title: Characterization and staging of central bile duct stenosis--evaluation of the hepatocyte specific contrast agent gadoxetate disodium.
abstract: OBJECTIVE
  To assess the value of gadoxetate disodium for characterization and staging of central bile duct stenosis (CBDS).
  
  
  METHODS
  This prospective HIPAA-compliant study was IRB approved. 14 patients (8 male, 6 female; 36-80 years) with clinical suspicion of CBDS underwent preoperative MRI. To estimate the value of hepatocyte phase images (10, 20, 120 min p.i.), only T2w images (T2), only post-contrast images (CM), or both image datasets were assessed in three reading sessions by 3 readers. Agreement of each reading session with the intraoperative findings in terms of CBDS etiology and tumor extension (weighted kappa statistic) was calculated.
  
  
  RESULTS
  CBDS was caused by hilar cholangiocarcinoma (n=9), gallbladder carcinoma (n=4) and pancreatic carcinoma (n=1). Characterization of CBDS etiology was correct by use of: T2w images in 57%, 64%, 50%; CM images in 64%, 57%, 50%; both in 71%, 64%, 64%. Agreement comparing reading sessions and intraoperative findings regarding tumor extension was fair up to moderate (κ-range=0.21-0.54) as a result of common underestimation. Interobserver agreement for tumor extension was fair (κ-range=0.31-0.33).
  
  
  CONCLUSIONS
  By means of combined evaluation of T2 and CM images a more reliable characterization of CBDS was possible. Even though CBDS tended to be underestimated assessment of exact tumor extension was improved by contrast administration.
authors: Hannover Medical School, Department of Diagnostic and Interventional Radiology, Carl-Neuberg Str. 1, 30625 Hannover, Germany. ringe.kristina@mh-hannover.de
authors: Kristina I
authors: KI
authors: Ringe
authors: Bastian P
authors: BP
authors: Ringe
authors: Hüseyin
authors: H
authors: Bektas
authors: Jan P
authors: JP
authors: Opherk
authors: Angela
authors: A
authors: Reichelt
authors: Joachim
authors: J
authors: Lotz
authors: Frank
authors: F
authors: Wacker
authors: Bernhard C
authors: BC
authors: Meyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002779:Cholestasis / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D022781:Hepatocytes / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA