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Ludwig DR, Itani M, Childs DD, Revzin MV, Das KK, Anderson MA, Arif-Tiwari H, Lockhart ME, Fulcher AS. Biliary Duct Dilatation: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024; 222:e2329671. [PMID: 37493325 DOI: 10.2214/ajr.23.29671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Biliary duct dilatation is a common incidental finding in practice, but it is unlikely to indicate biliary obstruction in the absence of clinical symptoms or elevated levels on liver function tests (LFTs). However, the clinical presentation may be nonspecific, and LFTs may either be unavailable or difficult to interpret. The goal of this AJR Expert Panel Narrative Review is to highlight a series of topics fundamental to the management of biliary duct dilatation, providing consensus recommendations in a question-and-answer format. We start by covering a basic approach to interpreting LFT results, the strengths and weaknesses of the biliary imaging modalities, and how and where to measure the extrahepatic bile duct. Next, we define the criteria for biliary duct dilatation, including patients with prior cholecystectomy and advanced age, and discuss when and whether biliary duct dilatation can be attributed to papillary stenosis or sphincter of Oddi dysfunction. Subsequently, we discuss two conditions in which the duct is pathologically dilated but not obstructed: congenital cystic dilatation (i.e., choledochal cyst) and intraductal papillary neoplasm of the bile duct. Finally, we provide guidance regarding when to recommend obtaining additional imaging or testing, such as endoscopic ultrasound or ERCP, and include a discussion of future directions in biliary imaging.
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Affiliation(s)
- Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, Saint Louis, MO 63110
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, Saint Louis, MO 63110
| | - David D Childs
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC
| | | | - Koushik K Das
- Division of Gastroenterology, Washington University School of Medicine, Saint Louis, MO
| | - Mark A Anderson
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Hina Arif-Tiwari
- Department of Radiology, University of Arizona College of Medicine, Tucson, AZ
| | - Mark E Lockhart
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL
| | - Ann S Fulcher
- Department of Radiology, Medical College of Virginia/Virginia Commonwealth Medical Center, Richmond, VA
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2
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Poetter-Lang S, Messner A, Bastati N, Ringe KI, Ronot M, Venkatesh SK, Ambros R, Kristic A, Korajac A, Dovjak G, Zalaudek M, Hodge JC, Schramm C, Halilbasic E, Trauner M, Ba-Ssalamah A. Diagnosis of functional strictures in patients with primary sclerosing cholangitis using hepatobiliary contrast-enhanced MRI: a proof-of-concept study. Eur Radiol 2023; 33:9022-9037. [PMID: 37470827 PMCID: PMC10667158 DOI: 10.1007/s00330-023-09915-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/20/2023] [Accepted: 05/09/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES PSC strictures are routinely diagnosed on T2-MRCP as dominant- (DS) or high-grade stricture (HGS). However, high inter-observer variability limits their utility. We introduce the "potential functional stricture" (PFS) on T1-weighted hepatobiliary-phase images of gadoxetic acid-enhanced MR cholangiography (T1-MRC) to assess inter-reader agreement on diagnosis, location, and prognostic value of PFS on T1-MRC vs. DS or HGS on T2-MRCP in PSC patients, using ERCP as the gold standard. METHODS Six blinded readers independently reviewed 129 MRIs to diagnose and locate stricture, if present. DS/HGS was determined on T2-MRCP. On T1-MRC, PFS was diagnosed if no GA excretion was seen in the CBD, hilum or distal RHD, or LHD. If excretion was normal, "no functional stricture" (NFS) was diagnosed. T1-MRC diagnoses (NFS = 87; PFS = 42) were correlated with ERCP, clinical scores, labs, splenic volume, and clinical events. Statistical analyses included Kaplan-Meier curves and Cox regression. RESULTS Interobserver agreement was almost perfect for NFS vs. PFS diagnosis, but fair to moderate for DS and HGS. Forty-four ERCPs in 129 patients (34.1%) were performed, 39 in PFS (92.9%), and, due to clinical suspicion, five in NFS (5.7%) patients. PFS and NFS diagnoses had 100% PPV and 100% NPV, respectively. Labs and clinical scores were significantly worse for PFS vs. NFS. PFS patients underwent more diagnostic and therapeutic ERCPs, experienced more clinical events, and reached significantly more endpoints (p < 0.001) than those with NFS. Multivariate analysis identified PFS as an independent risk factor for liver-related events. CONCLUSION T1-MRC was superior to T2-MRCP for stricture diagnosis, stricture location, and prognostication. CLINICAL RELEVANCE STATEMENT Because half of PSC patients will develop clinically-relevant strictures over the course of the disease, earlier more confident diagnosis and correct localization of functional stricture on gadoxetic acid-enhanced MRI may optimize management and improve prognostication. KEY POINTS • There is no consensus regarding biliary stricture imaging features in PSC that have clinical relevance. • Twenty-minute T1-weighted MRC images correctly classified PSC patients with potential (PFS) vs with no functional stricture (NFS). • T1-MRC diagnoses may reduce the burden of diagnostic ERCPs.
