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

Abstract

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.

2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy

“…In a series of 99 patientsincluding 24 followed after cholecystectomy, 20 after surgical reconstruction of traumatic BDI, and 16 after hydatid cystectomythe use of CE-MRCP increased the sensitivity, specificity, and accuracy, with respective ranges (depending on the bile leak etiology) of 76-82%, 100%, and 75-91% compared to 53-63%, 51-66%, and 55-63% observed with conventional MRCP [183]. The optimal timing for hepatobiliary phase acquisitions with CE-MRCP appears to range between 60 and 90 min when looking for bile leaks [182,186].…”

Differences of liver CT perfusion of blunt trauma treated with therapeutic embolization and observation management

“…Complications of blunt liver trauma such as hepatic necrosis, liver abscess and biloma have been reported previously [8][9][10][11][12][13] . Among them, the most concerning complication is hepatic necrosis.…”

“…According to a study by Dabb et al, patients with hepatic necrosis had higher grade of liver injuries and were more likely to have undergone damage control surgery in addition to embolization 8 . However, these complications may occur regardless of whether blunt liver trauma is treated with observational, embolization or surgery [8][9][10][11][12][13] . In this study, only two patients developed infected biloma and was successfully treated with percutaneous catheter drainage.…”

“…Potential delayed complications of embolization for liver trauma are massive liver necrosis, liver abscess and biloma [8][9][10][11][12][13] . Among them, massive hepatic necrosis is a major concern among trauma surgeons because the death of a large number of contiguous hepatocytes can contribute to a high morbidity and late mortality 8,9 .…”

Valoración anatómica de la vía biliar y de sus alteraciones por medio de resonancia magnética con el contraste hepatoespecífico ácido gadoxético

“…Los contrastes hepatoespecíficos como el ácido gadoxético se han empleado para la caracterización de diferentes tipos de lesiones hepáticas y la evaluación de la integridad de la vía biliar, sobre todo en pacientes con colecistectomía y una lesión secundaria al proceso quirúrgico 3,[7][8][9][10] .…”