Defining Intrahepatic Biliary Anatomy in Living Liver Transplant Donor Candidates at Mangafodipir Trisodium–enhanced MR Cholangiography versus Conventional T2-weighted MR Cholangiography

Lee, Vivian S.; Krinsky, Glenn A.; Nazzaro, Carol A.; Chang, Jerry; Babb, James S.; Lin, Jennifer; Morgan, G. W.; Teperman, Lewis

doi:10.1148/radiol.2333031977

Cited by 69 publications

(42 citation statements)

References 22 publications

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“…To overcome the above limitations, radiologists have developed new imaging strategies in recent years by using contrast agents that are excreted by the bile ducts for T 1 weighted MRI [9]. In addition to functional assessment of the biliary tree, hepatobiliary contrast agents enable definition of intrahepatic ductal anatomy because it acts as a positive biliary contrast by differentiating hepatic vessels from bile ducts, which can be difficult on conventional MRC because of slow flow [5].…”

Section: Discussionmentioning

confidence: 99%

“…The specific indications include pre-operative anatomical assessment of the biliary tree in preventing inadvertent complications in common laparoscopic cholecystectomy, and also in complex biliary surgical procedures such as biliary-enteric anastomosis and liver transplantation; post-operative assessment of the biliary tree after surgery when complications such as bile leak or inadvertent biliary tree stricture or ligation are suspected; and functional assessment of bile secretion and excretion [7][8][9].…”

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confidence: 99%

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Contrast-enhanced MR cholangiography: comparison of Gd-EOB-DTPA and Mn-DPDP in healthy volunteers

Bae

Na²,

Ds³

et al. 2012

BJR

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Objective: The purpose of this study was to compare the biliary enhancement dynamics of gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic-acid (Gd-EOB-DTPA) and mangafodipir trisodium (Mn-DPDP) for contrast-enhanced MR cholangiography (MRC) in healthy subjects. Methods: 15 healthy volunteers underwent MRI at 1.5 T with volumetric interpolated breath-hold examination sequence. Each volunteer was scanned once for each contrast agent. The signal-to-noise ratio (SNR) of the liver parenchyma and common hepatic duct (CHD) and the contrast-to-noise ratio (CNR) of CHD to liver parenchyma were evaluated and compared before and at several time points (5,15, 30, 45, 60, 90, and 120 min) after injection of each agent. Results: SNR was significantly higher for Gd-EOB-DTPA than for Mn-DPDP in liver parenchyma after 5 min and in CHD after 15 min (p,0.05). CNR of CHD to liver parenchyma using Gd-EOB-DTPA showed an initial decrease at 5 min post-injection followed by a steep increase to a peak at 15 min post-injection. CNR using Mn-DPDP showed a steady increase to a peak at 15 min post-injection without an initial decrease. At 15 min, the value of CNR was significantly higher for Gd-EOB-DTPA than for Mn-DPDP (p,0.05). Conclusion: For both contrast agents, CNR reached a peak at 15 min after contrast injection. At this time point, CNR of Gd-EOB-DTPA was significantly higher than that of Mn-DPDP. Therefore, Gd-EOB-DTPA may provide better contrast-enhanced MRC than Mn-DPDP at 15 min after contrast administration. The bile ducts are generally studied using fast spin echo T 2 weighted sequences with half-Fourier reconstruction. This conventional MR cholangiography (MRC) examination is highly accurate in detecting biliary tree disease [1,2]. However, the conventional MRC has diagnostic limitations, which include poor visualisation of the intrahepatic biliary tree compared with the extrahepatic biliary tree [3], limited spatial resolution and not being able to provide functional information of the biliary tree.Contrast-enhanced MRC has created interest in the field of MRC because of its potential to provide functional assessment and to improve the visualisation of the intrahepatic biliary trees [4][5][6]. The specific indications include pre-operative anatomical assessment of the biliary tree in preventing inadvertent complications in common laparoscopic cholecystectomy, and also in complex biliary surgical procedures such as biliary-enteric anastomosis and liver transplantation; post-operative assessment of the biliary tree after surgery when complications such as bile leak or inadvertent biliary tree stricture or ligation are suspected; and functional assessment of bile secretion and excretion [7][8][9].Contrast-enhanced MRC is performed with hepatobiliary MR contrast agents such as mangafodipir trisodium (Mn-DPDP), gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic-acid (Gd-EOB-DPTA) or gadobenate dimeglumine (Gd-BOPTA), which are administered intravenously, taken up by the hepatocytes, and then excreted via the biliary syste...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Contrast-enhanced MR cholangiography: comparison of Gd-EOB-DTPA and Mn-DPDP in healthy volunteers

