Accepted: 03/24/2013] [Indexed: 02/07/2023]
Abstract
Objective To evaluate the added role of T1-weighted (T1w) gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance cholangiography (MRC) compared with T2-weighted MRC (T2w-MRC) in the detection of biliary leaks. Methods Ninety-nine patients with suspected biliary complications underwent routine T2w-MRC and T1w contrast-enhanced (CE) MRC using Gd-EOB-DTPA to identify biliary leaks. Two observers reviewed the image sets separately and together. MRC findings were compared with those of surgery and percutaneous transhepatic cholangiopancreatography. The sensitivity, specificity and accuracy of the techniques in identifying biliary leaks were calculated. Results Accuracy of locating biliary leaks was superior with the combination of Gd-EOB-DTPA-enhanced MRC and T2w-MRC (P < 0.05).The mean sensitivities were 79 % vs 59 %, and the mean accuracy rates were 84 % vs 58 % for combined CE-MRC and T2w-MRC vs sole T2w-MRC. Nineteen out of 21 patients with biliary-cyst communication, 90.4 %, and 12/15 patients with post-traumatic biliary extravasations, 80 %, were detected by the combination of Gd-EOB-DTPA-enhanced MRC and T2w-MRC images, P < 0.05. Conclusions Gd-EOB-DTPA-enhanced MRC yields information that complements T2w-MRC findings and improves the identification and localisation of the bile extravasations (84 % accuracy, 100 % specificity, P < 0.05). We recommend Gd-EOB-DTPA-enhanced MRC in addition to T2w-MRC to increase the preoperative accuracy of identifying and locating extravasations of bile. Key Points • Magnetic resonance cholangiography (MRC) does not always detect bile leakage and cysto-biliary communications. • Gd-EOB-DTPA-enhanced MRC helps by demonstrating extravasation of contrast material into fluid collections. • Gd-EOB-DTPA-enhanced MRC also demonstrates the leakage site and bile duct injury type. • Combined Gd-EOB-DTPA-enhanced and T2w-MRC can provide comprehensive information about biliary system. • Gd-EOB-DTPA-enhanced MRC is non-invasive and does not use ionising radiation.
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Affiliation(s)
- Mecit Kantarcı
- School of Medicine, Department of Radiology, Atatürk University, Erzurum, Turkey,
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Gupta RT. Evaluation of the Biliary Tree and Gallbladder With Hepatocellular MR Contrast Agents. Curr Probl Diagn Radiol 2013; 42:67-76. [DOI: 10.1067/j.cpradiol.2012.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Krishnan P, Gupta RT, Boll DT, Brady CM, Husarik DB, Merkle EM. Functional evaluation of cystic duct patency with Gd-EOB-DTPA MR imaging: an alternative to hepatobiliary scintigraphy for diagnosis of acute cholecystitis? ACTA ACUST UNITED AC 2012; 37:457-64. [PMID: 21870116 DOI: 10.1007/s00261-011-9785-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine if MR cholangiography with Gd-EOB-DTPA can be used to assess cystic duct patency and to establish normal time range for reflux of contrast material into the cystic duct/gallbladder. MATERIALS AND METHODS This retrospective study is HIPAA-compliant and IRB-approved with waiver for informed consent granted. From September 2008 to June 2009, 300 patients who underwent Gd-EOB-DTPA-enhanced MR imaging for various clinical indications, not specifically limited to evaluation for acute cholecystitis, were identified. 112 patients were excluded: prior cholecystectomy (n = 93), severe technical limitations (n = 9), or absence of appropriate clinical follow-up (n = 10). 188 total patients (82 male, 106 female, mean age 51.0 years) were included in the final dataset. Time between contrast administration and contrast reflux into the cystic duct/gallbladder on delayed phase imaging was measured. RESULTS Reflux of contrast into the gallbladder was identified in 130/188 patients (69.1%) on delayed phase imaging. Average time to gallbladder reflux was 15:24 ± 5:51 minutes (range: 6:01-41:05 min). 58/188 patients (30.9%) demonstrated no reflux of contrast into the gallbladder at time of final delayed phase images. Of 58 patients who demonstrated no reflux into cystic duct/gallbladder, 15 patients demonstrated no extrahepatic biliary excretion, limiting evaluation of cystic duct patency. A total of 173 patients demonstrated biliary excretion of contrast with 76% overall sensitivity of detection of cystic duct patency. CONCLUSION MR cholangiography with hepatobiliary MR contrast agents such as Gd-EOB-DTPA can demonstrate cystic duct patency with high sensitivity. MR protocols can be designed within a clinically feasible timeframe to optimize diagnosis of acute cholecystitis.
