title: Prospective assessment of dynamic CT and MR cholangiography in functional biliary pain.
abstract: OBJECTIVE
  The objectives of our study were to assess the feasibility of dynamic CT and MR cholangiography during gallbladder stimulation, to compare CT and MR cholangiography with biliary scintigraphy, and to identify morphologic differences between patients with functional biliary pain and healthy control subjects.
  
  
  METHODS
  In this prospective study, 30 patients with functional biliary pain underwent biliary scintigraphy, CT cholangiography, and MR cholangiography before and during 45-minute sincalide infusions. Thirty healthy control subjects also underwent MR cholangiography with sincalide infusion. IV contrast agents (iodipamide meglumine or gadobenate dimeglumine) were administered before scanning. CT and MR images were qualitatively and quantitatively analyzed.
  
  
  RESULTS
  Diagnostic images were obtained of all participants. There was good agreement for gallbladder ejection fraction (EF) at 40 minutes by all three methods (Lin's concordance correlation coefficient ≥ 0.6). Gallbladder contraction and refilling occurred more promptly by CT and MR cholangiography than scintigraphy. CT and MR cholangiography showed previously undiagnosed gallstones in two patients (7%). Gallbladder shape was categorized as straight, curved, or folded; a folded gallbladder was present in 37% and 23% of patients at baseline and 40 minutes, respectively, versus in 3% of control subjects at both times (p ≤ 0.004). Asymmetric patterns of gallbladder contraction occurred in 10 patients (33%) and four control subjects (13%) (p = 0.13).
  
  
  CONCLUSIONS
  Dynamic CT cholangiography and MR cholangiography performed during pharmacologic stimulation accurately measure gallbladder EFs and detect missed gallstones. Gallbladder shape before and during contraction differs between patients with functional biliary pain and healthy control subjects. Dynamic CT cholangiography and MR cholangiography are promising techniques that might improve selection of patients to undergo cholecystectomy for functional biliary pain.
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Jeff L
authors.initials: JL
authors.lastname: Fidler
authors.forename: John M
authors.initials: JM
authors.lastname: Knudsen
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Collins
authors.forename: Kiaran P
authors.initials: KP
authors.lastname: McGee
authors.forename: Brian
authors.initials: B
authors.lastname: Lahr
authors.forename: Johnson L
authors.initials: JL
authors.lastname: Thistle
authors.forename: Mark
authors.initials: M
authors.lastname: Topazian
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002758:Cholangiography / Q000379:methods*; D049448:Cholangiopancreatography, Magnetic Resonance; D003085:Colic / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003287:Contrast Media; D005260:Female; D005705:Gallbladder Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007458:Iodipamide; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives; D008875:Middle Aged; D009942:Organometallic Compounds; D019047:Phantoms, Imaging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D012008:Recurrence; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine; D007458:Iodipamide