Top

Published in:

Open Access 01-10-2013 | Gastrointestinal

Non-invasive detection of biliary leaks using Gd-EOB-DTPA-enhanced MR cholangiography: comparison with T2-weighted MR cholangiography

Authors: Mecit Kantarcı, Berhan Pirimoglu, Nevzat Karabulut, Ummugulsum Bayraktutan, Hayri Ogul, Gurkan Ozturk, Bulent Aydinli, Yesim Kizrak, Suat Eren, Sinan Yilmaz

Published in: European Radiology | Issue 10/2013

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.

Balci NC, Semelka RC (2005) Contrast agents for MR imaging of the liver. Radiol Clin North Am 43:887–898PubMedCrossRef

Lewall DB, McCorkell SJ (1986) Rupture of echinococcal cysts: diagnosis, classification, and clinical implications. AJR Am J Roentgenol 146:391–394PubMedCrossRef

Reimer P, Schneider G, Schima W (2004) Hepatobiliary contrast agents for contrast-enhanced MRI of the liver: properties, clinical development and applications. Eur Radiol 14:559–578PubMedCrossRef

Fayad LM, Holland GA, Bergin D et al (2003) Functional magnetic resonance cholangiography (fMRC) of the gallbladder and biliary tree with contrast-enhanced magnetic resonance cholangiography. J Magn Reson Imaging 18:449–460PubMedCrossRef

Hammerstingl R, Huppertz A, Breuer J et al (2008) Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol 18:457–467PubMedCrossRef

Ergen FB, Akata D, Sarikaya B et al (2008) Visualization of the biliary tract using gadobenate dimeglumine: preliminary findings. J Comput Assist Tomogr 32:54–60PubMedCrossRef

An SK, Lee JM, Suh KS et al (2006) Gadobenate dimeglumine-enhanced liver MRI as the sole preoperative imaging technique: a prospective study of living liver donors. AJR Am J Roentgenol 187:1223–1233PubMedCrossRef

Sheppard D, Allan L, Martin P, McLeay T, Milne W, Houston JG (2004) Contrast-enhanced magnetic resonance cholangiography using mangafodipir compared with standard T2W MRC sequences: a pictorial essay. J Magn Reson Imaging 20:256–263PubMedCrossRef

Fayad LM, Kamel IR, Mitchell DG, Bluemke DA (2005) Functional MR cholangiography: diagnosis of functional abnormalities of the gallbladder and biliary tree. AJR Am J Roentgenol 184:1563–1571PubMedCrossRef

10.

Seale MK, Catalano OA, Saini S, Hahn PF, Sahani DV (2009) Hepatobiliary-specific MR contrast agents: role in imaging the liver and biliary tree. Radiographics 29:1725–1748PubMedCrossRef

11.

Karabulut N, Cakmak V, Kiter G (2010) Confident diagnosis of bronchobiliary fistula using contrast-enhanced magnetic resonance cholangiography. Korean J Radiol 11:493–496PubMedCrossRef

12.

Bae K, Na JB, Choi DS et al (2012) Contrast-enhanced MR cholangiography: comparison of Gd-EOB-DTPA and Mn-DPDP in healthy volunteers. Br J Radiol 85:1250–1254PubMedCrossRef

13.

Onur MR, Poyraz AK, Kocakoc E, Ogur E, Akyol M (2012) Diagnosis of peritoneal metastases with abdominal malignancies: role of ADC measurement on diffusion weighted MRI. Eurasian J Med 44:163–168CrossRef

14.

Dahlstrom N, Persson A, Albiin N, Smedby O, Brismar TB (2007) Contrast-enhanced magnetic resonance cholangiography with Gd-BOPTA and Gd-EOB-DTPA in healthy subjects. Acta Radiol 48:362–368PubMedCrossRef

15.

Aduna M, Larena JA, Martin D, Martinez-Guereñu B, Aguirre I, Astigarraga E (2005) Bile duct leaks after laparoscopic cholecystectomy: value of contrast-enhanced MRCP. Abdom Imaging 30:480–487PubMedCrossRef

16.

