Biliary Leak in the Postsurgical Abdomen: A Primer to HIDA Scan Interpretation

Matesan, Manuela; Bermo, Mohammed; Cruite, Irene; Shih, Cheng-Han; Elojeimy, Saeed; Behnia, Fatemeh; Lewis, David H.; Vesselle, Hubert

doi:10.1053/j.semnuclmed.2017.06.002

Cited by 14 publications

(2 citation statements)

References 38 publications

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“…Hepatobiliary iminodiacetic acid scan can serve as a test for bile leaks detection 15 , 16 . However, the lack of anatomical details on planar images can sometimes misinterpret radioactive tracer in duodenum or normal anatomical variant of biliary tree as bile leaks 15 . Delayed imaging up to twenty four hours is required for biloma confirmation and that is not practical among trauma patients 15 .…”

Section: Introductionmentioning

confidence: 99%

“…However, the lack of anatomical details on planar images can sometimes misinterpret radioactive tracer in duodenum or normal anatomical variant of biliary tree as bile leaks 15 . Delayed imaging up to twenty four hours is required for biloma confirmation and that is not practical among trauma patients 15 . The site of biliary injuries and extent of bile leak can be directly evaluated with endoscopic retrograde cholangiography and percutaneous transhepatic cholangiography 3 .…”

Section: Introductionmentioning

confidence: 99%

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Detection and characterization of traumatic bile leaks using Gd-EOB-DTPA enhanced magnetic resonance cholangiography

Wong

Wang

et al. 2018

Sci Rep

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Expanding bile leaks after blunt liver trauma require more aggressive treatment than contained bile leaks. In this retrospective study approved by institution review board, we analyzed if non-invasive contrast-enhanced magnetic resonance cholangiography (CEMRC) using hepatocyte-specific contrast agent (gadoxetic acid disodium) could detect and characterize traumatic bile leaks. Between March 2012 and December 2014, written informed consents from 22 included patients (17 men, 5 women) with a median age of 24.5 years (IQR 21.8, 36.0 years) were obtained. Biliary tree visualization and bile leak detection on CEMRC acquired at 10, 20, 30, 90 minutes time points were independently graded by three radiologists on a 5-point Likert scale. Intraclass Correlation (ICC) was computed as estimates of interrater reliability. Accuracy was measured by area under receiver operating characteristic curves (AUROC). Biliary tree visualization was the best on CEMRC at 90 minutes (score 4.30) with excellent inter-rater reliability (ICC = 0.930). Of 22 CEMRC, 15 had bile leak (8 expanding, 7 contained). The largest AUROC of bile leak detection by three radiologists were 0.824, 0.914, 0.929 respectively on CEMRC at 90 minutes with ICC of 0.816. In conclusion, bile leaks of blunt liver trauma can be accurately detected and characterized on CEMRC.

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