Does intravenous glucagon improve common bile duct visualisation during magnetic resonance cholangiopancreatography? Results in 42 patients

Dalal, Paras U.; Howlett, David; Sallomi, D. F.; Marchbank, N.; Watson, Gillian M.T.; Marr, Amanda; Dunk, Arthur A.; Smith, Alastair D.

doi:10.1016/s0720-048x(03)00084-6

Cited by 15 publications

(12 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…23 We also assessed the utility of using IP glucagon (Sigma-Aldrich, St Louis, MO, USA) at a dose of 0.15 mg/kg to help decrease gut motion artifact. 24 Both gadoxetate disodium and glucagon were injected in the left lower quadrant of the abdomen immediately before scanning.…”

Section: Methodsmentioning

confidence: 99%

Micro-computed tomography and nuclear magnetic resonance imaging for noninvasive, live-mouse cholangiography

Tabibian

Macura

O’Hara

et al. 2013

Laboratory Investigation

View full text Add to dashboard Cite

The cholangiopathies are a diverse group of biliary tract disorders, many of which lack effective treatment. Murine models are an important tool for studying their pathogenesis, but existing noninvasive methods for assessing biliary disease in vivo are not optimal. Here we report our experience with using micro-computed tomography (microCT) and nuclear magnetic resonance (MR) imaging to develop a technique for live-mouse cholangiography. Using mdr2 knockout (mdr2KO, a model for primary sclerosing cholangitis (PSC)), bile duct-ligated (BDL), and normal mice, we performed in vivo: (1) microCT on a Siemens Inveon PET/CT scanner and (2) MR on a Bruker Avance 16.4 T spectrometer, using Turbo Rapid Acquisition with Relaxation Enhancement, IntraGate Fast Low Angle Shot, and Half-Fourier Acquisition Single-shot Turbo Spin Echo methods. Anesthesia was with 1.5–2.5% isoflurane. Scans were performed with and without contrast agents (iodipamide meglumine (microCT), gadoxetate disodium (MR)). Dissection and liver histology were performed for validation. With microCT, only the gallbladder and extrahepatic bile ducts were visualized despite attempts to optimize timing, route, and dose of contrast. With MR, the gallbladder, extra-, and intrahepatic bile ducts were well-visualized in mdr2KO mice; the cholangiographic appearance was similar to that of PSC (eg, multifocal strictures) and could be improved with contrast administration. In BDL mice, MR revealed cholangiographically distinct progressive dilation of the biliary tree without ductal irregularity. In normal mice, MR allowed visualization of the gallbladder and extrahepatic ducts, but only marginal visualization of the diminutive intrahepatic ducts. One mouse died during microCT and MR imaging, respectively. Both microCT and MR scans could be obtained in ≤ 20min. We, therefore, demonstrate that MR cholangiography can be a useful tool for longitudinal studies of the biliary tree in live mice, whereas microCT yields suboptimal duct visualization despite requiring contrast administration. These findings support further development and application of MR cholangiography to the study of mouse models of PSC and other cholangiopathies.

show abstract

Section: Methodsmentioning

confidence: 99%

Micro-computed tomography and nuclear magnetic resonance imaging for noninvasive, live-mouse cholangiography

Tabibian

Macura

O’Hara

et al. 2013

Laboratory Investigation

View full text Add to dashboard Cite

show abstract

“…The diagnostic accuracy of MRCP has been reported to be comparable to that of endoscopic retrograde cholangiopancreatography in the evaluation of disorders and identification of anatomic variants of biliary ductal systems 1–5. Drugs can alter the physiology of the biliary system and improve the quality of MRCP images in patients with biliary diseases 6–11. Morphine and other opiates contract the sphincter of Oddi.…”

mentioning

confidence: 99%

“…Morphine and other opiates contract the sphincter of Oddi. Glucagon increases bile flow but relaxes the sphincter of Oddi 6…”

mentioning

confidence: 99%

Morphine- and glucagon-augmented magnetic resonance cholangiopancreatography to evaluate living liver donors

