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

Abstract

Background: Contrast enhanced magnetic resonance cholangiography is a novel technique and promising method in demonstrating biliary tree anatomy and evaluating biliary disorders. However, to date, there are a limited number of studies that have focused on the impact of this technique. Aims: We aimed to evaluate the additional role of contrast enhanced MR cholangiography (MRC) and compare contrast enhanced MRC with T2-weighted (w) magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of biliary disorders. Study Design: Diagnostic accuracy study. Methods: The T2w-MRCP and contrast enhanced MRC sequences of 31 patients whose gold standard test results were available were scored visually for the existence of pathological findings with regard to any of the biliary diseases. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) was used as the contrast agent. The correlation values were determined according to the statistical analysis made from those scores and the sensitivity, specificity and accuracy values of each sequence were detected as well. Results: We detected that the correlation values with gold standard methods of contrast enhanced MRC sequences were significantly higher than the ones of T2w-MRCP sequences. The correlation ratios of T2w-MRCP sequences were between 26 and 34%, while those for contrast enhanced MRC sequences were between 81 and 83% for the first reader and the correlation ratios of T2w-MRCP sequences were between 10 and 61%, whereas those of contrast enhanced MRC were between 79 and 81% for the second reader The mean sensitivity, specificity and accuracy values of T2w-MRCP sequences were 14.3-42.5%, 85-89.2% and 59.3-72.5%, respectively, while the mean sensitivity, specificity and accuracy values of contrast enhanced MRC sequences were 100%, 86.7% and 93.2-93.3%, respectively. Conclusion: We suggest that obtaining of contrast enhanced MRC sequences in addition to the T2w-MRCP can be useful in the diagnosis of many diseases in relation with biliary tree.

Keywords

• Cholangiopancreatography, contrast enhanced MRC, gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid, magnetic resonance

References

1. 1. 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. [CrossRef]
2. 2. Asbach P, Warmuth C, Stemmer A, Rief M, Huppertz A, Hamm B, et al. High spatial resolution T1-weighted MR imaging of liver and biliary tract during uptake phase of a hepatocyte-specific contrast medium. Invest Radiol 2008;43:809-15. [CrossRef]
3. 3. Holzapfel K, Breitwieser C, Prinz C, Rummeny EJ, Gaa J. Contrast-enhanced magnetic resonance cholangiography using gadolinium-EOB-DTPA. Preliminary experience and clinical applications. Radiologe 2007;47:536-44. [CrossRef]
4. 4. Marin D, Bova V, Agnello F, Youngblood R, Midiri M, Brancatelli G. Gadoxetate disodium-enhanced magnetic resonance cholangiography for the noninvasive detection of an active bile duct leak after laparoscopic cholecystectomy. J Comput Assist Tomogr 2010;34:213-6. [CrossRef]
5. 5. Krishnan P, Gupta RT, Boll DT, Brady CM, Husarik DB, Merkle EM. Functional evaluation of cystic duct patency with GdEOB-DTPA MR imaging: an alternative to hepatobiliary scintigraphy for diagnosis of acute cholecystitis? Abdom Imaging 2012;37:457-64. [CrossRef]
6. 6. Akpınar E, Turkbey B, Karcaaltincaba M, Balli O, Akkapulu N, Balas S, et al. Initial experience on utility of gadobenate dimeglumine (Gd-BOPTA) enhanced T1-weighted MR cholangiography in diagnosis of acute cholecystitis. J Magn Reson Imaging 2009;30:578-5. [CrossRef]
7. 7. Kim KW, Park MS, Yu JS, Chung JP, Ryu YH, Lee SI, et al. Acute cholecystitis at T2-weighted and manganese-enhanced T1-weighted MR cholangiography: preliminary study. Radiology 2003;227:580-4. [CrossRef]
8. 8. Aduna M, Larena JA, Martín D, Martínez-Guere-u B, Aguirre I, Astigarraga E. Bile duct leaks after laparoscopic cholecystectomy: value of contrast-enhanced MRCP. Abdom Imaging 2005;30:480-7. [CrossRef]

