Assessment of the optimal temporal window for intravenous CT cholangiography

Abstract

The optimal temporal window of intravenous (IV) computed tomography (CT) cholangiography was prospectively determined. Fifteen volunteers (eight women, seven men; mean age, 38 years) underwent dynamic CT cholangiography. Two unenhanced images were acquired at the porta hepatis. Starting 5 min after initiation of IV contrast infusion (20 ml iodipamide meglumine 52%), 15 pairs of images at 5-min intervals were obtained. Attenuation of the extrahepatic bile duct (EBD) and the liver parenchyma was measured. Two readers graded visualization of the higher-order biliary branches. The first biliary opacification in the EBD occurred between 15 and 25 min (mean, 22.3 min +/- 3.2) after initiation of the contrast agent. Biliary attenuation plateaued between the 35- and the 75-min time points. Maximum hepatic parenchymal enhancement was 18.5 HU +/- 2.7. Twelve subjects demonstrated poor or non-visualization of higher-order biliary branches; three showed good or excellent visualization. Body weight and both biliary attenuation and visualization of the higher-order biliary branches correlated significantly (P<0.05). For peak enhancement of the biliary tree, CT cholangiography should be performed no earlier than 35 min after initiation of IV infusion. For a fixed contrast dose, superior visualization of the biliary system is achieved in subjects with lower body weight.

Computed Tomographic Cholangiography in Living Liver Transplant Donors

“…20,22 The initial 10 mL was infused over 10 minutes, and, if well tolerated, the subsequent 110 mL was infused over the succeeding 20 minutes. Fifteen minutes after infusion completion (45 minutes from initiation), the abdomen was scanned from the diaphragm through the liver with 0.625-mm section thickness, 1.0 pitch, standard algorithm reconstructions with narrow field of view centered over the liver.…”

Effect of Intravenous Morphine Comedication on Bile Duct Visualization, Diameter and Volume Applying Intravenous CT Cholangiography in a Porcine Liver Model

“…Another biliary contrast material, iodipamide meglumine, was injected with a possibly different excretion profile compared to meglumine iotroxate [9] . Furthermore, Breiman et al [19] used 20 ml of iodipamide meglumine diluted in 80 ml of normal saline, whereas in our study, 50 ml of pure meglumine iotroxate was injected.…”

“…Multidetector row CT scanners with modern postprocessing software provide fast data acquisition, and complex image reconstruction is feasible [1,6,17,18] . While CT cholangiographic imaging of the extrahepatic biliary system is superb, exact delineation of higher-order bile ducts remains critical [9,19] . Since variations and abnormalities occur particularly in second-order and third-order branch ducts, excellent visualization of these is mandatory [19][20][21][22] .…”

“…Endoscopic retrograde cholangiography allows delineation of the biliary tree with high spatial resolution; however, it is more difficult and dangerous in patients with modified anatomy as Billroth II gastrectomy or biliodigestive anastomosis [8] . Additionally, these invasive procedures lead to complications in up to 5% of cases [9] . Magnetic resonance cholangiography as a technique without irradiation is reliable for the identification of biliary stones, strictures and tumors [10][11][12][13][14] .…”

“…Magnetic resonance cholangiography as a technique without irradiation is reliable for the identification of biliary stones, strictures and tumors [10][11][12][13][14] . Availability, costs, contraindications such as pacemakers and reduced image quality due to metallic clip artifacts or noncompliance make up its major limitations [9] . Intravenous administration of iodinated contrast materials with a biliary excretory profile in combination with a CT scan (CT cholangiography) has been reported to detect morphological and functional biliary pathologies with high sensitivity [15,17] .…”