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Affiliation(s)
- Sarah Poetter-Lang
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Alina Messner
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Nina Bastati
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Kristina I Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Maxime Ronot
- Department of Medical Imaging at the Beaujon University Hospital in Clichy, University of Paris, Clichy, France
| | - Sudhakar K Venkatesh
- Division of Abdominal Imaging, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Raphael Ambros
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Antonia Kristic
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Aida Korajac
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Gregor Dovjak
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Martin Zalaudek
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Jacqueline C Hodge
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Christoph Schramm
- Department of Gastroenterology, Hepatology, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
| | - Emina Halilbasic
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, General Hospital of Vienna (AKH), Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, General Hospital of Vienna (AKH), Vienna, Austria
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria.
- Department of Biomedical Imaging and Image-Guided Therapy, General Hospital of Vienna (AKH), Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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3
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Zhang H, Guo Y, Jiao J, Qiu Y, Miao Y, He Y, Li Z, Xia C, Li L, Cai J, Xu K, Liu X, Zhang C, Bay BH, Song S, Yang Y, Peng M, Wang Y, Fan H. A hepatocyte-targeting nanoparticle for enhanced hepatobiliary magnetic resonance imaging. Nat Biomed Eng 2023; 7:221-235. [PMID: 36536254 DOI: 10.1038/s41551-022-00975-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 10/27/2022] [Indexed: 12/24/2022]
Abstract
Hepatobiliary magnetic resonance imaging (MRI) can inform the diagnosis of liver tumours in patients with liver cirrhosis and hepatitis. However, its clinical utility has been hampered by the lack of sensitive and specific contrast agents, partly because hepatocyte-specific nanoparticles, regardless of their surface ligands, are readily sequestered by Kupffer cells. Here we show, in rabbits, pigs and macaques, that the performance of hepatobiliary MRI can be enhanced by an ultrasmall nanoparticle composed of a manganese ferrite core (3 nm in diameter) and poly(ethylene glycol)-ethoxy-benzyl surface ligands binding to hepatocyte-specific transmembrane metal and anion transporters. The nanoparticle facilitated faster, more sensitive and higher-resolution hepatobiliary MRI than the clinically used contrast agent gadoxetate disodium, a substantial enhancement in the detection rate (92% versus 48%) of early-stage liver tumours in rabbits, and a more accurate assessment of biliary obstruction in macaques. The nanoparticle's performance and biocompatibility support the further translational development of liver-specific MRI contrast agents.