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Affiliation(s)
- Pranay Krishnan
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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Corwin MT, Lamba R, McGahan JP. Functional MR cholangiography of the cystic duct and sphincter of Oddi using gadoxetate disodium: is a 30-minute delay long enough? J Magn Reson Imaging 2012; 37:993-8. [PMID: 23001618 DOI: 10.1002/jmri.23816] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 08/09/2012] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To determine if excreted contrast is consistently visualized in the gallbladder and duodenum after a 30-minute delay using gadoxetate disodium-enhanced MRI in patients without hepatobiliary disease. MATERIALS AND METHODS Twenty-two patients without evidence of liver or biliary disease underwent gadoxetate disodium-enhanced magnetic resonance imaging (MRI) from February 17, 2009 through October 3, 2011. The mean age was 45 years (range 25-72). T1-weighted hepatobiliary phase images at 5, 10, 20, and 30 minutes after contrast injection were reviewed in consensus by two radiologists to determine the delay at which enhancement of the gallbladder and duodenum first occurred. RESULTS Thirteen of 22 (59.1%) patients demonstrated duodenal filling by 20 minutes and 16/22 (72.7%) filled by 30 minutes. The mean time to duodenal enhancement was 19.9 minutes (range 11.4-30.2 min). Seventeen of 22 (77.3%) patients demonstrated gallbladder filling by 20 minutes and 21/22 (95.5%) filled by 30 minutes. The mean time to gallbladder enhancement was 16.5 minutes (range 4.4-30.2 min). CONCLUSION A significant number of normal patients do not show duodenal filling by 30 minutes, while the majority fill the gallbladder by 30 minutes using functional MR cholangiography (fMRC) with gadoxetate disodium. These findings will guide fMRC protocol design for patients with suspected acute cholecystitis and sphincter of Oddi dysfunction.
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Affiliation(s)
- Michael T Corwin
- University of California, Davis Medical Center, Department of Radiology, Sacramento, California 95817, USA.
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Abstract
Hepatobiliary scintigraphy is a mature imaging technique for evaluation of patients with acute cholecystitis (AC). It is effective in calculous and acalculous forms of AC. The test is used in contemporary medical practice as the arbiter when the findings from screening abdominal ultrasound do not fit a clinical picture. It is also performed in severely ill patients who have AC suspected on other testing, but whose frail condition and high operative risk demand the highest level of certainty. This review, therefore, examines all technique variations of hepatobiliary scintigraphy, offering an approach that may best fit a variety of clinical situations and philosophies on AC.
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Affiliation(s)
- Mark Tulchinsky
- Division of Nuclear Medicine, Department of Radiology, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, PA 17033, USA.
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Bae K, Na JB, Choi DS, Cho JM, Choi HC, Jeon KN, Park MJ, Choi HY, Kim JE, Chung SH. Contrast-enhanced MR cholangiography: comparison of Gd-EOB-DTPA and Mn-DPDP in healthy volunteers. Br J Radiol 2012; 85:1250-4. [PMID: 22553292 DOI: 10.1259/bjr/22238911] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare the biliary enhancement dynamics of gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic-acid (Gd-EOB-DTPA) and mangafodipir trisodium (Mn-DPDP) for contrast-enhanced MR cholangiography (MRC) in healthy subjects. METHODS 15 healthy volunteers underwent MRI at 1.5 T with volumetric interpolated breath-hold examination sequence. Each volunteer was scanned once for each contrast agent. The signal-to-noise ratio (SNR) of the liver parenchyma and common hepatic duct (CHD) and the contrast-to-noise ratio (CNR) of CHD to liver parenchyma were evaluated and compared before and at several time points (5, 15, 30, 45, 60, 90, and 120 min) after injection of each agent. RESULTS SNR was significantly higher for Gd-EOB-DTPA than for Mn-DPDP in liver parenchyma after 5 min and in CHD after 15 min (p<0.05). CNR of CHD to liver parenchyma using Gd-EOB-DTPA showed an initial decrease at 5 min post-injection followed by a steep increase to a peak at 15 min post-injection. CNR using Mn-DPDP showed a steady increase to a peak at 15 min post-injection without an initial decrease. At 15 min, the value of CNR was significantly higher for Gd-EOB-DTPA than for Mn-DPDP (p<0.05). CONCLUSION For both contrast agents, CNR reached a peak at 15 min after contrast injection. At this time point, CNR of Gd-EOB-DTPA was significantly higher than that of Mn-DPDP. Therefore, Gd-EOB-DTPA may provide better contrast-enhanced MRC than Mn-DPDP at 15 min after contrast administration.
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Affiliation(s)
- K Bae
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
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Griffin N, Charles-Edwards G, Grant LA. Magnetic resonance cholangiopancreatography: the ABC of MRCP. Insights Imaging 2011; 3:11-21. [PMID: 22695995 PMCID: PMC3292642 DOI: 10.1007/s13244-011-0129-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 09/09/2011] [Indexed: 02/07/2023] Open
Abstract
Magnetic resonance cholangiopancreatography (MRCP) is a technique that has evolved over the past two decades. It continues to have a fundamental role in the non-invasive investigation of many pancreatico-biliary disorders. The purpose of this review is to summarise the key concepts behind MRCP, the different techniques that are currently employed (including functional and secretin-stimulated MRCP), the pitfalls the reader should be aware of, and the main clinical indications for its use.
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Affiliation(s)
- Nyree Griffin
- Department of Radiology, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK,
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Gd-EOB-DTPA as a functional MR cholangiography contrast agent: imaging gallbladder filling in patients with and without hepatobiliary dysfunction. J Comput Assist Tomogr 2011; 35:439-45. [PMID: 21765298 DOI: 10.1097/rct.0b013e31821f4e29] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate cystic duct patency on hepatobiliary-phase magnetic resonance (MR) images after intravenous gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) administration. METHODS A radiology information system search identified patients with gallbladders that had MR imaging after intravenous Gd-EOB-DTPA injection. No patients had acute cholecystitis. Magnetic resonance image findings were correlated with clinical notes, other imaging studies, time of contrast injection, and serum laboratory tests. RESULTS Contrast accumulated in the gallbladder in 80% of patients (n = 100) with hepatobiliary-phase MR imaging at a median of 22 minutes (range, 15-83 minutes). Absence of contrast accumulation in the gallbladder (n = 20) was associated with hepatobiliary imaging less than 30 minutes after contrast administration, gallbladder contraction, cholelithiasis, elevated liver function tests, elevated bilirubin, and cirrhosis. CONCLUSIONS Functional assessment of cystic duct patency by Gd-EOB-DTPA-enhanced liver MR is best conducted when hepatobiliary-phase T1-weighted imaging is delayed by more than 30 minutes after contrast injection. Hepatobiliary dysfunction is associated with nonfilling of the gallbladder.
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Magnetic Resonance Cholangiopancreatography of Benign Disorders of the Biliary System. Magn Reson Imaging Clin N Am 2010; 18:497-514, xi. [DOI: 10.1016/j.mric.2010.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Marin D, Husarik DB, Boll DT, Merkle EM. Abdominal magnetic resonance imaging at 3 T: oncological applications. Top Magn Reson Imaging 2010; 21:149-156. [PMID: 21847034 DOI: 10.1097/rmr.0b013e3181e8fb7a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The gain in signal-to-noise ratio at 3 T magnetic resonance (MR) imaging produces many benefits for abdominal imaging applications, including the capability to reduce acquisition times and/or improve spatial resolution for a variety of pulse sequences, the potential for broader application of parallel imaging techniques, and an increased sensitivity to gadolinium-based contrast media. These advances have the potential of improving the accuracy of MR imaging in the detection, staging, treatment planning, and follow-up of patients with abdominal tumors. At the same time, because certain high-field-strength-related drawbacks could not be compensated for, abdominal 3 T MR imaging should be clinically implemented with caution in some patients (eg, patients with massive ascites).