Liang

et al. 2009

Liver Transpl

View full text Add to dashboard Cite

The purpose of this study was to investigate the effectiveness of the combined use of intravenous morphine and intramuscular glucagon in improving magnetic resonance cholangiopancreatography (MRCP) image quality in donors for living-related liver transplantation. Sixteen healthy donor candidates underwent an MRCP study. Coronal, single-shot, fast spin-echo, heavily T2-weighted dynamic MRCP images were obtained before and 3 minutes after the intravenous administration of morphine HCl with a dose of 0.04 mg/kg. Thirty minutes after the injection of morphine, intramuscular glucagon was used. Another MRCP image of the same pulse sequence was generated 15 minutes after the injection of glucagon with a dose of 1 mg. The diameter, signal intensity, and number of branches of bile ducts in MRCP images taken immediately before and after the injection of morphine and after the injection of glucagon (plus delayed morphine effects) were compared and analyzed. In all 16 donor candidates, the diameters of the right and left hepatic ducts, common bile duct, and main pancreatic duct were significantly increased (P Ͻ 0.05) in the MRCP images taken 3 minutes after the injection of morphine and 15 minutes after the injection of glucagon (plus delayed morphine effects) in comparison with MRCP images taken before any drug administration. The qualitative grading scores of the signal intensity and order of branches of bile ducts revealed improvements in the MRCP images after the injection of glucagon (plus delayed morphine effects; P Ͻ 0.05). In conclusion, combining the intravenous administration of low-dose morphine and the intramuscular use of glucagon before MRCP examination improves the visualization of the nondilated biliary ductal anatomy, which is important for the preoperative biliary evaluation of donor candidates for living-related liver transplantation.

show abstract

“…According to Dalal et al [35], the intravenous injection of the sphincter-relaxing agent glucagon during MRCP is able to improve the visualisation of the CBD and ampulla of Vater. However, these authors did not use any control group for their evaluation, in contrast to van Hoe et al…”

Section: Discussionmentioning

confidence: 99%

Choledocholithiasis: repetitive thick-slab single-shot projection magnetic resonance cholangiopancreaticography versus endoscopic ultrasonography

et al. 2006

View full text Add to dashboard Cite

This prospective study compares repetitive thick-slab singleshot projection magnetic resonance cholangiopancreatography (MRCP) with endoscopic ultrasonography (EUS) for the detection of choledocholithiasis. Fifty-seven consecutive patients (36 women, mean age 61) referred for suspected choledocholithiasis underwent MRCP, followed by EUS. Each procedure was performed by different operators blinded to the results of the other investigation. MR technique included a turbo spin-echo T2-weighted axial sequence with selective fat saturation (SPIR/ TSE, TE=70 ms, TR=1,600 ms), followed by coronal dynamic MRCP. The same thick-slab slice was sequentially acquired 12 times as breathhold single-shot projection imaging (SSh, TE=900 ms, TE=8,000 ms) centred on the common bile duct (CBD). Two experienced radiologists independently and blindly evaluated MR images for the detection of CBD stones. Their inter-observer agreement kappa was determined. Secondly, the two observers read MR images in consensus again. CBD stones were demonstrated in 18 out of 57 patients (31.6 %) and confirmed by endoscopic retrograde cholangiography (ERCP, n=17) or intraoperative cholangiography (n=1). Clinical follow-up served as the "gold standard" in patients with negative results without following invasive procedure (n=28). Sensitivity, specificity, accuracy, positive and negative predictive value for MRCP resulting from consensus reading were 94.9%, 94.4%, 94.7%, 97.4% and 89.5%, respectively. Corresponding values of EUS were 97.4%, 94.4%, 96.5%, 97.4% and 94.4%. Inter-observer agreement kappa was 0.81. Repetitive thick-slab single-shot projection MRCP is an accurate non-invasive imaging modality for suspected choledocholithiasis and should be increasingly used to select those patients who require a subsequent therapeutic procedure, namely ERCP.

show abstract

Does intravenous glucagon improve common bile duct visualisation during magnetic resonance cholangiopancreatography? Results in 42 patients

Cited by 15 publications

References 15 publications

Micro-computed tomography and nuclear magnetic resonance imaging for noninvasive, live-mouse cholangiography

Micro-computed tomography and nuclear magnetic resonance imaging for noninvasive, live-mouse cholangiography

Morphine- and glucagon-augmented magnetic resonance cholangiopancreatography to evaluate living liver donors

Choledocholithiasis: repetitive thick-slab single-shot projection magnetic resonance cholangiopancreaticography versus endoscopic ultrasonography

Contact Info

Product

Resources

About