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Affiliation(s)
- Huan Zhang
- Key Laboratory of Synthetic and Natural Functional Molecule of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xi'an, Shaanxi, China
| | - Yingkun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ju Jiao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ying Qiu
- Key Laboratory of Synthetic and Natural Functional Molecule of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xi'an, Shaanxi, China
| | - Yuqing Miao
- Key Laboratory of Synthetic and Natural Functional Molecule of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xi'an, Shaanxi, China
| | - Yuan He
- Key Laboratory of Synthetic and Natural Functional Molecule of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xi'an, Shaanxi, China
| | - Zhenlin Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Li
- State Key Laboratory of Oncology in South China, Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Jing Cai
- State Key Laboratory of Oncology in South China, Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Ke Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoli Liu
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Medicine, Northwest University, Xi'an, Shaanxi, China
| | - Ce Zhang
- College of Physics, Northwest University, Xi'an, Shaanxi, China
| | - Boon-Huat Bay
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shijie Song
- Key Laboratory of Standardization and Measurement for Nanotechnology, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yanlian Yang
- Key Laboratory of Standardization and Measurement for Nanotechnology, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Mingli Peng
- Key Laboratory of Synthetic and Natural Functional Molecule of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xi'an, Shaanxi, China
| | - Yaoyu Wang
- Key Laboratory of Synthetic and Natural Functional Molecule of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xi'an, Shaanxi, China
| | - Haiming Fan
- Key Laboratory of Synthetic and Natural Functional Molecule of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xi'an, Shaanxi, China.
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Medicine, Northwest University, Xi'an, Shaanxi, China.
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Zember J, Loomis J, Vyas P, Badalyan V, Shet N. Advances in Diagnostic Imaging in Pediatric Gastroenterology. Curr Gastroenterol Rep 2020; 22:22. [PMID: 32193706 DOI: 10.1007/s11894-020-00762-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW The purpose is to provide a review of cross-sectional imaging updates in the assessment of gastrointestinal diseases, relevant to clinical practice and research. RECENT FINDINGS New magnetic resonance imaging contrast agents (Eovist) are taken up by hepatocytes and excreted via the biliary tree. As such, a lesion will retain contrast only if hepatocytes are present, which aids in refining the differential diagnosis. Magnetic resonance enterography is a method for non-invasively diagnosing and following various GI conditions, predominantly inflammatory bowel disease. Contrast-enhanced ultrasound uses gas-filled microbubbles providing superb temporal resolution most notably in the arterial phase, which aids in differentiating lesions. Elastography is a new technique which assesses stiffness of liver for evaluating fibrosis. These new techniques provide more accurate diagnoses and information, often limiting ionizing radiation exposure from other modalities. While ultrasound will still remain the initial imaging modality, familiarity with these other options is valuable for appropriate pathology workup.
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Affiliation(s)
- Jonathan Zember
- Department of Radiology, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC, USA.
| | - Judyta Loomis
- Department of Radiology, Children's National Hospital, Washington, DC, USA
| | - Pranav Vyas
- Department of Radiology, Children's National Hospital, Washington, DC, USA
| | - Vahe Badalyan
- Department of Gastroenterology, Hepatology and Nutrition, Children's National Hospital, Washington, DC, USA
| | - Narendra Shet
- Department of Radiology, Children's National Hospital, Washington, DC, USA
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Shet NS, Flynn JF, Maloney E, Iyer RS. Use of Eovist in Pediatric Patients: Pearls and Pitfalls. Curr Probl Diagn Radiol 2019; 49:266-274. [PMID: 31047739 DOI: 10.1067/j.cpradiol.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/02/2019] [Indexed: 12/25/2022]
Abstract
Magnetic resonance imaging is excellent at characterizing pediatric hepatobiliary pathology. Noncontrast MRI is helpful due to T2 hyperintensity associated with bile, but contrast enhancement offers additional means of lesional characterization. In particular, hepatocyte-specific contrast agents such as gadoxetate disodium (Eovist) exhibit partial hepatobiliary excretion which may be leveraged in these contexts. In this review, we will discuss gadoxetate disodium usage, including a sample-imaging protocol, and demonstrate applications and limitations in the pediatric population.
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Affiliation(s)
- Narendra S Shet
- Division of Diagnostic Imaging and Radiology; Children's National Health System; Washington, DC.