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Affiliation(s)
- Daniele Marin
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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Gadoxetate Disodium-Enhanced Magnetic Resonance Cholangiography for the Noninvasive Detection of an Active Bile Duct Leak After Laparoscopic Cholecystectomy. J Comput Assist Tomogr 2010; 34:213-6. [DOI: 10.1097/rct.0b013e3181c1a72c] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Seale MK, Catalano OA, Saini S, Hahn PF, Sahani DV. Hepatobiliary-specific MR contrast agents: role in imaging the liver and biliary tree. Radiographics 2010; 29:1725-48. [PMID: 19959518 DOI: 10.1148/rg.296095515] [Citation(s) in RCA: 283] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hepatobiliary-specific contrast agents are one of several classes of contrast agents available for magnetic resonance (MR) imaging of the liver. These agents are taken up by functioning hepatocytes and excreted in the bile, and their paramagnetic properties cause shortening of the longitudinal relaxation time (T1) of the liver and biliary tree. The three contrast agents that have been developed are mangafodipir trisodium (Mn-DPDP), gadobenate dimeglumine (Gd-BOPTA), and gadoxetic acid (Gd-EOB-DTPA). These three MR contrast agents vary in mode of administration and dose, mechanism of cellular uptake, degree of excretion through the biliary pathway, and imaging characteristics. In the liver, hepatobiliary-specific agents can be used to improve lesion detection, to characterize lesions as hepatocellular or nonhepatocellular, and to specifically characterize some hepatocellular lesions, notably focal nodular hyperplasia. Biliary excretion of these agents can be used to evaluate the anatomic structure and function of the biliary tree. In the future, hepatobiliary-specific contrast agents may have wider applications, such as grading of cirrhosis and quantification of liver function.
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Affiliation(s)
- Melanie K Seale
- Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, White 270, 55 Fruit St, Boston, MA 02114, USA
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Lee NK, Kim S, Lee JW, Lee SH, Kang DH, Kim GH, Seo HI. Biliary MR imaging with Gd-EOB-DTPA and its clinical applications. Radiographics 2009; 29:1707-1724. [PMID: 19959517 DOI: 10.1148/rg.296095501] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The hepatocyte-specific contrast agent gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) was developed to improve the detection and characterization of focal liver lesions at magnetic resonance (MR) imaging. Approximately 50% of the injected dose is taken up into the functional hepatocyte and is excreted via the biliary system. Because of this property, Gd-EOB-DTPA has the potential to be a biliary contrast agent. When combined with T2-weighted MR cholangiography, Gd-EOB-DTPA-enhanced MR imaging can allow morphologic and functional assessment of the biliary system. Gd-EOB-DTPA-enhanced MR cholangiography could be effective in evaluation of biliary anatomy, differentiation of biliary from extrabiliary lesions, diagnosis of cholecystitis, assessment of bile duct obstruction, detection of bile duct injury including leakage and stricture, evaluation of biliary-enteric anastomoses, postprocedure evaluation, differentiation of biloma from other pathologic conditions, and evaluation of sphincter of Oddi dysfunction. However, the clinical applications of this imaging technique have not yet been fully explored, and further investigations are needed to determine the utility of Gd-EOB-DTPA-enhanced MR cholangiography in a clinical setting.
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Affiliation(s)
- Nam Kyung Lee
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan National University, 1-10 Ami-Dong, Seo-Gu, Busan 602-739, Republic of Korea
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Visualization of the biliary tract using gadobenate dimeglumine: preliminary findings. J Comput Assist Tomogr 2008; 32:54-60. [PMID: 18303288 DOI: 10.1097/rct.0b013e3180616b87] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To compare contrast-enhanced magnetic resonance (MR) cholangiography (CE-MRC) performed with gadobenate dimeglumine with T2-weighted MRC (T2-MRC) for visualization of the bile ducts in nondilated biliary systems. MATERIALS AND METHODS Twenty consecutive patients who underwent MR imaging (MRI) of the liver and pancreas with nondilated intrahepatic ducts were included in this retrospective study. T2-weighted MRC was performed using a multislice, high-resolution fat-suppressed half-Fourier acquisition turbo spin-echo sequence. Contrast-enhanced MR cholangiography was performed using a fat-suppressed 3-dimensional fast low-angle shot sequence acquired 1 to 1.5 hour after intravenous administration of gadobenate dimeglumine. For image interpretation, the biliary system was divided into 8 segments. Two readers graded visualization of each segment on T2-MRC and CE-MRC using a 5-point scale (0, nonvisualization; 4, excellent visualization). Final opinion for each sequence was rendered by consensus. Superiority of visualization was assessed using the McNemar test and comparing adequately (visualization scores 3 and 4) and inadequately (visualization scores 0, 1, and 2) visualized segments of the ducts on both sequences. Interobserver variability was assessed with kappa statistics. RESULTS Overall and segment-based evaluation revealed superior visualization of biliary segments with CE-MRC compared with T2-MRC. We also found a statistically significant difference between the 2 sequences for overall and for right hepatic duct and cystic channel visualization (P < 0.05). A high concordance between readers 1 and 2 both for T2-MRC and CE-MRC was achieved (85.8% and 89.4%, respectively). CONCLUSIONS Gadobenate dimeglumine can be used as an alternative intrabiliary contrast agent for contrast-enhanced MR cholangiography in nondilated biliary systems in patients with normal excretory liver function tests.
