Functional magnetic resonance cholangiography (fMRC) of the gallbladder and biliary tree with contrast‐enhanced magnetic resonance cholangiography

Abstract

Purpose:To determine the diagnostic performance of functional magnetic resonance cholangiography (fMRC) for the evaluation of anatomic and functional biliary disorders.Materials and Methods: At 1.5 T, 39 MR examinations with conventional MRC and mangafodipir trisodium-enhanced fMRC were retrospectively reviewed by three observers who recorded anatomic (duct dilation, stricture, filling defects) and functional (cholecystitis, obstruction) abnormalities in three modes: MRC alone, fMRC alone, and MRC and fMRC images together (combined-MRC). Performance was determined by comparing findings with each mode to findings of invasive cholangiography (IC) and surgery.Results: Among 75 biliary segments (correlated with IC), the sensitivity/specificity for diagnosing dilation (N ϭ 41) with MRC was 95%/97%; with fMRC, 90%/100%; with combined-MRC, 100%/97%. For stricture (N ϭ 7), the sensitivity/specificity of MRC was 86%/98%; of fMRC, 43%/100%; of combined-MRC, 86%/100%. For filling defects (N ϭ 9), the sensitivity/specificity of MRC was 91%/98%; of fMRC, 82%/ 100%; of combined-MRC, 91%/100%. For diagnosing obstruction (N ϭ 9), the sensitivity/specificity of MRC, fMRC, and combined-MRC were 89%/100%, 100%/100%, and 100%/100%, respectively. For surgically proven cholecystitis (N ϭ 13), positive predictive values for diagnosing acute/ chronic cholecystitis for MRC were 33%/40%; for fMRC, 100%/50%; for combined-MRC, 100%/50%. Conclusion:Although single-shot fast spin echo (SSFSE)-MRC is valuable, the addition of fMRC increased diagnostic performance for functional biliary disorders.

MR Imaging of the Gallbladder: A Pictorial Essay

“…The enhancement is usually smooth, slow, and prolonged (Fig 10), unlike in gallbladder carcinoma, in which it is usually irregular, early, and prolonged (3,4). However, the utility of conventional MR cholangiography, functional MR cholangiography, and a combination of the two in the evalu- ation of chronic cholecystitis has not been clearly established; in the study mentioned earlier, Fayad et al (19) found a 50% positive predictive value for the detection of chronic cholecystitis for both conventional and functional MR cholangiography.…”

Functional evaluation of cystic duct patency with Gd-EOB-DTPA MR imaging: an alternative to hepatobiliary scintigraphy for diagnosis of acute cholecystitis?

“…Previous authors have demonstrated the potential efficacy of MR cholangiography utilizing Mangafodipir trisodium and Gd-BOPTA in the diagnosis of cholecystitis [18][19][20], however, these studies have extended imaging well beyond the standard 30 min imaging window. Morphologic features of cholecystitis on MR have also been established [21,22], but if MR is to play a significant role in the diagnosis of cholecystitis, it must be able to demonstrate cystic duct patency, and gallbladder reflux via functional evaluation akin to hepatobiliary scintigraphy.…”

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

“…An alternative approach to improving delineation of the biliary anatomy in liver donor candidates has been proposed (12)(13)(14)(15)(16)(17). Mangafodipir trisodium (Teslascan; Amersham Health, Princeton, NJ), a safe U.S. Food and Drug Administration-approved hepatobiliary MR imaging contrast agent (18), is excreted primarily by way of the biliary system and can be used as a T1-weighted MR imaging biliary contrast agent because of the T1 shortening caused by the manganese metal ion.…”