| | - John F Flynn
- Division of Diagnostic Imaging and Radiology; Children's National Health System; Washington, DC
| | - Ezekiel Maloney
- Department of Radiology; Seattle Children's Hospital; Seattle, WA
| | - Ramesh S Iyer
- Department of Radiology; Seattle Children's Hospital; Seattle, WA
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6
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Helmberger H, Kammer B. [Radiologic diagnosis of the gallbladder and bile ducts - part 2 : Acute and chronic cholecystitis, primary sclerosing cholangitis (PSC), benign and malignant masses of the biliary system]. Radiologe 2018; 58:1099-1114. [PMID: 30430195 DOI: 10.1007/s00117-018-0463-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Upper abdominal pain, icterus and cholestasis are the symptoms leading to evaluation of the biliary tract. Together with its complications biliary stone disease is the main reason for inflammation of the biliary system. A distinction is made between acute and chronic variants. In chronic bile duct inflammation primary sclerosing cholangitis (PSC), primary biliary cirrhosis (PBC) and more recently IgG4-associated sclerosing cholangitis are of particular importance. Besides benign and tumor-like-lesions, malignant entities as gallbladder carcinoma and cholangiocarcinoma (CCC) in its three locations have to be mentioned. Despite all recent improvements, specificity of bile-tract imaging still remains limited, especially regarding malignant masses. Therefore the final diagnosis is made in many cases by histological analysis.
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Affiliation(s)
- H Helmberger
- Zentrum für Radiologie und Nuklearmedizin Nymphenburg, Klinikum Dritter Orden, Menzingerstr. 44, 80638, München, Deutschland.
| | - B Kammer
- Kinderradiologie im Dr. von Haunerschen Kinderspital der Radiologischen Klinik und Poliklinik, Ludwig-Maximilian-Universität München, München, Deutschland
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7
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Helmberger H, Kammer B. [Radiologic diagnostics of the gall bladder and bile ducts-part 1 : Imaging techniques-normal variants and congenital disorders-cholelithiasis]. Radiologe 2018; 58:1021-1034. [PMID: 30353209 DOI: 10.1007/s00117-018-0460-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Upper abdominal pain, icterus and cholestasis are the main symptoms leading to evaluation of the biliary tract. Since the advent of contrast-enhanced ultrasound techniques the accuracy of bile duct imaging has significantly improved. This is also true for computed tomography using isotropic secondary reconstructions as well as magnetic resonance imaging (MRI) including MR cholangiography (MRC), classically and after iv injection of hepatobiliary contrast agent. Diffusion-weighted imaging sequences have a recently proven ability for improving biliary tract imaging. These technical improvements provide the depiction of the non-dilated biliary tract system in diagnostic quality. Therefore, normal variants and congenital disorders of biliary tract anatomy are delineated as well as insights into the postoperative situs and complications related to surgery. Cholelithiasis is the most frequent disease of the gall bladder and biliary tract. Together with related complications, in the majority of cases it is also the reason for bile duct inflammation. Due to the immediate need for treatment special care has to be taken for hydrops of the gall bladder.
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Affiliation(s)
- H Helmberger
- Zentrum für Radiologie und Nuklearmedizin Nymphenburg, Klinikum Dritter Orden, Menzingerstr. 44, 80638, München, Deutschland.
| | - B Kammer
- Kinderradiologie im Dr. von Haunerschen Kinderspital der Radiologischen Klinik und Poliklinik, Ludwig-Maximilians-Universität München, München, Deutschland
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8
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Kinner S, Schubert TB, Said A, Mezrich JD, Reeder SB. Added value of gadoxetic acid-enhanced T1-weighted magnetic resonance cholangiography for the diagnosis of post-transplant biliary complications. Eur Radiol 2017; 27:4415-4425. [PMID: 28409358 DOI: 10.1007/s00330-017-4797-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/18/2017] [Accepted: 03/07/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Biliary complications after liver transplantation (LT) are common. This study aimed to ascertain the value of gadoxetic acid-enhanced T1-weighted (T1w) magnetic resonance cholangiography (MRC) to evaluate anastomotic strictures (AS), non-anastomotic strictures (NAS) and biliary casts (BC). METHODS Sixty liver-transplanted patients with suspicion of biliary complications and T2w-MRCP and T1w-MRC followed by endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) were analysed. Two readers reviewed the MRCs and rated image quality (IQ) and likelihood for AS/NAS/BC on Likert scales. Sensitivity, specificity and predictive values were calculated, ROC curve analysis performed, and inter-reader variability assessed. The subjective added value of T1w-MRC was rated. RESULTS IQ was high for all sequences without significant differences (2.83-2.88). In 39 patients ERCP/PTC detected a complication. Sensitivity and specificity for AS were 64-96 using T2w-MRCP, increasing to 79-100 using all sequences. Use of all sequences increased the sensitivity of detecting NAS/BC from 72-92% to 88-100% and 67-89% to 72-94%, respectively. Kappa values were substantial (0.45-0.62). T1w-MRC was found to be helpful in 75-83.3%. CONCLUSIONS Combining T1w-MRC and T2w-MRCP increased sensitivity and specificity and diagnostic confidence in patients after LT with suspected biliary complications. T1w-MRC is a valuable tool for evaluating post-transplant biliary complications. KEY POINTS • T1w-MRC is a valuable tool for evaluating post-transplant biliary complications. • Adding T1w-MRC to T2w-MRC increases diagnostic confidence for detection of biliary complications. • A combination of T1w-MRC and T2w-MRCP leads to the best results.
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Affiliation(s)
- Sonja Kinner
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave., Madison, WI, 53792-3252, USA. .,Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
| | - Tilman B Schubert
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave., Madison, WI, 53792-3252, USA.,Clinic of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland
| | - Adnan Said
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Joshua D Mezrich
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave., Madison, WI, 53792-3252, USA.,Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.,Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
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Corwin MT, Malutich S, Salcedo ES, Fananapazir G, Brock JM, McGahan JP. Evaluation of cystic duct patency: comparison of functional MR cholangiography with gadoxetate disodium and hepatobiliary scintigraphy in suspected acute cholecystitis. Clin Imaging 2016; 40:973-8. [PMID: 27240319 DOI: 10.1016/j.clinimag.2016.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/01/2016] [Accepted: 04/22/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE This study aims to compare assessment of cystic duct patency between gadoxetate disodium MRI and hepatobiliary scintigraphy. MATERIALS AND METHODS We performed a prospective study of patients who underwent gadoxetate disodium MRI within 16 h of scintigraphy. RESULTS The gallbladder filled on MRI and scintigraphy in 8 patients, none with acute cholecystitis. The mean time to gallbladder filling was 14.6 and 18.9 min for MRI and scintigraphy, respectively. The gallbladder did not fill on both MRI and scintigraphy in 3 patients, all of whom had acute cholecystitis. CONCLUSION Evaluation of cystic duct patency using gadoxetate disodium MRI is comparable to hepatobiliary scintigraphy.
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Affiliation(s)
- Michael T Corwin
- University of California, Davis Medical Center, Department of Radiology, 4860 Y Street, ACC Suite 3100, Sacramento, CA, 95817.
| | - Stephen Malutich
- University of California, Davis Medical Center, Department of Radiology, 4860 Y Street, ACC Suite 3100, Sacramento, CA, 95817
| | - Edgardo S Salcedo
- University of California, Davis Medical Center, Department of Surgery, 2315 Stockton Blvd., Sacramento, CA, 95817
| | - Ghaneh Fananapazir
- University of California, Davis Medical Center, Department of Radiology, 4860 Y Street, ACC Suite 3100, Sacramento, CA, 95817
| | - John M Brock
- University of California, Davis Medical Center, Department of Radiology, 4860 Y Street, ACC Suite 3100, Sacramento, CA, 95817
| | - John P McGahan
- University of California, Davis Medical Center, Department of Radiology, 4860 Y Street, ACC Suite 3100, Sacramento, CA, 95817
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10
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Schwope RB, May LA, Reiter MJ, Lisanti CJ, Margolis DJA. Gadoxetic acid: pearls and pitfalls. ACTA ACUST UNITED AC 2016; 40:2012-29. [PMID: 25613332 DOI: 10.1007/s00261-015-0354-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gadoxetic acid is a hepatocyte-specific magnetic resonance imaging contrast agent with the ability to detect and characterize focal liver lesions and provide structural and functional information about the hepatobiliary system. Knowledge of the pharmacokinetics of gadoxetic acid is paramount to understanding imaging protocol and lesion appearance and facilitates identification and avoidance of undesired effects with use of this intravenous contrast agent. This article reviews the utility of gadoxetic acid in liver and biliary imaging, with emphasis on the hepatobiliary phase.