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Catalano OA, Sahani DV, Kalva SP, Cushing MS, Hahn PF, Brown JJ, Edelman RR. MR imaging of the gallbladder: a pictorial essay. Radiographics 2008; 28:135-55; quiz 324. [PMID: 18203935 DOI: 10.1148/rg.281065183] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The gallbladder serves as the repository for bile produced in the liver. However, bile within the gallbladder may become supersaturated with cholesterol, leading to crystal precipitation and subsequent gallstone formation. The most common disorders of the gallbladder are related to gallstones and include symptomatic cholelithiasis, acute and chronic cholecystitis, and carcinoma of the gallbladder. Other conditions that can affect the gallbladder include biliary dyskinesia (functional), adenomyomatosis (hyperplastic), and postoperative changes or complications (iatrogenic). Ultrasonography (US) has been the traditional modality for evaluating gallbladder disease, primarily owing to its high sensitivity and specificity for both stone disease and gallbladder inflammation. US performed before and after ingestion of a fatty meal may also be useful for functional evaluation of the gallbladder. However, US is limited by patient body habitus, with degradation of image quality and anatomic detail in obese individuals. With the advent of faster and more efficient imaging techniques, magnetic resonance (MR) imaging has assumed an increasing role as an adjunct modality for gallbladder imaging, primarily in patients who are incompletely assessed with US. MR imaging allows simultaneous anatomic and physiologic assessment of the gallbladder and biliary tract in both initial evaluation of disease and examination of the postoperative patient. This assessment is accomplished chiefly through the use of MR imaging contrast agents excreted preferentially via the biliary system.
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Affiliation(s)
- Onofrio A Catalano
- Department of Radiology, Division of Gastrointestinal Radiology, Massachusetts General Hospital, WHT 270, 55 Fruit St, Boston, MA 02114, USA
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Chang KJ, Fayad LM. Magnetic Resonance Cholangiopancreatography. Cancer Imaging 2008. [DOI: 10.1016/b978-012374212-4.50115-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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[Contrast-enhanced magnetic resonance cholangiography using gadolinium-EOB-DTPA. Preliminary experience and clinical applications]. Radiologe 2007; 47:536-44. [PMID: 17965849 DOI: 10.1007/s00117-006-1444-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Magnetic resonance cholangiopancreaticography (MRCP) with heavily T2-weighted RARE and HASTE sequences has become an important imaging modality for the morphologic evaluation of intra- and extrahepatic bile ducts. However, for the diagnosis of functional biliary disorders, cholangiopancreaticography (ERCP) and endoscopic manometry, two invasive techniques with considerable morbidity and mortality, remain the standard. Biliary scintigraphy, secretin-stimulated MRCP, and secretin-stimulated endoscopic ultrasound have not proven to be sufficient to replace these techniques as they lack diagnostic accuracy and correlate poorly with manometry results. Contrast-enhanced magnetic resonance cholangiography (CE-MRC) uses hepatocyte-selective contrast agents that are eliminated by the biliary system. Therefore, these substances can serve as biliary contrast agents in T1-weighted MR imaging. This method makes a noninvasive functional evaluation of the hepatobiliary system possible. In the present article, our preliminary experience with Gd-EOB-DTPA-enhanced MRC is summarized and potential clinical applications of this method are discussed. Additionally, the article reviews publications evaluating a possible benefit of CE-MRC with other hepatobiliary contrast agents such as mangafodipir trisodium.
