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Zhang Y, Numata K, Du Y, Maeda S. Contrast Agents for Hepatocellular Carcinoma Imaging: Value and Progression. Front Oncol 2022; 12:921667. [PMID: 35720001 PMCID: PMC9200965 DOI: 10.3389/fonc.2022.921667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/02/2022] [Indexed: 11/25/2022] Open
Abstract
Hepatocellular carcinoma (HCC) has the third-highest incidence in cancers and has become one of the leading threats to cancer death. With the research on the etiological reasons for cirrhosis and HCC, early diagnosis has been placed great hope to form a favorable prognosis. Non-invasive medical imaging, including the associated contrast media (CM)-based enhancement scan, is taking charge of early diagnosis as mainstream. Meanwhile, it is notable that various CM with different advantages are playing an important role in the different imaging modalities, or even combined modalities. For both physicians and radiologists, it is necessary to know more about the proper imaging approach, along with the characteristic CM, for HCC diagnosis and treatment. Therefore, a summarized navigating map of CM commonly used in the clinic, along with ongoing work of agent research and potential seeded agents in the future, could be a needed practicable aid for HCC diagnosis and prognosis.
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Affiliation(s)
- Ying Zhang
- Department of Medical Ultrasound, Ningbo Medical Centre Li Huili Hospital, Ningbo, China.,Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.,Department of Gastroenterology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuewu Du
- Department of Medical Ultrasound, Ningbo Medical Centre Li Huili Hospital, Ningbo, China
| | - Shin Maeda
- Department of Gastroenterology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Onishi O, Ikoma K, Kido M, Kabuto Y, Ueshima K, Matsuda KI, Tanaka M, Kubo T. Early detection of osteoarthritis in rabbits using MRI with a double-contrast agent. BMC Musculoskelet Disord 2018. [PMID: 29534754 PMCID: PMC5851162 DOI: 10.1186/s12891-018-2002-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Articular cartilage degeneration has been evaluated by magnetic resonance imaging (MRI). However, this method has several problems, including its time-consuming nature and the requirement of a high magnetic field or specialized hardware. The purpose of this study was to sequentially assess early degenerative changes in rabbit knee articular cartilage using MRI with a new double-contrast agent. METHODS We induced osteoarthritis (OA) in the right knee of rabbits by anterior cruciate ligament transection and partial medial meniscectomy. Proton density-weighted images and T2-calculated images were obtained before and after contrast agent injection into the knee. The signal intensity ratio (SIR) values on the proton density-weighted images were calculated by dividing the signal intensity of the articular cartilage by that of joint fluid. Six rabbits were examined using MRI at 2 (designated 2-w OA) and 4 weeks (4-w OA) after the operation. Histological examination was performed 4 weeks after the operation. One rabbit was histologically examined 2 weeks after the operation. The control consisted of six rabbits that were not subjected to the operation. The SIR values, T2 values and the thicknesses of the cartilage of the 2-w OA, 4-w OA and the control before and after contrast agent injection were analyzed. The Mankin score and OARSI (Osteoarthritis Research Society International) score were used for the histological evaluation. RESULTS Significant differences in the SIR and T2 values of the medial and lateral condyles of the femur were found between the control and the 4-w OA only after contrast agent injection. No significant differences were found in the SIR and T2 values before contrast agent injection between the control, the 2-w OA and 4-w OA. The thickness of the articular cartilage revealed no significant differences. In the histological assessment, the Mankin score and OARSI score sequentially increased from the control to the 4-w OA. CONCLUSION We evaluated the SIR and T2 values of the knees in a rabbit OA model and a control model using a new double-contrast agent. MRI with this agent enabled OA detection earlier than using conventional MRI.
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Affiliation(s)
- Okihiro Onishi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 602-8566 465, Kajiicho, Kamigyo-ku Kyoto-shi, Kyoto, Japan
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 602-8566 465, Kajiicho, Kamigyo-ku Kyoto-shi, Kyoto, Japan.
| | - Masamitsu Kido
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 602-8566 465, Kajiicho, Kamigyo-ku Kyoto-shi, Kyoto, Japan
| | - Yukichi Kabuto
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 602-8566 465, Kajiicho, Kamigyo-ku Kyoto-shi, Kyoto, Japan
| | - Keiichiro Ueshima
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 602-8566 465, Kajiicho, Kamigyo-ku Kyoto-shi, Kyoto, Japan
| | - Ken-Ichi Matsuda
- Department of Anatomy and Neurobiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaki Tanaka
- Department of Anatomy and Neurobiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 602-8566 465, Kajiicho, Kamigyo-ku Kyoto-shi, Kyoto, Japan
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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: 0.7] [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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Park MS, Yu JS, Lee JH, Kim KW. Value of manganese-enhanced T1- and T2-weighted MR cholangiography for differentiating cystic parenchymal lesions from cystic abnormalities which communicate with bile ducts. Yonsei Med J 2007; 48:1072-4. [PMID: 18159606 PMCID: PMC2628188 DOI: 10.3349/ymj.2007.48.6.1072] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We present a case report to show how manganese-enhanced T1- and T2-weighted MR cholangiography could differentiate cystic parenchymal lesions from cystic abnormalities which communicate with the bile ducts.
