Pediatric Radiology

, Volume 41, Issue 4, pp 488–494

Gadopentetate dimeglumine-enhanced MR cholangiopancreatography in infants with cholestasis

  • Mi-Jung Lee
  • Myung-Joon Kim
  • Choon-Sik Yoon
  • Yong Eun Chung
  • Seok Joo Han
  • Hong Koh
Original Article

DOI: 10.1007/s00247-010-1911-4

Cite this article as:
Lee, MJ., Kim, MJ., Yoon, CS. et al. Pediatr Radiol (2011) 41: 488. doi:10.1007/s00247-010-1911-4

Abstract

Background

Biliary atresia (BA) is a progressive, obliterative cholangiopathy that occurs in neonates with hepatic portoenterostomy the treatment of choice, but early surgery is important for optimum outcomes. MRI, including MR cholangiopancreatography (MRCP) may be a diagnostically useful alternative to US, but the heavily T2-weighted sequences used include not only bile duct signals, but also other heterogeneously high signal intensities from surrounding structures.

Objective

To evaluate the effects of gadolinium when used to decrease background signal intensity on T2-weighted MR cholangiopancreatography (MRCP) in infants and to evaluate the qualitative improvement of the depiction of the common bile duct (CBD) for evaluating neonatal cholestasis.

Materials and methods

Our Institutional Review Board approved this prospective study. MRCP was performed with gadopentetate dimeglumine injection using a 1.5-T scanner. Pre- and postcontrast MRCP images were compared. Forty-nine infants (male:female = 21:28; age 0–12 months, mean 2.3) were included. The final diagnoses were biliary atresia (BA) in 28 cases and non-BA in 21. Quantitative analysis was conducted using region-of-interest measurements of mean signal intensities of the liver, pancreatic head and gallbladder (if defined). Qualitative analysis was performed by four radiologists who subjectively scored image confidence in the presence of CBD on a 4-point scale (0 for definitely absent, 1 for probably absent, 2 for probably present, and 3 for definitely present).

Results

The signal-to-noise ratios were significantly decreased in the liver and pancreatic head after contrast medium enhancement (mean 5.7→4.0 in liver and mean 44.9→12.7 in the pancreatic head; P < 0.0001), and this finding was constant in both the BA and the non-BA group. The mean confidence score in the presence of CBD decreased in the BA group (0.9→0.5; P < 0.0001), but did not change significantly in the non-BA group (2.0→2.1; P = 0.459) after contrast medium enhancement. Both intra- and interobserver agreement was higher after contrast medium enhancement (P = 0.046).

Conclusion

Gadopentetate dimeglumine-enhanced MRCP increased the diagnostic confidence of absence of the CBD in cholestatic infants with increased intra- and interobserver agreement.

Keywords

CholestasisBiliary atresiaMRIMR cholangiopancreatographyGadoliniumInfant

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Mi-Jung Lee
    • 1
    • 5
  • Myung-Joon Kim
    • 1
    • 5
  • Choon-Sik Yoon
    • 2
  • Yong Eun Chung
    • 1
  • Seok Joo Han
    • 3
    • 5
  • Hong Koh
    • 4
    • 5
  1. 1.Department of Radiology and Research Institute of Radiological Science, Severance Children’s HospitalYonsei University, College of MedicineSeoulSouth Korea
  2. 2.Department of Radiology, Gangnam Severance HospitalYonsei University, College of MedicineSeoulSouth Korea
  3. 3.Department of Pediatric Surgery, Severance Children’s HospitalYonsei University, College of MedicineSeoulSouth Korea
  4. 4.Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Severance Children’s HospitalYonsei University, College of MedicineSeoulSouth Korea
  5. 5.Severance Pediatric Liver Disease Research GroupSeoulSouth Korea