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Laurent V, Corby S, Barbary C, Kermarrec E, Béot S, Régent D. [New possibilities to study biliary tree and gallbladder: functional magnetic resonance cholangiography contrast-enhanced with mangafodipir trisodium (Mn DPDP)]. ACTA ACUST UNITED AC 2007; 88:531-40. [PMID: 17464251 DOI: 10.1016/s0221-0363(07)89852-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Mangafodipir trisodium (Teslascan) is a hepatobiliary contrast agent that provides noninvasive opacification of the bile ducts. Using this contrast medium combined with a T1-weighted gradient echo enhanced sequence provides functional imaging of the bile ducts. Second-intention MRI was obtained after the usual morphological study of the bile ducts using heavily T2-weighted sequences (SS-FSE Te eff long and SS FSE Te eff short). This method can detect many biliary duct anomalies: biliary leakage in the postoperative context, mapping of bile ducts and the gallbladder in the search for anatomical variants, analysis of biliodigestive or biliobiliary anastomoses, or a dynamic study of bile secretion and excretion. Opacification of the bile ducts has only been possible until now with invasive tests aggravated by a certain co-morbidity rate and their functional study using biliary scintigraphy limited by mediocre spatial resolution. This new possibility provides access not only to morphological imaging, but also to functional imaging with excellent spatial resolution.
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Affiliation(s)
- V Laurent
- Service de Radiologie Adultes - Hôpital de Brabois, Allée du Morvan, 54500 Vandoeuvre les Nancy, France.
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Hiotis SP, Pachter HL. Liver and Biliary Tract. ACUTE CARE SURGERY 2007:479-496. [DOI: 10.1007/978-0-387-69012-4_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Assaban M, Aubé C, Lebigot J, Ridereau-Zins C, Hamy A, Caron C. Intérêt de l’IRM avec perfusion de mangafodipir trisodium dans la détection des fuites biliaires. ACTA ACUST UNITED AC 2006; 87:41-7. [PMID: 16415779 DOI: 10.1016/s0221-0363(06)73968-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To assess the value of contrast-enhanced magnetic resonance cholangiography with Teslascan perfusion for the detection and localization of trauma-induced and postoperative bile leaks. MATERIALS AND METHODS Between October 2002 and December 2004, 7 patients with suspected bile duct leaks after trauma (n = 2) or surgery (n = 5) requiring morphological evaluation were included. MRI examination included single shot fast spin- echo T2 weighted and gradient echo T1 weighted images prior to and 112 minutes in average after IV administration of mangafodipir trisodium. The results of contrast enhanced MR cholangiography were correlated to surgery (n = 3), clinical course (n = 3) and percutaneous drainage (n = 1). RESULTS Mangafodipir trisodium-enhanced imaging showed extravasated Teslascan in collections in 6 patients (86%) whereas the combination of T2 weighted images and mangafodipir trisodium enhanced images revealed biliary collections in 7 patients (100%). The fistula between bile duct and collection was visualized in 4 patients (57%) before mangafodipir trisodium perfusion and in 3 patients (43%) after injection. In one patient the fistula was visible only after injection. Combination of both pre- and post injection MR correctly depicted the origin of bile leak in 5 cases (71%). CONCLUSION Mangafodipir trisodium-enhanced magnetic resonance cholangiography is a non invasive technique that can successfully detect the presence of bile duct leaks. The combination of T2 weighted MR cholangiography and mangafodipir trisodium-enhanced T1 weighted MR cholangiography increases the sensitivity in detection and localization of the site of bile leak.