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Affiliation(s)
- Mi-Suk Park
- Department of Diagnostic Radiology, and Institute of Gastroenterology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
- Department of Diagnostic Radiology, Yongdong Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Sik Yu
- Department of Diagnostic Radiology, Yongdong Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hee Lee
- Department of Diagnostic Radiology, Ajou University, College of Medicine, Kyunggido, Korea
| | - Ki Whang Kim
- Department of Diagnostic Radiology, and Institute of Gastroenterology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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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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Yan GP, Robinson L, Hogg P. Magnetic resonance imaging contrast agents: Overview and perspectives. Radiography (Lond) 2007. [DOI: 10.1016/j.radi.2006.07.005] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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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Kim YK, Kim CS, Lee JM, Ko SW, Chung GH, Lee SO, Han YM, Lee SY. Value of adding T1-weighted image to MR cholangiopancreatography for detecting intrahepatic biliary stones. AJR Am J Roentgenol 2006; 187:W267-74. [PMID: 16928904 DOI: 10.2214/ajr.05.0266] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the value of adding a T1-weighted image to MR cholangiopancreatography (MRCP) to detect bile duct stones. MATERIALS AND METHODS During a 30-month period, 148 patients suspected of having biliary stones and who underwent MRI including MRCP, a fat-suppressed T1-weighted fast low-angle shot (FLASH) sequence, and an axial HASTE sequence were enrolled in this study. The biliary stones were confirmed by ERCP, surgery, and percutaneous transhepatic cholangiography. Of these 148 patients, 73 had extrahepatic stones, 45 had intrahepatic stones, 20 had both extrahepatic and intrahepatic stones, and 10 had no biliary stones. Two separate sets of images, the MRCP set (composed of MRCP and axial HASTE) and the combined interpretion of the MRCP set and the T1-weighted image, were analyzed independently and separately by two observers. The diagnostic accuracy was evaluated using the receiver operating characteristic method. The sensitivity and specificity were also calculated. RESULTS For common duct stones, the diagnostic accuracy and the sensitivity of both image sets showed similar values without any significant difference (0.998 [97.8%] for the combined interpretation; 0.988 [97.8%] for observer 1 and 0.995 [96.8%] for observer 2 for the MRCP set). However, for the intrahepatic stones, the diagnostic accuracy (0.993) and the sensitivity (98.5%) of the combined interpretation were significantly higher than those of the MRCP set for the two observers (0.926 [83.8%] for observer 1 and 0.922 [85.3%] for observer 2) (p < 0.05). No significant difference was seen in the specificity of the two image sets for both the intrahepatic and the common duct stones. CONCLUSION Combining the axial T1-weighted image with MRCP is valuable for detecting intrahepatic stones.
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Affiliation(s)
- Young Kon Kim
- Department of Diagnostic Radioology, Chonbuk National University Medical School and Hospital, 634-18 Keumam dong, Jeonju, Chonbuk, South Korea.
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Lim JS, Kim MJ, Jung YY, Kim KW. Gadobenate dimeglumine as an intrabiliary contrast agent: comparison with mangafodipir trisodium with respect to non-dilated biliary tree depiction. Korean J Radiol 2006; 6:229-34. [PMID: 16374080 PMCID: PMC2684969 DOI: 10.3348/kjr.2005.6.4.229] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the efficacy of Mangafodipir trisodium (Mn-DPDP)-enhanced MR cholangiogrphy (MRC) and Gadobenate dimeglumine (Gd-BOPTA)-enhanced MRC in visualizing a non-dilated biliary system. MATERIALS AND METHODS Eighty-eight healthy liver donor candidates underwent contrast-enhanced T1-weighted MRC. Mn-DPDP and Gd-BOPTA was used in 36 and 52 patients, respectively. Two radiologists reviewed the MR images and rated the visualization of the common duct, the right and left hepatic ducts, and the second-order branches using a 4-point scale. The contrast-to-noise ratio (CNR) of the common duct to the liver in the two groups was also compared. RESULTS Mn-DPDP MRC and Gd-BOPTA MRC both showed similar visualization grades in the common duct (p=.380, Mann-Whitney U test). In the case of the proximal bile ducts, the median visualization grade was significantly higher with Gd-BOPTA MRC than with Mn-DPDP MRC (right hepatic duct: p=0.016, left hepatic duct: p=0.014, right secondary order branches: p=0.006, left secondary order branches, p=0.003). The common duct-to-liver CNR of the Gd-BOPTA MRC group was significantly higher (38.90+/-24.50) than that of the Mn-DPDP MRC group (24.14+/-17.98) (p=.003, Student's t test). CONCLUSION Gd-BOPTA, as a biliary contrast agent, is a potential substitute for Mn-DPDP.