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Affiliation(s)
- Ryan B Schwope
- Department of Radiology, San Antonio Military Medical Center, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA,
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11
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Value of Magnetic Resonance Cholangiopancreatography in Assessment of Nonanastomotic Biliary Strictures After Liver Transplantation. Transplant Direct 2015; 1:e42. [PMID: 27500210 PMCID: PMC4946454 DOI: 10.1097/txd.0000000000000556] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 10/19/2015] [Indexed: 12/13/2022] Open
Abstract
Nonanastomotic biliary strictures (NAS) remain a frequent complication after orthotopic liver transplantation (OLT). The aim of this study was to evaluate whether magnetic resonance cholangiopancreatography (MRCP) could be used to detect NAS and to grade the severity of biliary strictures.
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12
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Polistina FA, Frego M, Bisello M, Manzi E, Vardanega A, Perin B. Accuracy of magnetic resonance cholangiography compared to operative endoscopy in detecting biliary stones, a single center experience and review of literature. World J Radiol 2015; 7:70-78. [PMID: 25918584 PMCID: PMC4404370 DOI: 10.4329/wjr.v7.i4.70] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/25/2014] [Accepted: 03/18/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare diagnostic sensitivity, specificity and accuracy of magnetic resonance cholangiopancreatography (MRCP) without contrast medium and endoscopic ultrasound (EUS)/endoscopic retrograde cholangiopancreatography (ERCP) for biliary calculi.
METHODS: From January 2012 to December 2013, two-hundred-sixty-three patients underwent MRCP at our institution, all MRCP procedure were performed with the same machinery. In two-hundred MRCP was done for pure hepatobiliary symptoms and these patients are the subjects of this study. Among these two-hundred patients, one-hundred-eleven (55.5%) underwent ERCP after MRCP. The retrospective study design consisted in the systematic revision of all images from MRCP and EUS/ERCP performed by two radiologist with a long experience in biliary imaging, an experienced endoscopist and a senior consultant in Hepatobiliopancreatic surgery. A false positive was defined an MRCP showing calculi with no findings at EUS/ERCP; a true positive was defined as a concordance between MRCP and EUS/ERCP findings; a false negative was defined as the absence of images suggesting calculi at MRCP with calculi localization/extraction at EUS/ERCP and a true negative was defined as a patient with no calculi at MRCP ad at least 6 mo of asymptomatic follow-up. Biliary tree dilatation was defined as a common bile duct diameter larger than 6 mm in a patient who had an in situ gallbladder. A third blinded radiologist who examined the MRCP and ERCP data reviewed misdiagnosed cases. Once obtained overall data on sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) we divided patients in two groups composed of those having concordant MRCP and EUS/ERCP (Group A, 72 patients) and those having discordant MRCP and EUS/ERCP (Group B, 20 patients). Dataset comparisons had been made by the Student’s t-test and χ2 when appropriate.
RESULTS: Two-hundred patients (91 men, 109 women, mean age 67.6 years, and range 25-98 years) underwent MRCP. All patients attended regular follow-up for at least 6 mo. Morbidity and mortality related to MRCP were null. MRCP was the only exam performed in 89 patients because it did show only calculi into the gallbladder with no signs of the presence of calculi into the bile duct and symptoms resolved within a few days or after colecistectomy. The patients remained asymptomatic for at least 6 mo, and we assumed they were true negatives. One hundred eleven (53 men, 58 women, mean age 69 years, range 25-98 years) underwent ERCP following MRCP. We did not find any difference between the two groups in terms of race, age, and sex. The overall median interval between MRCP and ERCP was 9 d. In detecting biliary stones MRCP Sensitivity was 77.4%, Specificity 100% and Accuracy 80.5% with a PPV of 100% and NPV of 85%; EUS showed 95% sensitivity, 100% specificity, 95.5% accuracy with 100% PPV and 57.1% NPV. The association of EUS with ERCP performed at 100% in all the evaluated parameters. When comparing the two groups, we did not find any statistically significant difference regarding age, sex, and race. Similarly, we did not find any differences regarding the number of extracted stones: 116 stones in Group A (median 2, range 1 to 9) and 27 in Group B (median 2, range 1 to 4). When we compared the size of the extracted stones we found that the patients in Group B had significantly smaller stones: 14.16 ± 8.11 mm in Group A and 5.15 ± 2.09 mm in Group B; 95% confidence interval = 5.89-12.13, standard error = 1.577; P < 0.05. We also found that in Group B there was a significantly higher incidence of stones smaller than 5 mm: 36 in Group A and 18 in Group B, P < 0.05.