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Affiliation(s)
- M Assaban
- Département de Radiologie, CHU Angers
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Aduna M, Larena JA, Martín D, Martínez-Guereñu B, Aguirre I, Astigarraga E. Bile duct leaks after laparoscopic cholecystectomy: value of contrast-enhanced MRCP. ACTA ACUST UNITED AC 2005; 30:480-7. [PMID: 15688109 DOI: 10.1007/s00261-004-0276-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND We assessed the role of mangafodipir-enhanced magnetic resonance (MR) cholangiography in the detection and location of bile duct leaks after laparoscopic cholecystectomy. METHODS In a prospective study, 34 patients with clinical suspicion of bile duct leak after laparoscopic cholecystectomy underwent MR imaging. Our protocol included conventional heavily T2-weighted MR cholangiography and three-dimensional T1-weighted MR cholangiography after an intravenous bolus injection of mangafodipir trisodium. All studies were performed on a 1.5-T or 1-T scanner. Contrast-enhanced MR cholangiograms were evaluated for the presence and location of bile duct leaks. Correlation was obtained in all cases with surgery (n=15), endoscopic retrograde cholangiography (n=5), percutaneous drainage (n=5), and clinical follow-up (n=9). RESULTS In 20 of 34 patients, bile duct leakage was proved by surgery, endoscopic retrograde cholangiography, or drainage. Contrast enhancement displayed the leakage in 19 of 20 patients and ruled out leaks in the other 14 patients (95% sensitivity, 100% specificity). The leak site was depicted in 14 patients and contrast-enhanced MR cholangiography successfully located the origin of the leak in 11 patients. CONCLUSIONS Contrast-enhanced MR cholangiography with intravenous mangafodipir trisodium can accurately diagnose the presence and location of bile duct leaks in patients who have undergone laparoscopic cholecystectomy.
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Affiliation(s)
- M Aduna
- OSATEK, Unidad de Galdakao, Barrio Labeaga s/n, Galdakao(Vizcaya), 48960 Basque Country, Spain.
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Hottat N, Winant C, Metens T, Bourgeois N, Devière J, Matos C. MR cholangiography with manganese dipyridoxyl diphosphate in the evaluation of biliary-enteric anastomoses: preliminary experience. AJR Am J Roentgenol 2005; 184:1556-62. [PMID: 15855115 DOI: 10.2214/ajr.184.5.01841556] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The purpose of our study was to assess the usefulness of manganese dipyridoxyl diphosphate (Mn-DPDP)-enhanced T1-weighted MR cholangiography for evaluating patients with biliary-enteric anastomoses. CONCLUSION Mn-DPDP-enhanced T1-weighted MR cholangiography may provide useful functional information and may aid in the assessment of the patency of biliary-enteric anastomoses.
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Affiliation(s)
- Nathalie Hottat
- Department of Radiology, Hôpital Erasme, University Clinics of Brussels, Free University of Brussels, Route de Lennik, 808, Brussels B-1070, Belgium.
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Abstract
MR imaging is an established technique for the diagnosis of a spectrum of biliary and gallbladder pathologies and continues to improve with the advent of technologic advances, including new contrast agents and new sequences that are capable of improving upon the contrast resolution and signal-to-noise that are afforded by conventional MR imaging. These improvements already have shown promise for the increasing role of MRC as the initial modality in assessing living liver donors and evaluating post-operative hepato-biliary complications. Improved spatial resolution and the added functional or physiologic information afforded by MR imaging promise ever expanding clinical applicability and usefulness.
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Affiliation(s)
- Samantha L Heller
- Department of Radiology, New York University Medical Center, 530 First Avenue, New York, NY 10016, USA
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Fayad LM, Kamel IR, Mitchell DG, Bluemke DA. Functional MR Cholangiography: Diagnosis of Functional Abnormalities of the Gallbladder and Biliary Tree. AJR Am J Roentgenol 2005; 184:1563-71. [PMID: 15855116 DOI: 10.2214/ajr.184.5.01841563] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our objective was to describe the technique and utility of functional MR cholangiography (fMRC) in the evaluation of the gallbladder and biliary tree. CONCLUSION FMRC has the potential to provide a comprehensive examination for the anatomic and functional assessment of the gallbladder and biliary tree. Complex anatomic abnormalities and functional disorders can be shown by fMRC, including biliary obstruction and extravasation.
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Affiliation(s)
- Laura M Fayad
- Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N Wolfe St., JHOC 3171C, Baltimore, MD 21287, USA.
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Sheppard D, Allan L, Martin P, McLeay T, Milne W, Houston JG. Contrast-enhanced magnetic resonance cholangiography using mangafodipir compared with standard T2W MRC sequences: a pictorial essay. J Magn Reson Imaging 2004; 20:256-63. [PMID: 15269951 DOI: 10.1002/jmri.20114] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Mangafodipir, a manganese-containing hepatobiliary contrast agent, is excreted in bile. We review the principles and practice of a contrast-enhanced MRC technique using mangafodipir and compare it with standard T2-weighted magnetic resonance cholangiography (MRC) sequences. Potential applications include the evaluation of leaks and strictures; the assessment of drainage in normal, surgically by-passed, stented and obstructed biliary systems; the diagnosis of cholecystitis; and the evaluation of normal and variant biliary anatomy.