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Affiliation(s)
- Joon Seok Lim
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Korea
| | - Myeong-Jin Kim
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Korea
- Brain Korea 21 Project of Medical Science, Yonsei University College of Medicine, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Korea
| | - Yong Yun Jung
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Korea
| | - Ki Whang Kim
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Korea
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Mutlu H, Basekim CC, Silit E, Pekkafali Z, Erenoglu C, Kantarci M, Karsli AF, Kizilkaya E. Value of contrast-enhanced magnetic resonance cholangiography in patients undergoing laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 2005; 15:195-8; discussion 198-201. [PMID: 16082305 DOI: 10.1097/01.sle.0000174553.17543.fa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Laparoscopic cholecystectomy (LC) is the preferred treatment of symptomatic gallstone disease. Biliary injury during LC is still a serious problem. Knowledge of anatomic detail is important for not encountering the injury. Magnetic resonance cholangiography (MRC) is a noninvasive method for imaging the biliary ducts. However, MRC has many drawbacks such as not showing anatomic structures in detail and respiratory motion. In this study, contrast-enhanced MRC is used to show cystic ducts that are not seen by MRC. Reasons for patient referral for MRC and contrast-enhanced MRC included suspicion of cholecystolithiasis, adenomyomatosis, and gallbladder polyp. Our results show that routine MRC revealed cystic ducts in 38 patients (77.5%) and contrast-enhanced MRC in 46 patients (93.8%). Intraoperative cholangiography (IOC) was taken as gold standard for all patients. We found that contrast-enhanced MRC can provide a useful supplement to MRC in patients with nonvisualized cystic ducts by MRC. To our knowledge, this is the first study of visualization of cystic duct in patients undergoing LC depicted by both MRC and contrast-enhanced MRC.
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Affiliation(s)
- Hakan Mutlu
- Department of Radiology, Gulhane Military Medical Academy Haydarpasa Teaching Hospital, Istanbul, Turkey.
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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: 76] [Impact Index Per Article: 4.0] [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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Mutlu H, Basekim CC, Silit E, Pekkafali Z, Erenoglu C, Kantarci M, Karsli AF, Kizilkaya E. Value of contrast-enhanced magnetic resonance cholangiography in patients undergoing laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 2005; 15:133-6; discussion 136-8. [PMID: 15956896 DOI: 10.1097/01.sle.0000166968.56898.44] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Laparoscopic cholecystectomy (LC) is the preferred treatment for symptomatic gallstone disease. Biliary injury during LC is still a serious problem. Knowledge of anatomic detail is important for not encountering the injury. Magnetic resonance cholangiography (MRC) is a noninvasive method for imaging the biliary ducts. However, MRC has many drawbacks such as not showing anatomic structures in detail and respiratory motion. In this study, contrast-enhanced MRC was used to show cystic ducts that are not seen on MRC. Reasons for patient referral for MRC and contrast-enhanced MRC included suspicion of cholecystolithiasis, adenomyomatosis, and gallbladder polyp. Our results show that routine MRC revealed cystic ducts in 38 patients (77.5%) and contrast-enhanced MRC in 46 patients (93.8%). Intraoperative cholangiography (IOC) was taken as gold standard for all patients. We found that contrast-enhanced MRC can provide a useful supplement to MRC in patients with cystic ducts not seen on MRC. To our knowledge, this is the first study of visualization of a cystic duct in patients undergoing LC depicted by both MRC and contrast-enhanced MRC.
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Affiliation(s)
- Hakan Mutlu
- Department of Radiology, Gulhane Military Medical Academy, Haydarpasa Teaching Hospital, Istanbul, Turkey.
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Lim JS, Kim MJ, Kim JH, Kim SI, Choi JS, Park MS, Oh YT, Yoo HS, Lee JT, Kim KW. Preoperative MRI of potential living-donor-related liver transplantation using a single dose of gadobenate dimeglumine. AJR Am J Roentgenol 2005; 185:424-31. [PMID: 16037515 DOI: 10.2214/ajr.185.2.01850424] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE This article evaluates the feasibility of single-dose gadobenate dimeglumine-enhanced MRI as both an angiographic and biliary contrast medium for making a preoperative evaluation of the donor candidates for a living-donor-related liver transplantation. SUBJECTS AND METHODS Eleven right hepatic lobe donors underwent MRI examinations using T1- and T2-weighted imaging and T2-weighted MR cholangiography (MRC). The MR angiography (MRA) and contrast-enhanced (CE) T1-weighted MRC images then were obtained after injecting a single dose of gadobenate dimeglumine. One radiologist and one surgeon prospectively reviewed all the MRI examinations for hepatic vascular and biliary abnormalities and compared them with the surgical findings and intraoperative cholangiograms. In addition, two blinded reviewers evaluated the two sets of MRC (T2-weighted MRC set and T2-weighted MRC plus CE-T1-weighted MRC set) retrospectively and recorded the anatomic types of the hilar biliary branching pattern along with their confidence in the interpretation. RESULTS Prospective analysis detected the following vascular variants: hepatic arterial variation in two patients, portal venous variation in one, and a significantly large accessory hepatic vein (> 5 mm) in one. Biliary variants also were identified in two patients. All the MRI findings on the vascular and biliary anatomy were corroborated intraoperatively. Retrospective analysis showed that the mean diagnostic confidence in the combined set was significantly higher than that of the T2-weighted MRC alone by both reviewers (p < 0.05). CONCLUSION Obtaining both MRA and CE-T1-weighted MRC is feasible using a single dose of gadobenate dimeglumine. Therefore, gadobenate dimeglumine-enhanced MRI might play a role as a preoperative imaging technique for the vascular and biliary evaluation of potential living donors.
