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

Abstract

ObjectiveTo 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.MethodsNinety-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.ResultsAccuracy 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.ConclusionsGd-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.

The Impact of Gd-Eob-Dtpa-Enhanced MR Cholangiography in Biliary Diseases: Comparison with T2-Weighted MR Cholangiopancreatography

“…T2w-MRCP highlights the biliary tree, especially with heavily T2w sequences. However, in some circumstances, T2w-MRCP might be insufficient, especially in the diagnosis of acute cholecystitis biliary leakage and gallbladder perforation (5,14,15). We suggest that contrast enhanced MRC sequences can increase the diagnostic performance of Currently, there are two contrast agents which can be used to perform contrast enhanced MRC: Gd-EOB-DTPA and Gd-BOPTA.…”

“…In cases where the findings are non-diagnostic, T2w-MRCP should be considered (14). T2w-MRCP highlights the biliary tree, especially with heavily T2w sequences.…”

Diagnosing the duct of Luschka injury at magnetic resonance imaging with hepatospecific contrast agents after laparoscopic cholecystectomy

“…Safra kaçaği travmatik veya iatrojenik safra yollari yaralanmasi sonucu gelişebilir [1]. Safra yolu yaralanmalari cerrahide özellikle laparoskopik kolesistektomide (LK) en sik ve en ciddi komplikasyondur.…”

“…Safra kaçağini saptamada radyolojik olarak ultrasonografi (US), bilgisayarli tomografi (BT) ve manyetik rezonans görüntüleme (MRG) gibi kesitsel yöntemler kullanilmaktadir. Bu tekniklerle safra kaçağini düşündürebilecek ancak spesifik olmayan sivi koleksiyonu gibi bulgular saptanabilir [1]. Hepatospesifik kontrast maddelerle yapilan MRG' de ise direk kontrast madde ekstravazasyon alaninin gösterilmesiyle aktif safra kaçaği noninvaziv bir şekilde saptanabilir [6].…”

Magnetic resonance cholangiography in the assessment and management of biliary complications after OLT

“…Despite the increasing use of CE-MRC, there is a paucity of literature-based evidence in the setting of OLT, mainly focused on the preoperative evaluation of liver donors [33,34] . However, studies on patients with BC after hepatobiliary surgery, including OLT subjects, suggest that CE-MRC improves the accuracy of C-MRC in evaluating bile leakage showing the site of the leak and direct contrast extravasation into perihepatic/peribiliary fluid collections [35] . Moreover, CE-MRC is indicated to "functionally" assess the degree of biliary obstruction …”