Bae

Na²,

Ds³

et al. 2012

BJR

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“…The anatomy of the intrahepatic bile ducts, especially the branching pattems at the biliary confluence are widely discussed in the literature because of the surgical importance of this area in liver transplantation (7)(8)(9)(10). Nevertheless there has been no study describing the variability of the biliary confluence angle width.…”

Section: Discussionmentioning

confidence: 99%

Normal Biliary Confluence Angle In Classical Junction Type: Assessment With MR Cholangiopancreatography

Nuray;ERDEM¹

2009

Ankara Üniversitesi Tıp Fakültesi Mecmuası

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MR kolanjiopankreatografi (MRKP) görüntüleri üzerinden ortalama biliyer konfluens açısını hesaplayarak bu açı ile yaş, cins ve vücut kitle indeksi arasındaki olası ilişkiyi araştırmak amaçlanmıştır. Gereç ve Yöntem:Mayıs 2006 ile Aralık 2006 tarihleri arasında karaciğer fonksiyon testlerinde bozukluk ya da safra kanallarında patoloji şüphesi başta olmak üzere çeşitli endikasyonlarla MRKP yapılan toplam 40 hasta (18 kadın, 22 erkek, yaş aralığı 22-86 yaş) çalışmaya dahil edildi. Hastaların hiçbirinde geçirilmiş karaciğer ameliyatı öyküsü ve biliyer konfluens düzeyinde yer kaplayan lezyon yoktu. Safra kanalı varyasyonu olanlar ve bilinen safra yolu ya da kronik karaciğer parankim hastalığı tanısı olanlar çalışma dışı bırakıldı. Biliyer konfluens açısı iki radyolog tarafından koronal oblik planda alınan üç ardışık kalın kesit MRKP görüntüsü üzerinden ve açının en geniş olduğu dü-zeylerden ayrı ayrı ölçülerek her araştırmacı için ortalama değerler kaydedildi. Sonuçlar:İstatistiksel olarak iki araştırmacı arasında yüksek uyum mevcuttu (p<0.001, intraclass correlation coefficient= 0.93). Birinci araştırmacı için hesaplanan ortalama açı 87.87± 22.92° (aralık 51-155°) iken ikinci araştırmacı için ortalama açı 85.40± 25.80° (aralık 45-166°) idi. Biliyer konfluens açısı ile yaş, cins ya da vücut kitle indeksi arasında istatistiksel olarak anlamlı bir ilişki bulunmadı. Birinci araştırmacı için ortalama açının %95 güven aralığı üst ve alt sınırları 80.54-95.20° iken, ikinci araştırmacı için 77.14-93.65° idi.Sonuç: İstatistiksel olarak normal biliyer konfluens açısının yaş, cins ve vücut kitle indeksinden bağımsız olduğu ortaya konmuştur.Anahtar Sözcükler: Safra Yolları, Kolanjiyopankreatografi, Safra KanallarıWe aimed to determine the mean biliary confluence angle on MR cholangiopancreatography (MRCP) images and investigated the variability of the angle by age, gender, and body mass index. Material and Methods:The study population was drawn from the patients referred to MRCP between May 2006 and December 2006 for various indications; the most being for abnormal liver function tests or suspected biliary disease. A total of 40 patients (18 women and 22 men, age range 22-86 years) who denied a history of prior liver surgery, and in whom MRCP excluded bile duct variations, biliary diseases or chronic parenchymal liver disease were enrolled. The confluence angle was measured independently by 2 observers on 3 successive coronal oblique thick-collimation images where the angle is widest and the mean values were noted for each observer. Results:Statistically there was almost perfect agreement between 2 observers (p<0.001, intraclass correlation coeffıcient= 0.93). The mean value was 87.87± 22.92 degrees for the lst observer (range 51-155 degrees) and 85.40± 25.80 degrees for the 2nd observer (range 45-166 degrees). No statistically significant correlation was found between biliary confluence angle and age, gender or body mass index. The lower and upper bounds of 95% confîdence interval for mean were 80.54-95.20 degrees for the lst ...