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Affiliation(s)
- Joon Seok Lim
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Seodaemun-ku Shinchondong 134, Seoul 120-752, Republic of Korea
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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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Ryeom HK, Choe BH, Kim JY, Kwon S, Ko CW, Kim HM, Lee SB, Kang DS. Biliary Atresia: Feasibility of Mangafodipir Trisodium–enhanced MR Cholangiography for Evaluation. Radiology 2005; 235:250-8. [PMID: 15749972 DOI: 10.1148/radiol.2343040028] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The study was approved by the institutional review board, and informed consent was obtained from the patients' parents. Twenty-three consecutive infants suspected of having biliary atresia (BA) were prospectively examined by using mangafodipir trisodium (Mn-DPDP)-enhanced magnetic resonance (MR) cholangiography. Sequential T1-weighted spoiled gradient-echo MR cholangiograms were obtained 1, 2, and 3 hours after intravenous administration of Mn-DPDP. The possibility of BA was excluded if bowel excretion of contrast material was noted at contrast material-enhanced MR cholangiography. The diagnostic specificity and accuracy of contrast-enhanced MR cholangiography were compared with those of conventional MR cholangiography, technetium 99m Tc ((99m)Tc)-disofenin (DISIDA) scintigraphy, and the triangular cord sign at ultrasonography (US). MR cholangiography was used to accurately distinguish four cases of BA from 19 cases of other cholestatic liver diseases, without false-positive results. Conventional MR cholangiography, (99m)Tc-DISIDA scintigraphy, and the triangular cord sign at US respectively yielded false-positive results of 42% (eight of 19 infants), 35% (six of 17 infants), and 11% (two of 19 infants) in patients without BA. Mn-DPDP-enhanced MR cholangiography appears to be a promising modality for early diagnosis of BA as the cause of neonatal cholestasis.
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Affiliation(s)
- Hun Kyu Ryeom
- Department of Radiology, Kyungpook National University School of Medicine, Samduk 2Ga, Jung-Gu, Daegu 700-721, Republic of Korea
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Park MS, Kim KW, Yu JS, Kim MJ, Kim KW, Lim JS, Cho ES, Yoon DS, Kim TK, Lee SI, Lee JD, Lee WJ, Ha HK, Lee JT, Yoo HS. Early biliary complications of laparoscopic cholecystectomy: evaluation on T2-weighted MR cholangiography in conjunction with mangafodipir trisodium-enhanced 3D T1-weighted MR cholangiography. AJR Am J Roentgenol 2005; 183:1559-66. [PMID: 15547191 DOI: 10.2214/ajr.183.6.01831559] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Our aim was to assess preliminary experience with combined conventional T2-weighted and mangafodipir trisodium (MnDPDP)-enhanced T1-weighted MR cholangiography in evaluating early biliary complications of laparoscopic cholecystectomy. SUBJECTS AND METHODS Conventional heavily T2-weighted MR cholangiography with MnDPDP-enhanced T1-weighted MR cholangiography and ERCP were performed in seven patients with high clinical suspicion of biliary complications after laparoscopic cholecystectomy. The final diagnoses of complications were classified according to the presence and degree of bile duct injury, bile leakage, and retained stones. RESULTS The diagnoses on MR cholangiography were as follows: complete transection and occlusion of the common bile duct with bile leakage (n = 3), partial strictures of the common bile duct with bile leakage (n = 1), cystic duct leakage (n = 1), partial ligation of an aberrant right hepatic duct (n = 1), and hemorrhage without biliary complication (n = 1). The final diagnoses at surgery (n = 2) and ERCP (n = 5) were as follows: complete transection and occlusion of the common bile duct with bile leakage (n = 2), partial strictures of the common bile duct with bile leakage (n = 2), cystic duct leakage (n = 1), partial ligation of an aberrant right hepatic duct (n = 1), and hemorrhage without biliary complication (n = 1). MR cholangiography accurately yielded the same findings as the final diagnoses, except in one case with partial stricture of the bile duct with bile leakage (overdiagnosed as complete occlusion on MR cholangiography). CONCLUSION Combined conventional T2-weighted and MnDPDP-enhanced T1-weighted MR cholangiography may eliminate the use of other studies for the imaging of biliary complications after cholecystectomy if this preliminary data can be verified in a larger study.
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Affiliation(s)
- Mi-Suk Park
- Department of Diagnostic Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
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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: 1.3] [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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Ayuso JR, Ayuso C, Bombuy E, De Juan C, Llovet JM, De Caralt TM, Sánchez M, Pagés M, Bruix J, García-Valdecasas JC. Preoperative evaluation of biliary anatomy in adult live liver donors with volumetric mangafodipir trisodium enhanced magnetic resonance cholangiography. Liver Transpl 2004; 10:1391-7. [PMID: 15497156 DOI: 10.1002/lt.20281] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Accurate preoperative depiction of biliary anatomy is not always adequately accomplished by imaging techniques in living donor liver transplantation (LDLT). We present the results of a prospective study designed to evaluate the ability of mangafodipir trisodium (Mn-DPDP)-enhanced magnetic resonance (MR) cholangiography (MRC) for this purpose in a series of 25 adult living liver donors (LLDs). We also analyze if a simple or a more complex surgical procedure can be preoperatively suggested for biliary reconstruction in the recipients. Findings on MRC were compared with operative cholangiography (OC). A conventional distribution with a right hepatic duct (RHD) longer than 1 cm anticipated a simple procedure (duct-to-duct anastomosis or hepaticojejunostomy [HJ]). A shorter RHD or any variant were predictors of a more complex surgery (bench ductoplasty or multiple anastomoses). Agreement between MRC and OC in assessing the biliary anatomy was measured using the kappa statistic, and differences between the kind of surgery predicted at MRC and the biliary anastomosis performed were evaluated with Fisher's exact test. Normal variants were present in 16 / 25 donors (64%). MRC was accurate in depicting the pattern of bile duct distribution observed at OC in 22 / 25 (88%) donors (kappa = .831), and correctly predicted the complexity of biliary anastomosis in the recipient in 22 / 25 (88%) donors. No significant differences were observed between complexity of biliary surgery proposed at MRC and the final surgery performed (P = .002). In conclusion, Mn-DPDP-enhanced MRC is highly accurate in depicting the biliary duct anatomy and can be used preoperatively for surgical planning in LDLT.
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Affiliation(s)
- Juan R Ayuso
- Department of Radiology, Centre de Diagnostic per la Imatge Clinic, Institut Clinic de Malalties Digestives, Hospital Clinic, Institut d'Investigacions Biomediques August PiI Sunyer, University of Barcelona, Barcelona, Spain.
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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: 3.0] [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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Bridges MD, May GR, Harnois DM. Diagnosing biliary complications of orthotopic liver transplantation with mangafodipir trisodium-enhanced MR cholangiography: comparison with conventional MR cholangiography. AJR Am J Roentgenol 2004; 182:1497-504. [PMID: 15149996 DOI: 10.2214/ajr.182.6.1821497] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study was designed to determine whether the addition of mangafodipir trisodium-enhanced MRI could improve the image quality, visualization of ductal structures, and diagnostic confidence provided by conventional T2-based MR cholangiography (MRC) in patients with suspected biliary complications after orthotopic liver transplantation. SUBJECTS AND METHODS. Our study group consisted of 25 consecutive patients who were referred for MR evaluation of clinically suspected biliary complications after orthotopic liver transplantation. Conventional MRC in the axial and coronal planes was performed in each patient, followed by fat-suppressed volumetric gradient-echo imaging in the same planes both before and after the IV administration of mangafodipir trisodium. Imaging was performed in all patients until the contrast agent was seen in the bowel. Images were then graded for quality, visualization of bile ducts and anastomoses, presence of significant stricture or leak, and level of diagnostic confidence. RESULTS Mangafodipir trisodium-enhanced MRC tended to outperform conventional MRC in overall image quality and extrahepatic duct visualization; it was also more effective in delineating biliary anastomoses, and the difference was statistically significant (p < 0.001). All 25 enhanced examinations were considered diagnostic. Diagnostic confidence was scored as poor or lacking in 14 of the conventional MRC examinations for biliary stenosis and in 12 examinations for biliary leak. CONCLUSION Enhancement with mangafodipir trisodium improves the performance of MRC for the detection and exclusion of biliary abnormalities after orthotopic liver transplantation. Future investigations should compare the performance of mangafodipir trisodium-enhanced MRC with the performance of more invasive techniques.
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Affiliation(s)
- Mellena D Bridges
- Department of Radiology, Mayo Clinic Jacksonville, 4500 San Pablo Rd., Jacksonville, FL 32224, USA.
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Pilleul F, Billaud Y, Gautier G, Monneuse O, Crombé-Ternamian A, Fouque P, Valette PJ. Mangafodipir-enhanced magnetic resonance cholangiography for the diagnosis of bile duct leaks. Gastrointest Endosc 2004; 59:818-22. [PMID: 15173794 DOI: 10.1016/s0016-5107(04)00347-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The purpose of this prospective study was to assess the value of contrast-enhanced magnetic resonance cholangiography with mangafodipir trisodium perfusion for detection and localization of trauma-induced and postoperative bile duct leaks. METHODS Eleven patients with suspected bile duct leaks after trauma (n=5) or surgery (n=6) were included. Patients with suspected leaks after cholecystectomy were excluded. All patients underwent contrast-enhanced magnetic resonance cholangiography with two-dimensional axial and three-dimensional coronal gradient-echo images acquired 1 to 3 hours after intravenous administration of mangafodipir trisodium perfusion. Contrast-enhanced magnetic resonance cholangiography findings were correlated with direct cholangiography obtained in all patients, including endoscopic retrograde (n=7) and percutaneous transhepatic cholangiography (n=4). RESULTS Biliary tract enhancement was identified in all patients on contrast-enhanced magnetic resonance cholangiography. Peritoneal cavity fluid and bile collections that contained extravasated mangafodipir trisodium (increased signal intensity on gradient-echo sequences) were demonstrated in 6 patients. Direct cholangiography confirmed the presence of bile duct leaks in these 6 patients and the absence of bile duct leaks in 5 patients. There was no false-negative or false-positive contrast-enhanced magnetic resonance cholangiography. CONCLUSIONS Mangafodipir-enhanced magnetic resonance cholangiography is a noninvasive technique that can provide functional biliary information with excellent depiction of bile duct leaks.
