title: Unusual Use of Gd-EOB-DTPA in MRCP in Order to Reveal the Source of Bile Leakage in a Patient with Neuroendocrine Tumor - Case Report.
abstract: BACKGROUND
  MRCP is the method of choice in diagnosing pathologies of the biliary system. One of them is bile fistulae. They are uncommon but tend to cause many diagnostic problems. The possible way to improve MRCP is using it with intravenous injection of hepatobiliary-specific contrast agents. As it is eliminated via the hepatobiliary system, it can be visualized in the bile ducts and may help to reveal disorders undetected by a standard MRCP.
  
  
  METHODS
  We report a case of a 36-year-old woman with leakage in the biliary system which led to creation of a subcutaneous bile reservoir. By means of a regular MRCP protocol it was impossible to reveal any disorders of the biliary system and thus a decision to inject Gd-EOB-DTPA was taken. As a result, a fistula with its opening in the fundus of the gall bladder was revealed. Patient was qualified for treatment with somatostatin analogues in order to stop bile secretion.
  
  
  CONCLUSIONS
  The Gd-EOB-DTPA in combination with regular T2-weighted MRCP may be helpful in detecting anomalies of the biliary system. Although a high price of the procedure restricts its accessibility, such advantages as lower risk of complications, lower costs of hospitalization, and less traumatic nature make it a technique that may take precedence over ERCP in ambiguous cases.
authors.affiliation: Department of General and Pediatric Radiology, Independent Public Clinical Hospital No. 1, Wrocław, Poland.
authors.forename: Rafał
authors.initials: R
authors.lastname: Mazur
authors.affiliation: Department of General and Pediatric Radiology, Independent Public Clinical Hospital No. 1, Wrocław, Poland; Department of Radiology, Wrocław Medical University, Wrocław, Poland.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Pawluś
authors.affiliation: Department of General and Pediatric Radiology, Independent Public Clinical Hospital No. 1, Wrocław, Poland.
authors.forename: Kinga
authors.initials: K
authors.lastname: Szymańska
authors.affiliation: Department of Radiology, Wrocław Medical University, Wrocław, Poland.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Patyk
authors.affiliation: Clinic of Endocrinology, Diabetology and Isotope Therapy, Independent Public Clinical Hospital No. 1, Wrocław, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Otlewska
authors.affiliation: Department of Radiology, Wrocław Medical University, Wrocław, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Międzybrodzki
authors.affiliation: Department of Radiology, Wrocław Medical University, Wrocław, Poland.
authors.forename: Dąbrówka
authors.initials: D
authors.lastname: Sokołowska-Dąbek
authors.affiliation: Clinic of Endocrinology, Diabetology and Isotope Therapy, Independent Public Clinical Hospital No. 1, Wrocław, Poland.
authors.forename: Eliza
authors.initials: E
authors.lastname: Kubicka
authors.affiliation: Department of General and Pediatric Radiology, Independent Public Clinical Hospital No. 1, Wrocław, Poland; Department of Radiology, Wrocław Medical University, Wrocław, Poland.
authors.forename: Urszula
authors.initials: U
authors.lastname: Zaleska-Dorobisz
keywords: Biliary Fistula; Cholangiopancreatography, Magnetic Resonance; Gadolinium DTPA