title: Non-invasive detection of biliary leaks using Gd-EOB-DTPA-enhanced MR cholangiography: comparison with T2-weighted MR cholangiography.
abstract: OBJECTIVE
  To evaluate the added role of T1-weighted (T1w) gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance cholangiography (MRC) compared with T2-weighted MRC (T2w-MRC) in the detection of biliary leaks.
  
  
  METHODS
  Ninety-nine patients with suspected biliary complications underwent routine T2w-MRC and T1w contrast-enhanced (CE) MRC using Gd-EOB-DTPA to identify biliary leaks. Two observers reviewed the image sets separately and together. MRC findings were compared with those of surgery and percutaneous transhepatic cholangiopancreatography. The sensitivity, specificity and accuracy of the techniques in identifying biliary leaks were calculated.
  
  
  RESULTS
  Accuracy of locating biliary leaks was superior with the combination of Gd-EOB-DTPA-enhanced MRC and T2w-MRC (P < 0.05).The mean sensitivities were 79 % vs 59 %, and the mean accuracy rates were 84 % vs 58 % for combined CE-MRC and T2w-MRC vs sole T2w-MRC. Nineteen out of 21 patients with biliary-cyst communication, 90.4 %, and 12/15 patients with post-traumatic biliary extravasations, 80 %, were detected by the combination of Gd-EOB-DTPA-enhanced MRC and T2w-MRC images, P < 0.05.
  
  
  CONCLUSIONS
  Gd-EOB-DTPA-enhanced MRC yields information that complements T2w-MRC findings and improves the identification and localisation of the bile extravasations (84 % accuracy, 100 % specificity, P < 0.05). We recommend Gd-EOB-DTPA-enhanced MRC in addition to T2w-MRC to increase the preoperative accuracy of identifying and locating extravasations of bile.
  
  
  CONCLUSIONS
  • Magnetic resonance cholangiography (MRC) does not always detect bile leakage and cysto-biliary communications. • Gd-EOB-DTPA-enhanced MRC helps by demonstrating extravasation of contrast material into fluid collections. • Gd-EOB-DTPA-enhanced MRC also demonstrates the leakage site and bile duct injury type. • Combined Gd-EOB-DTPA-enhanced and T2w-MRC can provide comprehensive information about biliary system. • Gd-EOB-DTPA-enhanced MRC is non-invasive and does not use ionising radiation.
authors.affiliation: School of Medicine, Department of Radiology, Atatürk University, Erzurum, Turkey, akkanrad@hotmail.com.
authors.forename: Mecit
authors.initials: M
authors.lastname: Kantarcı
authors.forename: Berhan
authors.initials: B
authors.lastname: Pirimoglu
authors.forename: Nevzat
authors.initials: N
authors.lastname: Karabulut
authors.forename: Ummugulsum
authors.initials: U
authors.lastname: Bayraktutan
authors.forename: Hayri
authors.initials: H
authors.lastname: Ogul
authors.forename: Gurkan
authors.initials: G
authors.lastname: Ozturk
authors.forename: Bulent
authors.initials: B
authors.lastname: Aydinli
authors.forename: Yesim
authors.initials: Y
authors.lastname: Kizrak
authors.forename: Suat
authors.initials: S
authors.lastname: Eren
authors.forename: Sinan
authors.initials: S
authors.lastname: Yilmaz
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000473:pathology*; D001660:Biliary Tract Diseases / Q000473:pathology*; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods*; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / 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