Vitellas KM, El-Dieb A, Vaswani KK et al (2002) Using contrast-enhanced MR cholangiography with IV mangafodipir trisodium (Teslascan) to evaluate bile duct leaks after cholecystectomy: a prospective study of 11 patients. AJR Am J Roentgenol 179:409–416PubMedCrossRef

17.

Lee MS, Lee JY, Kim SH et al (2011) Gadoxetic acid disodium-enhanced magnetic resonance imaging for biliary and vascular evaluations in preoperative living liver donors: comparison with gadobenate dimeglumine-enhanced MRI. J Magn Reson Imaging 33:149–159PubMedCrossRef

18.

Salvolini L, Urbinati C, Valeri G, Ferrara C, Giovagnoni A (2012) Contrast-enhanced MR cholangiography (MRCP) with GD-EOB-DTPA in evaluating biliary complications after surgery. Radiol Med 117:354–368PubMedCrossRef

19.

Hyodo T, Kumano S, Kushihata F et al (2012) CT and MR cholangiography: advantages and pitfalls in perioperative evaluation of biliary tree. Br J Radiol 85:887–896PubMedCrossRef

20.

Gandhi SN, Brown MA, Wong JG, Aguirre DA, Sirlin CB (2006) MR contrast agents for liver imaging: what, when, how. Radiographics 26:1621–1636PubMedCrossRef

21.

Tamada T, Ito K, Sone T, Kanki A, Sato T, Higashi H (2010) Gd-EOB-DTPA enhanced MR imaging: evaluation of biliary and renal excretion in normal and cirrhotic livers. European J Radiol 80:207–211CrossRef

22.

Lee NK, Kim S, Lee WJ et al (2009) Biliary MR imaging with Gd-EOB-DTPA and its clinical applications. Radiographics 29:1707–1724PubMedCrossRef

23.

Tschirch FT, Struwe A, Petrowsky H, Kakales I, Marincek B, Weishaupt D (2008) Contrast-enhanced MR cholangiography with Gd-EOB-DTPA in patients with liver cirrhosis: visualization of the biliary ducts in comparison with patients with normal liver parenchyma. Eur Radiol 18:1577–1586PubMedCrossRef

24.

Kessel CS, Veldhuis WB, Bosch MAAJ, Leeuwen MS (2012) MR liver imaging with Gd-EOB-DTPA: a delay time of 10 minutes is sufficient for lesion characterisation. Eur Radiol 22:2153–2160PubMedCrossRef

25.

Bollow M, Taupitz M, Hamm B, Staks T, Wolf KJ, Weinmann HJ (1997) Gadoliniumethoxybenzyl-DTPA as a hepatobiliary contrast agent for use in MR cholangiography: results of an in vivo phase-I clinical evaluation. Eur Radiol 7:126–132PubMedCrossRef

26.

Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180:101–125PubMed

27.

Macera A, Lario C, Petracchini M et al (2013) Staging of colorectal liver metastases after preoperative chemotherapy. Diffusion-weighted imaging in combination with Gd-EOB-DTPA MRI sequences increases sensitivity and diagnostic accuracy. Eur Radiol 23:739–747PubMedCrossRef

28.

Papanikolaou N, Prassopoulos P, Eracleous E, Maris T, Gogas C, Gourtsoyiannis N (2001) Contrast-enhanced magnetic resonance cholangiography versus heavily T2-weighted magnetic resonance cholangiography. Invest Radiol 36:682–686PubMedCrossRef

29.

Carlos RC, Hussain HK, Song JH, Francis IR (2002) Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid as an intrabiliary contrast agent: preliminary assessment. AJR Am J Roentgenol 179:87–92PubMedCrossRef

30.

Pavone P, Laghi A, Catalano C et al (1997) MR cholangiography in the examination of patients with biliary-enteric anastomoses. AJR Am J Roentgenol 169:807–811PubMedCrossRef

31.

Ragozzino A, De Ritis R, Mosca A et al (2004) Value of MR Cholangiography in patients with iatrogenic bile duct injury after cholecystectomy. AJR Am J Roentgenol 183:1567–1572PubMedCrossRef

32.

Thurley PD, Dhingsa R (2008) Laparoscopic cholecystectomy: postoperative imaging. AJR Am J Roentgenol 191:794–801PubMedCrossRef

33.

Marin D, Bova V, Agnello F et al (2010) Gadoxetate disodium-enhanced magnetic resonance cholangiography for the noninvasive detection of an active bile duct leak after laparoscopic cholecystectomy. J Comput Assist Tomogr 34:213–216PubMedCrossRef

34.

Lau WY, Lai EC (2007) Classification of iatrogenic bile duct injury. Hepatobiliary Pancreat Dis Int 6:459–463PubMed

35.

Adaletli I, Yilmaz S, Cakir Y et al (2005) Fistulous communication between a hepatic hydatid cyst and the gallbladder: diagnosis with MR cholangiopancreatography. AJR Am J Roentgenol 185:1211–1213PubMedCrossRef

36.

Prat F, Pelletier G, Ponchon T et al (1997) What role can endoscopy play in the management of biliary complications after laparoscopic cholecystectomy? Endoscopy 29:341–348PubMedCrossRef

37.

Freeman ML, Overby C (2003) Selective MRCP and CT targeted drainage of malignant hilar biliary obstruction with self-expanding metallic stents. Gastrointest Endosc 58:41–49PubMedCrossRef

38.

Fulcher AS, Turner MA (1999) Orthotopic liver transplantation: evaluation with MR cholangiography. Radiology 215:715–722

39.

Kim HJ, Kim KW, Byun JH et al (2006) Comparison of mangafodipir trisodium and ferucarbotran enhanced MRI for detection and characterization of hepatic metastases in colorectal cancer patients. AJR Am J Roentgenol 186:1059–1066PubMedCrossRef

40.

Catalano OA, Singh AH, Uppot RN, Hahn PF, Ferrone CR, Sahani DV (2008) Vascular and biliary variants in the liver: implications for liver surgery. Radiographics 28:359–378PubMedCrossRef

41.

Tsuda N, Okada M, Murakami T (2010) New proposal for the staging of nonalcoholic steatohepatitis: evaluation of liver fibrosis on Gd-EOB-DTPA enhanced MRI. Eur J Radiol 73:137–142PubMedCrossRef

42.

Holzapfel K, Breitwieser C, Prinz C et al (2007) Contrast-enhanced magnetic resonance cholangiography using gadolinium-EOB-DTPA. Preliminary experience and clinical applications. Radiologe 47:536–544PubMedCrossRef

Title: Non-invasive detection of biliary leaks using Gd-EOB-DTPA-enhanced MR cholangiography: comparison with T2-weighted MR cholangiography
Authors: Mecit Kantarcı
Berhan Pirimoglu
Nevzat Karabulut
Ummugulsum Bayraktutan
Hayri Ogul
Gurkan Ozturk
Bulent Aydinli
Yesim Kizrak
Suat Eren
Sinan Yilmaz
Publication date: 01-10-2013
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 10/2013
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-013-2880-4

At a glance: The STEP trials

Springer Medicine

Non-invasive detection of biliary leaks using Gd-EOB-DTPA-enhanced MR cholangiography: comparison with T2-weighted MR cholangiography

Abstract

Objective

Methods

Results

Conclusions

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 10/2013

Intravoxel incoherent motion MR imaging: comparison of diffusion and perfusion characteristics between nasopharyngeal carcinoma and post-chemoradiation fibrosis

Endovascular treatment of brain arteriovenous malformations using a liquid embolic agent: results of a prospective, multicentre study (BRAVO)

Technical and clinical breast cancer screening performance indicators for computed radiography versus direct digital radiography

Time-of-flight angiography: a viable alternative to contrast-enhanced MR angiography and fat-suppressed T1w images for the diagnosis of cervical artery dissection?

ECG-gated computed tomography to assess pulmonary capillary wedge pressure in pulmonary hypertension

Proton magnetic resonance spectroscopy in the evaluation of patients with acute Charcot neuro-osteoarthropathy