Skip to main content

Advertisement

SpringerLink
Log in

Gadopentetate dimeglumine-enhanced MR cholangiopancreatography in infants with cholestasis

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hartley JL, Davenport M, Kelly DA (2009) Biliary atresia. Lancet 374:1704–1713

    Article  PubMed  Google Scholar 

  2. Makin E, Quaglia A, Kvist N et al (2009) Congenital biliary atresia: liver injury begins at birth. J Pediatr Surg 44:630–633

    Article  PubMed  Google Scholar 

  3. Carceller A, Blanchard H, Alvarez F et al (2000) Past and future of biliary atresia. J Pediatr Surg 35:717–720

    Article  PubMed  CAS  Google Scholar 

  4. Humphrey TM, Stringer MD (2007) Biliary atresia: US diagnosis. Radiology 244:845–851

    Article  PubMed  Google Scholar 

  5. Farrant P, Meire HB, Mieli-Vergani G (2000) Ultrasound features of the gall bladder in infants presenting with conjugated hyperbilirubinaemia. Br J Radiol 73:1154–1158

    PubMed  CAS  Google Scholar 

  6. Choi SO, Park WH, Lee HJ (1998) Ultrasonographic “triangular cord”: the most definitive finding for noninvasive diagnosis of extrahepatic biliary atresia. Eur J Pediatr Surg 8:12–16

    Article  PubMed  CAS  Google Scholar 

  7. Kamisawa T, Tu Y, Egawa N et al (2007) MRCP of congenital pancreaticobiliary malformation. Abdom Imaging 32:129–133

    Article  PubMed  CAS  Google Scholar 

  8. Krause D, Cercueil JP, Dranssart M et al (2002) MRI for evaluating congenital bile duct abnormalities. J Comput Assist Tomogr 26:541–552

    Article  PubMed  Google Scholar 

  9. Takaya J, Nakano S, Imai Y et al (2007) Usefulness of magnetic resonance cholangiopancreatography in biliary structures in infants: a four-case report. Eur J Pediatr 166:211–214

    Article  PubMed  Google Scholar 

  10. Kanematsu M, Matsuo M, Shiratori Y et al (2002) Thick-section half-Fourier rapid acquisition with relaxation enhancement MR cholangiopancreatography: effects of i.v. administration of gadolinium chelate. AJR 178:755–761

    PubMed  Google Scholar 

  11. Kuperman VY, Alley MT (1999) Differentiation between the effects of T1 and T2* shortening in contrast-enhanced MRI of the breast. J Magn Reson Imaging 9:172–176

    Article  PubMed  CAS  Google Scholar 

  12. Elster AD, Sobol WT, Hinson WH (1990) Pseudolayering of Gd-DTPA in the urinary bladder. Radiology 174:379–381

    PubMed  CAS  Google Scholar 

  13. May DA, Pennington DJ (2000) Effect of gadolinium concentration on renal signal intensity: an in vitro study with a saline bag model. Radiology 216:232–236

    PubMed  CAS  Google Scholar 

  14. Takahashi S, Kim T, Murakami T et al (2000) Influence of paramagnetic contrast on single-shot MRCP image quality. Abdom Imaging 25:511–513

    Article  PubMed  CAS  Google Scholar 

  15. Kim SM, Chang HK, Song JW et al (2010) Agranular platelets as a cardinal feature of ARC syndrome. J Pediatr Hematol Oncol 32:253–258

    Article  PubMed  Google Scholar 

  16. Kuhl CK, Gieseke J, von Falkenhausen M et al (2005) Sensitivity encoding for diffusion-weighted MR imaging at 3.0 T: intraindividual comparative study. Radiology 234:517–526

    Article  PubMed  Google Scholar 

  17. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  PubMed  CAS  Google Scholar 

  18. Carneiro RC, Fordham LA, Semelka RC (2002) MR imaging of the pediatric liver. Magn Reson Imaging Clin N Am 10:137–164

    Article  PubMed  Google Scholar 

  19. Miyazaki T, Yamashita Y, Tsuchigame T et al (1996) MR cholangiopancreatography using HASTE (half-Fourier acquisition single-shot turbo spin-echo) sequences. AJR 166:1297–1303

    PubMed  CAS  Google Scholar 

  20. Glockner JF (2007) Hepatobiliary MRI: current concepts and controversies. J Magn Reson Imaging 25:681–695

    Article  PubMed  Google Scholar 

  21. Carlos RC, Hussain HK, Song JH et al (2002) Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid as an intrabiliary contrast agent: preliminary assessment. AJR 179:87–92

    PubMed  Google Scholar 

  22. Miyazaki T, Yamashita Y, Tang Y et al (1998) Single-shot MR cholangiopancreatography of neonates, infants, and young children. AJR 170:33–37

    PubMed  CAS  Google Scholar 

  23. Jaw TS, Kuo YT, Liu GC et al (1999) MR cholangiography in the evaluation of neonatal cholestasis. Radiology 212:249–256

    PubMed  CAS  Google Scholar 

  24. Weinmann HJ, Brasch RC, Press WR et al (1984) Characteristics of gadolinium-DTPA complex: a potential NMR contrast agent. AJR 142:619–624

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiological Science, Severance Children’s Hospital, Yonsei University, College of Medicine, 250 Seongsanno (134 Sinchon-dong), Seodaemun-gu, Seoul, 120-752, South Korea

    Mi-Jung Lee, Myung-Joon Kim & Yong Eun Chung

  2. Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, 135-720, South Korea

    Choon-Sik Yoon

  3. Department of Pediatric Surgery, Severance Children’s Hospital, Yonsei University, College of Medicine, Seoul, 120-752, South Korea

    Seok Joo Han

  4. Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Severance Children’s Hospital, Yonsei University, College of Medicine, Seoul, 120-752, South Korea

    Hong Koh

  5. Severance Pediatric Liver Disease Research Group, Seoul, 120-752, South Korea

    Mi-Jung Lee, Myung-Joon Kim, Seok Joo Han & Hong Koh

Authors
  1. Mi-Jung Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Myung-Joon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Choon-Sik Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yong Eun Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seok Joo Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hong Koh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Myung-Joon Kim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, MJ., Kim, MJ., Yoon, CS. et al. Gadopentetate dimeglumine-enhanced MR cholangiopancreatography in infants with cholestasis. Pediatr Radiol 41, 488–494 (2011). https://doi.org/10.1007/s00247-010-1911-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-010-1911-4

Keywords

Search

Navigation