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“…Preoperative assessment of biliary anatomy and possible variations in order to prevent intraoperative injury is currently performed by means of three dimensional helical computed tomography cholangiography [20][21][22][23] and various magnetic resonance imaging techniques [24][25][26][27] . If a biliary variant is assumed to be injured intraoperatively, the surgeon should perform an intraoperative cholangiography through the injured bile duct in order to estimate the type and extent of injury.…”

Section: Discussionmentioning

confidence: 99%

Managing injuries of hepatic duct confluence variants after major hepatobiliary surgery: An algorithmic approach

Fragulidis

Marinis²,

Polydorou³

et al. 2008

WJG

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AIM:To investigate injuries of anatomy variants of hepatic duct confluence during hepatobiliary surgery a n d t h e i r i m p a c t o n m o r b i d i ty a n d m o r t a l i ty o f these procedures. An algorithmic approach for the management of these injuries is proposed. METHODS:During a 6-year period 234 patients who had undergone major hepatobiliary surgery were retrospectively reviewed in order to study postoperative bile leakage. Diagnostic workup included endoscopic and magnetic retrograde cholangiopancreatography (E/MRCP), scintigraphy and fistulography.RESULTS: Thirty (12.8%) patients who developed postoperative bile leaks were identified. Endoscopic stenting and percutaneous drainage were successful in 23 patients with bile leaks from the liver cut surface. In the rest seven patients with injuries of hepatic duct confluence, biliary variations were recognized and a stepwise therapeutic approach was considered. Conservative management was successful only in 2 patients. Volume of the liver remnant and functional liver reserve as well as local sepsis were used as criteria for either resection of the corresponding liver segment or construction of a biliary-enteric anastomosis. Two deaths occurred in this group of patients with hepatic duct confluence variants (mortality rate 28.5%). CONCLUSION:Management of major biliary fistulae that are disconnected from the mainstream of the biliary tree and related to injury of variants of the hepatic duct confluence is extremely challenging. These patients have a grave prognosis and an early surgical procedure has to be considered.

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Defining Intrahepatic Biliary Anatomy in Living Liver Transplant Donor Candidates at Mangafodipir Trisodium–enhanced MR Cholangiography versus Conventional T2-weighted MR Cholangiography

Abstract: Mangafodipir trisodium-enhanced 3D MR cholangiography depicts intrahepatic biliary anatomy, especially right duct variants, more accurately than does conventional T2-weighted MR cholangiography.

Cited by 69 publications

References 22 publications

Contrast-enhanced MR cholangiography: comparison of Gd-EOB-DTPA and Mn-DPDP in healthy volunteers

Contrast-enhanced MR cholangiography: comparison of Gd-EOB-DTPA and Mn-DPDP in healthy volunteers

Normal Biliary Confluence Angle In Classical Junction Type: Assessment With MR Cholangiopancreatography

Managing injuries of hepatic duct confluence variants after major hepatobiliary surgery: An algorithmic approach

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