9. 9. Algin O, Ozlem N, Kilic E, Karaoglanoglu M, Arslan H. GdBOPTA-enhanced MR cholangiography findings in gall bladder perforation. Emerg Radiol 2010;17:487-91. [CrossRef]
10. 10. Seale MK, Catalano OA, Saini S, Hahn PF, Sahani DV. Hepatobiliary-specific MR contrast agents: role in imaging the liver and biliary tree. Radiographics 2009;29:1725-48. [CrossRef]
11. 11. Lee NK, Kim S, Lee JW, Lee SH, Kang DH, Kim GH, et al. Biliary MR imaging with Gd-EOB-DTPA and its clinical applications. Radiographics 2009;29:1707-24. [CrossRef]
12. 12. Landis JR, Brennan P, Silman A. Statistical methods for assessing observer variability in clinical measures. BMJ 1992;304:1491-4. [CrossRef]
13. 13. Landis JR, Koch GC. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-74. [CrossRef]
14. 14. Kantarcı M, Pirimoglu B, Karabulut N, Bayraktutan U, Ogul H, Ozturk G, et al. Non-invasive detection of biliary leaks using Gd-EOB-DTPA-enhanced MR cholangiography: comparison with T2-weighted MR cholangiography. Eur Radiol 2013;23:2713-22. [CrossRef]
15. 15. Domagk D, Wessling J, Reimer P, Hertel L, Poremba C, Senninger N, et al. Endoscopic retrograde cholangiopancreatography, intraductal ultrasonography, and magnetic resonance cholangiopancreatography in bile duct strictures: a prospective comparison of imaging diagnostics with histopathological correlation. Am J Gastroenterol 2004;99:1684-9. [CrossRef]
16. 16. Salvolini L, Urbinati C, Valeri G, Ferrara C, Giovagnoni A. Contrast enhanced MR cholangiography (MRCP) with GdEOB-DTPA in evaluating biliary complications after surgery. Radiol Med 2012;177:354-68. [CrossRef]
17. 17. Frydrychowicz A, Jedynak AR, Kelcz F, Nagle SK, Reeder SB. Gadoxetic acid-enhanced T1-weighted MR cholangiography in primary sclerosing cholangitis. J Magn Reson Imaging 2012;36:632-40. [CrossRef]
18. 18. Ahuja AT, Griffith JF, Wong KT, Antonio GE, Chu WCW, Ho SSY. Biliary System. In: Ahuja AT, ed. Diagnostic Imaging Ultrasound, UK: Amirsys 2007;20-36.
19. 19. Carlos RC, Hussain HK, Song JH, Francis IR. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid as an intrabiliary contrast agent: preliminary assessment. AJR Am J Roentgenol 2002;179:87-92. [CrossRef]
20. 20. Dahlström N, Persson A, Albiin N, Smedby O, Brismar TB. Contrast enhanced magnetic resonance cholangiography with Gd-BOPTA and Gd-EOB-DTPA in healthy subjects. Acta Radiol 2007;48:362-8. [CrossRef]
21. 21. Halefoğlu AM. Magnetic resonance cholangiopancreatography: a useful tool in the evaluation of pancreatic and biliary disorders. World J Gastroenterol 2007;13:2529-34. [CrossRef]
22. 22. Kats J, Kraai M, Dijkstra AJ, Koster K, Ter Borg F, Hazenberg HJ, et al. Magnetic resonance cholangiopancreaticography as a diagnostic tool for common bile duct stones: a comparison with ERCP and clinical follow-up. Dig Surg 2003;20:32-7. [CrossRef]
23. 23. Angulo P, Pearce DH, Johnson CD, Henry JJ, LaRusso NF, Petersen BT, et al. Magnetic resonance cholangiography in patients with biliary disease: its role in primary sclerosing cholangitis. J Hepatol 2000;33:520-7. [CrossRef]
24. 24. Turkbey B, Akpinar E, Balli O, Tirnaksiz B, Akata D, Akhan O, et al. Clinical applications of gadobenate dimeglumine-enhanced magnetic resonance cholangiography: an expanded pictorial review. Jpn J Radiol 2011;29:3-10. [CrossRef]
25. 25. Kantarci M, Pirimoglu B, Ogul H, Bayraktutan U, Eren S, Aydinli B, et al. Can biliary-cyst communication be predicted by Gd-EOB-DTPA-enhanced MR Cholangiography before treatment for hepatic hydatic disease? Clin Radiol 2013;23:2713-22