title: Gadoxetic acid-enhanced MRI with MR cholangiography for the preoperative evaluation of bile duct cancer.
abstract: OBJECTIVE
  To assess the diagnostic accuracy of gadoxetic acid-enhanced biliary MRI with MR cholangiography (MRC) in the preoperative evaluation of bile duct cancer (BDC) staging and resectability.
  
  
  METHODS
  Seventy-three patients with BDC who underwent gadoxetic acid-enhanced biliary MRI and MRC, were included in this study. Two abdominal radiologists evaluated the biliary MRI findings regarding the tumor extent, vascular involvement, lymph node metastasis, and tumor resectability. The results were compared with the surgical and pathology findings which were used as the standard reference. The diagnostic performance of the MRI was evaluated using receiver operating characteristics (ROC) analysis. In addition, to determine whether the hepatobiliary phase images had been successfully obtained, the enhancement percentage of the hepatic parenchyma was measured on the portal venous images (PVI) and hepatobiliary phase images (HBPI), respectively.
  
  
  RESULTS
  The overall accuracy of the two reviewers for determining the tumor resectability was 61.6% and 83.5%, respectively. The Az values were 0.802 for reviewer 1 and 0.892 for reviewer 2 in the evaluation of the secondary biliary confluence tumor involvement and 0.773 for reviewer 1 and 0.846 for reviewer 2 in the evaluation of the intrapancreatic bile duct involvement. In the evaluation of the vascular involvement, the Az values were 0.718 and 0.906, respectively, for the hepatic artery evaluation and 0.55 and 0.88, respectively, for the portal vein evaluation. For assessment of lymph node metastasis, the overall accuracy was 69.6% and 79.7%, respectively. The mean enhancement percentages of hepatic parenchyma on PVI and HBPI were 39.3% and 65.9%, respectively (P % 0.05), and 49 of 73 patients (67.1%) showed higher enhancement percentage on HBPI than on PVI CONCLUSION: Gadoxetic acid-enhanced MRI with MRC is a reliable diagnostic method for assessing the tumor extent and resectability of BDC.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hye Young
authors.initials: HY
authors.lastname: Sun
authors.forename: Jeong Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Hee Sun
authors.initials: HS
authors.lastname: Park
authors.forename: Jeong Hee
authors.initials: JH
authors.lastname: Yoon
authors.forename: Jee Hyun
authors.initials: JH
authors.lastname: Baek
authors.forename: Joon Koo
authors.initials: JK
authors.lastname: Han
authors.forename: Byung Ihn
authors.initials: BI
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000473:pathology* / Q000601:surgery*; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods*; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D015588:Observer Variation; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA
keywords: MRI with MR cholangiography; bile duct cancer; gadoxetic acid