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Affiliation(s)
- Frank Pilleul
- Département de radiologie digestive, hôpital universitaire E. Herriot, Lyon, France
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Fayad LM, Holland GA, Bergin D, Iqbal N, Parker L, Curcillo PG, Kowalski TE, Park P, Intenzo C, Mitchell DG. Functional magnetic resonance cholangiography (fMRC) of the gallbladder and biliary tree with contrast-enhanced magnetic resonance cholangiography. J Magn Reson Imaging 2004; 18:449-60. [PMID: 14508782 DOI: 10.1002/jmri.10369] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To determine the diagnostic performance of functional magnetic resonance cholangiography (fMRC) for the evaluation of anatomic and functional biliary disorders. MATERIALS AND METHODS At 1.5 T, 39 MR examinations with conventional MRC and mangafodipir trisodium-enhanced fMRC were retrospectively reviewed by three observers who recorded anatomic (duct dilation, stricture, filling defects) and functional (cholecystitis, obstruction) abnormalities in three modes: MRC alone, fMRC alone, and MRC and fMRC images together (combined-MRC). Performance was determined by comparing findings with each mode to findings of invasive cholangiography (IC) and surgery. RESULTS Among 75 biliary segments (correlated with IC), the sensitivity/specificity for diagnosing dilation (N = 41) with MRC was 95%/97%; with fMRC, 90%/100%; with combined-MRC, 100%/97%. For stricture (N = 7), the sensitivity/specificity of MRC was 86%/98%; of fMRC, 43%/100%; of combined-MRC, 86%/100%. For filling defects (N = 9), the sensitivity/specificity of MRC was 91%/98%; of fMRC, 82%/100%; of combined-MRC, 91%/100%. For diagnosing obstruction (N = 9), the sensitivity/specificity of MRC, fMRC, and combined-MRC were 89%/100%, 100%/100%, and 100%/100%, respectively. For surgically proven cholecystitis (N = 13), positive predictive values for diagnosing acute/chronic cholecystitis for MRC were 33%/40%; for fMRC, 100%/50%; for combined-MRC, 100%/50%. CONCLUSION Although single-shot fast spin echo (SSFSE)-MRC is valuable, the addition of fMRC increased diagnostic performance for functional biliary disorders.
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Affiliation(s)
- Laura M Fayad
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
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Viremouneix L, Pilleul F, Crozon J, Gruner L, Valette PJ. [Contribution of MR cholangiography after Teslascan infusion for the diagnosis of post-traumatic biliary injury]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2004; 28:87-8. [PMID: 15041819 DOI: 10.1016/s0399-8320(04)94853-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Kim KW, Park MS, Yu JS, Chung JP, Ryu YH, Lee SI, Lee KS, Yoon SW, Lee KH. Acute cholecystitis at T2-weighted and manganese-enhanced T1-weighted MR cholangiography: preliminary study. Radiology 2003; 227:580-4. [PMID: 12637680 DOI: 10.1148/radiol.2272020207] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Twelve patients with symptoms of acute cholecystitis underwent heavily T2-weighted and mangafodipir trisodium-enhanced T1-weighted magnetic resonance (MR) cholangiography and cholescintigraphy before they underwent cholecystectomy. On T2-weighted MR cholangiographic images, morphologic evidence of outflow obstruction of the gallbladder was definitive in seven patients, equivocal in one, and absent in four. In all 12 patients, biliary dynamics depicted at manganese-enhanced T1-weighted MR cholangiography agreed completely with those depicted at hepatobiliary scintigraphy. T2-weighted MR cholangiography combined with manganese-enhanced T1-weighted MR cholangiography provides not only morphologic information but also functional information about the biliary system.
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Affiliation(s)
- Ki Whang Kim
- Department of Diagnostic Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, YongDong Severance Hospital, Kangnam-Ku, Seoul 135-270, South Korea.
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26
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Abstract
The article reviews the current MR imaging techniques commonly utilized for imaging liver tumors. Breath-hold T1-weighted GRE sequences, FSE T2-weighted sequences, and properly timed contrast-enhanced 3D SGE are important for lesion characterization. New liver-specific contrast agents improve lesion detection and are useful in lesion characterization.
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Affiliation(s)
- Ihab R Kamel
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
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Bravo FDA, Martí-Bonmatí L, Ruiz A, Jiménez JJ, Isarría S. Colangiografía por RM: estudio funcional con EG-T1 tras Mn-DPDP y comparación con el estudio convencional SS-TSE-T2. RADIOLOGIA 2003. [DOI: 10.1016/s0033-8338(03)77845-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kapoor V, Peterson MS, Baron RL, Patel S, Eghtesad B, Fung JJ. Intrahepatic biliary anatomy of living adult liver donors: correlation of mangafodipir trisodium-enhanced MR cholangiography and intraoperative cholangiography. AJR Am J Roentgenol 2002; 179:1281-6. [PMID: 12388514 DOI: 10.2214/ajr.179.5.1791281] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The purpose of our study was to assess the usefulness of mangafodipir trisodium-enhanced MR cholangiography for evaluating intrahepatic biliary anatomy of adult living liver donors and to correlate the results with intraoperative cholangiography. CONCLUSION Mangafodipir trisodium-enhanced MR cholangiography accurately shows the biliary anatomy in the livers of donors. Noninvasive preoperative evaluation of the biliary anatomy in donor candidates is important for the detection of common anatomic variants that may require alternative graft-harvesting surgery.