CONCLUSION: Major finding of the present study is that choledocholithiasis is still under-diagnosed in MRCP. Smaller stones (< 5 mm diameter) are hardly visualized on MRCP.
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Resolution of pneumobilia as a predictor of biliary stent occlusion. Clin Imaging 2015; 39:650-3. [PMID: 25892599 DOI: 10.1016/j.clinimag.2015.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 03/17/2015] [Accepted: 03/27/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To predict biliary stent occlusion on computed tomography (CT) from the loss of pneumobilia. METHODS A total of 66 patients with common bile duct stents with pneumobilia after initial stent placement had a follow-up CT and diagnostic endoscopic retrograde cholangiopancreatography (ERCP). Two readers evaluated all CT exams for pneumobilia. Resolution or decrease of pneumobilia on CT was compared with ERCP findings. RESULTS Sensitivity and specificity was 60-64% and 95% with a positive predictive value of 97% and a negative predictive value of 49-51%. CONCLUSION Resolution or reduction of pneumobilia after stent placement is specific (95%) and is moderately accurate (70-73%) for predicting biliary stent occlusion.
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Consensus Statements From a Multidisciplinary Expert Panel on the Utilization and Application of a Liver-Specific MRI Contrast Agent (Gadoxetic Acid). AJR Am J Roentgenol 2015; 204:498-509. [PMID: 25714278 DOI: 10.2214/ajr.13.12399] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Potential of Gd-EOB-DTPA-enhanced MR imaging for evaluation of bile duct ligation-induced liver injury in rabbits. Hepatol Int 2014; 9:303-9. [PMID: 25788184 DOI: 10.1007/s12072-014-9595-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 11/18/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the potential of gadoxetic acid (Gd-EOB-DTPA)-enhanced MRI for assessment of bile duct ligation (BDL)-induced chelostatic liver injury in an animal model by T1 relaxation time measurements and first-pass perfusion analyses. MATERIALS AND METHODS Twenty-four rabbits were classified into three groups as follows: control group (N group), n = 8; BDL group studied on the 5th postoperative day (BDL-5d group), n = 8; BDL group studied on the 14th postoperative day (BDL-14d group), n = 8. A dual flip angle three-dimensional gradient echo sequence with volumetric interpolated breath-hold examination was performed before and at 20 min [hepatobiliary phase (HBP)] after Gd-EOB-DTPA administration. Besides, early dynamic contrast-enhanced MRI was performed for 4.32 min with a temporal resolution of 2.2 s. T1 relaxation times of liver parenchyma were measured and perfusion parameters were calculated. RESULTS Dilatation of intra-hepatic bile duct was found only in the BDL-14d group. HBP T1 relaxation times of the BDL-5d and BDL-14d groups were significantly prolonged (p < 0.001) and the enhancement slope percentage of BDL-5d and BDL-14d groups were significantly lowered in comparison with that of the N group (p < 0.001). There were no differences between the BDL-5d group and the BDL-14d group for HBP T1 relaxation times and the enhancement slope percentage (p > 0.05). Area under the receiver operating characteristic curve of HBP T1 relaxation time and the enhancement slope percentage for the selection of chelostatic liver were 0.98 and 0.92 for the BDL-5d group, and 0.96 and 0.98 for the BDL-14d group, respectively. CONCLUSIONS HBP T1 relaxation time measurement in combination with first-pass enhancement slope percentage withhold promise to assess extrahepatic chelostatic liver injury.