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Affiliation(s)
- Declan Sheppard
- Department of Clinical Radiology, Ninewells Hospital, Tayside University Hospitals NHS Trust, Dundee, Scotland, UK.
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Lee VS, Krinsky GA, Nazzaro CA, Chang JS, Babb JS, Lin JC, Morgan GR, Teperman LW. Defining intrahepatic biliary anatomy in living liver transplant donor candidates at mangafodipir trisodium-enhanced MR cholangiography versus conventional T2-weighted MR cholangiography. Radiology 2004; 233:659-66. [PMID: 15516606 DOI: 10.1148/radiol.2333031977] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To compare three-dimensional (3D) mangafodipir trisodium-enhanced T1-weighted magnetic resonance (MR) cholangiography with conventional T2-weighted MR cholangiography for depiction and definition of intrahepatic biliary anatomy in liver transplant donor candidates. MATERIALS AND METHODS One hundred eight healthy liver transplant donor candidates were examined with two MR cholangiographic methods. All candidates gave written informed consent, and the study was approved by the institutional review board. First, breath-hold transverse and coronal half-Fourier single-shot turbo spin-echo and breath-hold oblique coronal heavily T2-weighted turbo spin-echo sequences were performed. Second, mangafodipir trisodium-enhanced breath-hold fat-suppressed 3D gradient-echo sequences were performed through the ducts (oblique coronal plane) and through the entire liver (transverse plane). Interpretation of biliary anatomy findings, particularly variants affecting right liver lobe biliary drainage, and degree of interpretation confidence at both 3D mangafodipir trisodium-enhanced MR cholangiography and T2-weighted MR cholangiography were recorded and compared by using the Wilcoxon signed rank test. Then, consensus interpretations of both MR image sets together were performed. Intraoperative cholangiography was the reference-standard examination for 51 subjects who underwent right lobe hepatectomy. The McNemar test was used to compare the accuracies of the individual MR techniques with that of the consensus interpretation of both image sets together and to compare each technique with intraoperative cholangiography. RESULTS Biliary anatomy was visualized with mangafodipir trisodium enhancement in all patients. Mangafodipir trisodium-enhanced image findings agreed with findings seen at combined interpretations significantly more often than did T2-weighted image findings (in 107 [99%] vs 88 [82%] of 108 donor candidates, P < .001). Confidence was significantly higher with the mangafodipir trisodium-enhanced images than with the T2-weighted images (mean confidence score, 4.5 vs 3.4; P < .001). In the 51 candidates who underwent intraoperative cholangiography, mangafodipir trisodium-enhanced imaging correctly depicted the biliary anatomy more often than did T2-weighted imaging (in 47 [92%] vs 43 [84%] donor candidates, P = .14), whereas the two MR imaging techniques combined correctly depicted the anatomy in 48 (94%) candidates. CONCLUSION Mangafodipir trisodium-enhanced 3D MR cholangiography depicts intrahepatic biliary anatomy, especially right duct variants, more accurately than does conventional T2-weighted MR cholangiography.
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Affiliation(s)
- Vivian S Lee
- Departments of Radiology and Transplant Surgery, New York University Medical Center, 530 First Avenue, New York, NY 10016, USA.
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Abstract
The current imaging technique and clinical application of MR cholangiopancreatography (MRCP) is reviewed. MRCP has evolved into a feasible method of non-invasively evaluating the pancreaticobiliary system and has considerable clinical utility. If endoscopic retrograde cholangiopancreatography (ERCP) is incomplete or has failed, or in patients with biliary and gastrointestinal surgical procedures, MRCP is a useful alternative modality. In the near future, MRCP may supplant diagnostic ERCP such that ERCP is reserved primarily for therapeutic interventions. Furthermore, when MRCP is performed in conjunction with abdominal MR and MR angiography, the 'all-in-one' examination can evaluate the solid organs and vessels of the abdomen as well as the ductal systems.
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Affiliation(s)
- Liang Zhong
- Department of Radiology, Renji Hospital, Shanghai Institute of Digestive Disease, Shanghai Second Medical University, Shanghai, China
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