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Affiliation(s)
- Vibhu Kapoor
- Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213, USA
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29
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Vitellas KM, El-Dieb A, Vaswani KK, Bennett WF, Fromkes J, Ellison C, Bova JG. 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 2002; 179:409-16. [PMID: 12130442 DOI: 10.2214/ajr.179.2.1790409] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The purpose of our study was to determine whether contrast-enhanced MR cholangiography using IV mangafodipir trisodium can accurately detect the presence and location of bile duct leaks in patients who have undergone cholecystectomy. SUBJECTS AND METHODS Our study group included 11 patients with suspected bile duct leaks after cholecystectomy. Axial single-shot fast spin-echo and gradient-echo images were acquired in all patients before and 1-2 hr after IV administration of mangafodipir trisodium. The contrast-enhanced MR cholangiograms were evaluated for image quality, degree of ductal or small bowel opacification, and the presence and location of bile duct leaks, strictures, and stones. MR cholangiograms were correlated with conventional contrast-enhanced cholangiograms obtained in all patients, including endoscopic retrograde cholangiography (n = 10) and percutaneous transhepatic cholangiography (n = 1). RESULTS Excretion of mangafodipir trisodium was noted in the intrahepatic and extrahepatic bile ducts in all patients from 1 to 2 hr after IV administration. Bile ducts and fluid collections that contained excreted mangafodipir trisodium showed increased signal intensity on gradient-echo sequences and decreased signal intensity on single-shot fast spin-echo sequences. Conventional contrast-enhanced cholangiography showed the presence of bile duct leaks in six patients and the absence of bile duct leaks in five patients, with false-negative findings in one patient and false-positive findings in one patient for bile duct leak (sensitivity, 86%; specificity, 83%). CONCLUSION Contrast-enhanced MR cholangiography with IV mangafodipir trisodium can successfully detect the presence and location of bile duct leaks in patients suspected of having such leaks after undergoing cholecystectomy. More research is necessary before acceptance of this examination as routine in the workup of these patients.
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Affiliation(s)
- Kenneth M Vitellas
- Department of Radiology, The Ohio State University Medical Center, S-211 Rhodes Hall, 450 W. 10th Ave., Columbus, OH 43210, USA
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Potential role of conventional and contrast-enhanced magnetic resonance cholangiography in the evaluation of the acute abdomen in the emergency setting. Emerg Radiol 2002. [DOI: 10.1007/s10140-002-0196-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
T2-weighted imaging and MRCP, which have high sensitivity to edema and fluid, are paramount in the evaluation of certain gallbladder diseases, such as cholelithiasis, cholecystitis, adenomyomatosis, and cystic duct abnormalities. Dynamic gadolinium-enhanced MR imaging has the potential to differentiate among the many nonspecific-appearing lesions involving the gallbladder. MR imaging may not yet replace ultrasound as the workhorse of acute gallbladder imaging. Currently, MRCP is an ideal complementary study to inconclusive sonographic studies and can help plan surgical intervention in the setting of acute cholecystitis. Further investigation of hepatobiliary contrast agents, however, may reveal that MR imaging may be considered as first-line imaging in the acute setting.
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Affiliation(s)
- Saroja Adusumilli
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
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Papanikolaou N, Prassopoulos P, Eracleous E, Maris T, Gogas C, Gourtsoyiannis N. Contrast-enhanced magnetic resonance cholangiography versus heavily T2-weighted magnetic resonance cholangiography. Invest Radiol 2001; 36:682-6. [PMID: 11606846 DOI: 10.1097/00004424-200111000-00008] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate the feasibility of contrast-enhanced magnetic resonance cholangiography (CE-MRC) and compare it with single-shot turbo spin-echo magnetic resonance cholangiography (SSTSE-MRC). METHODS Fifteen patients with suspected metastatic liver disease (n = 10) or biliary tree abnormalities (n = 5) underwent a magnetic resonance imaging (1.5-T system) examination before and after mangafodipir administration. Contrast-enhanced MRC with a three-dimensional fast low-angle shot sequence after mangafodipir trisodium administration was compared with SSTSE-MRC. Four anatomic segments were evaluated: the intrapancreatic and extrapancreatic common bile duct segments, the cystic duct, and the area of hepatic bifurcation. Contrast-enhanced MRC and SSTSE-MRC were separately analyzed on a 5-point grading scale in terms of ductal segment visualization and lumen narrowing or dilatation. RESULTS There was no difference (P = 0.375) in segment visualization between CE-MRC and SSTSE-MRC; 56 of the 60 segments were visualized by both techniques. In the evaluation of ductal narrowing or dilatation, nonsignificant differences (P = 0.500) were observed. Contrast-enhanced MRC was not influenced by fluid superimposition and provided additional information from background tissues. CONCLUSIONS Contract-enhanced MRC is a feasible technique showing anatomic correlation with SSTSE-MRC, and it can in addition provide functional information. Contrast-enhanced MRC may be used in selected patients when traditional SSTSE-MRC is inconclusive.