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Kühn JP, Spoerl M, Nassif A, Mester M, Weitschies W, Siegmund W, Hosten N, Mensel B. Feasibility of gadoxetate disodium-enhanced MR cholangiography in chronic cholestatic biliary disease. Clin Radiol 2014; 69:1027-33. [PMID: 24957855 DOI: 10.1016/j.crad.2014.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 05/05/2014] [Accepted: 05/08/2014] [Indexed: 12/22/2022]
Abstract
AIM To investigate the feasibility of gadoxetate disodium-enhanced magnetic resonance (MR) cholangiography in chronic obstructive cholestatic biliary disease in the clinical setting. MATERIALS AND METHODS Twenty-three patients with dilated bile duct trees and ten volunteers underwent gadoxetate disodium-enhanced liver MR cholangiography and were enrolled in the present retrospective study. Gadoxetate disodium was given in a standardized manner as a bolus injection at a dose of 0.25 mmol/kg of body weight (0.1 ml/kg). Region of interest-based measurement of mean enhancement of the dilated bile ducts was performed in series before gadoxetate disodium administration and during hepatobiliary phases. RESULTS Direct comparison of mean bile duct enhancement during hepatobiliary phases in the clinical imaging window between healthy volunteers [4.7 ± 2.2 arbitrary units (au)] and patients with dilated bile ducts (0.1 ± 0.3 au) revealed significantly lower or absent enhancement in dilated bile ducts (p = 0.001). CONCLUSION Standard clinical gadoxetate disodium-enhanced MR cholangiography is not a reliable technique for the evaluation of the biliary trees, because of altered biliary gadoxetate disodium elimination in patients with chronic obstructive biliary diseases.
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Affiliation(s)
- J-P Kühn
- Department of Radiology and Neuroradiology, Ernst Moritz Arndt University Greifswald, Ferdinand-Sauerbruch-Straße NK, Greifswald, D-17475, Germany.
| | - M Spoerl
- Department of Radiology and Neuroradiology, Ernst Moritz Arndt University Greifswald, Ferdinand-Sauerbruch-Straße NK, Greifswald, D-17475, Germany
| | - A Nassif
- Department of Clinical Pharmacology, Ernst Moritz Arndt University Greifswald, Felix Hausdorff-Strasse 3, Greifswald, D-17475, Germany
| | - M Mester
- Department of Radiology and Neuroradiology, Ernst Moritz Arndt University Greifswald, Ferdinand-Sauerbruch-Straße NK, Greifswald, D-17475, Germany
| | - W Weitschies
- Department of Biopharmacy and Pharmaceutical Technology, Ernst Moritz Arndt University Greifswald, Felix Hausdorff-Strasse 3, Greifswald, D-17475, Germany
| | - W Siegmund
- Department of Clinical Pharmacology, Ernst Moritz Arndt University Greifswald, Felix Hausdorff-Strasse 3, Greifswald, D-17475, Germany
| | - N Hosten
- Department of Radiology and Neuroradiology, Ernst Moritz Arndt University Greifswald, Ferdinand-Sauerbruch-Straße NK, Greifswald, D-17475, Germany
| | - B Mensel
- Department of Radiology and Neuroradiology, Ernst Moritz Arndt University Greifswald, Ferdinand-Sauerbruch-Straße NK, Greifswald, D-17475, Germany
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Taylor AJ. Invited commentary. Radiographics 2014; 34:586-7; discussion 588. [PMID: 24819782 DOI: 10.1148/rg.343135181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew J Taylor
- Department of Diagnostic Radiology, University of Minnesota Minneapolis, Minnesota
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Abstract
Although ultrasound, computed tomography, and cholescintigraphy play essential roles in the evaluation of suspected biliary abnormalities, magnetic resonance (MR) imaging and MR cholangiopancreatography can be used to evaluate inconclusive findings and provide a comprehensive noninvasive assessment of the biliary tract and gallbladder. This article reviews standard MR and MR cholangiopancreatography techniques, clinical applications, and pitfalls. Normal biliary anatomy and variants are discussed, particularly as they pertain to preoperative planning. A spectrum of benign and malignant biliary processes is reviewed, emphasizing MR findings that aid in characterization.
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