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Affiliation(s)
- N Papanikolaou
- Department of Radiology, University Hospital of Heraklion, Medical School of Crete, Stavrakia, 71110 Heraklion, Crete
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Lee VS, Morgan GR, Teperman LW, John D, Diflo T, Pandharipande PV, Berman PM, Lavelle MT, Krinsky GA, Rofsky NM, Schlossberg P, Weinreb JC. MR imaging as the sole preoperative imaging modality for right hepatectomy: a prospective study of living adult-to-adult liver donor candidates. AJR Am J Roentgenol 2001; 176:1475-82. [PMID: 11373217 DOI: 10.2214/ajr.176.6.1761475] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Our aim was to investigate the feasibility of MR imaging as a comprehensive preoperative imaging test for examination of liver donor candidates for adult-to-adult right lobe transplantation. SUBJECTS AND METHODS Twenty-five consecutive donor candidates were examined at 1.5 T using a torso phased array coil with breath-hold T1- and T2-weighted imaging of the abdomen, MR cholangiography using T2-weighted turbo spin-echo imaging, and MR angiography and venography of the liver using two interpolated three-dimensional spoiled gradient-echo sequences (average dose of gadolinium contrast material, 0.17 mmol/kg). Images were interpreted for liver parenchymal and extrahepatic abnormalities; measurements of right and left lobe liver volumes; definition of hepatic arterial, portal venous, and hepatic venous anatomy; and definition of the biliary branching pattern. Findings were compared with those of conventional angiography in 13 patients, 11 of whom also had surgical findings for comparison. RESULTS Nine patients were excluded as candidates for donation on the basis of MR imaging findings that included parenchymal or extrahepatic abnormalities in five patients, vascular anomalies in two, and biliary anomalies in three. Two patients who did not undergo surgery underwent conventional angiography that confirmed MR angiographic findings except for a small (<2 mm) accessory left hepatic artery missed on MR imaging. Of the nine patients who underwent successful right hepatectomy, all MR imaging findings were corroborated intraoperatively. In two patients, right hepatectomy was aborted at laparotomy because of intraoperative cholangiography findings; in one of them, the biliary finding was unsuspected on MR imaging. CONCLUSION A comprehensive MR imaging examination has the potential to serve as the sole preoperative imaging modality for living adult-to-adult liver donor candidates provided improvements in definition of intrahepatic biliary anatomy can be achieved.
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Affiliation(s)
- V S Lee
- Department of Radiology-MRI, New York University Medical Center, 530 First Ave., New York, NY 10016, USA
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Lee VS, Rofsky NM, Morgan GR, Teperman LW, Krinsky GA, Berman P, Weinreb JC. Volumetric mangafodipir trisodium-enhanced cholangiography to define intrahepatic biliary anatomy. AJR Am J Roentgenol 2001; 176:906-8. [PMID: 11264075 DOI: 10.2214/ajr.176.4.1760906] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- V S Lee
- Department of Radiology, MRI, New York University Medical Center, 530 First Ave., HCC Basement, New York, NY 10016, USA
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Abstract
A variety of different categories of contrast agents, and within each category a number of individual agents, are currently available for clinical use in magnetic resonance (MR) imaging of the liver. In this review, the use of nonspecific extracellular gadolinium chelates, reticuloendothelial system-specific iron oxide particulate agents, hepatocyte-selective agents, and combined perfusion and hepatocyte-selective agents are described. Most clinical experience is with nonspecific extracellular gadolinium chelates. The relatively low cost, safety, good patient tolerance, and ability to help detect and characterize a wide range of liver diseases have rendered gadolinium chelates as commonly used agents. Reticuloendothelial system-specific agents improve lesion detection by decreasing the signal intensity of background liver on T2-weighted MR images, which increases the conspicuity of focal hepatic lesions with negligible reticuloendothelial cells (eg, metastases). Hepatocyte-selective agents increase the signal intensity of background liver on T1-weighted images, which increases the conspicuity of focal lesions that do not contain hepatocytes (eg, metastases). The clinical application of the different categories of contrast agents, techniques for their administration, sequences to be used, and appearances of common entities on contrast agent-enhanced studies are described.
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Affiliation(s)
- R C Semelka
- Department of Radiology, University of North Carolina School of Medicine, CB 7510, Chapel Hill, NC 27599-7510, USA.
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Vitellas KM, El-Dieb A, Vaswani K, Bennett WF, Fromkes J, Steinberg S, Bova JG. Detection of bile duct leaks using MR cholangiography with mangfodipir trisodium (Teslascan). J Comput Assist Tomogr 2001; 25:102-5. [PMID: 11176303 DOI: 10.1097/00004728-200101000-00019] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mangafodipir trisodium (Teslascan), a hepatobiliary contrast agent, has the potential of providing functional biliary imaging similar to hepatobiliary scintigraphy. To our knowledge. the potential role of this biliary contrast agent in the detection of bile duct leaks has not been reported. In this case report, we report the first case of a bile duct leak diagnosed with enhanced MRI with mangafodipir trisodium in a patient following laparoscopic cholecystectomy. Our case illustrates that functional MR cholangiography images can be successfully acquired by using a post-mangafodipir fat-suppressed GRE technique and that bile duct leaks can be detected.
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Affiliation(s)
- K M Vitellas
- Department of Radiology, Ohio State University Medical Center, Columbus 43230, USA.
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