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Use of diffusion-weighted imaging in the noninvasive diagnostic of obstructed biliary ducts

  • Hepatobiliary
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Abstract

Objective

This study sought to evaluate the role of diffusion-weighted imaging (DWI) in differentiation between obstructed and unobstructed bile ducts in patients undergoing magnetic resonance imaging (MRI).

Methods

Eighty-four patients, 40 males and 44 females (mean age: 56.4 ± 15.1 years), undergoing MRI with DWI (0–50–500–700) were evaluated and divided into two groups: 58 with abnormal laboratory tests (obstructed group) and 26 with normal laboratory values (unobstructed group). Laboratory tests were total bilirubin, alkaline phosphatase, and gamma-glutamyltransferase. Median ADC values were calculated and correlated with laboratory tests and degree of bile-duct dilatation (absent, moderate, or severe). The persistence of signal on DWI (b500 and b700) in the biliary tract was evaluated. Bilirubin values were tested for correlation with bile-duct ADC values and persistence of b700 signal. For statistical analysis, Student t test, chi-square test and Wilcoxon–Mann–Whitney test were used. ADC maps were plotted for three levels of the biliary tree, and a receiver operating characteristic (ROC) curve was calculated.

Results

In the obstructed group, 15 patients had severe dilatation, 24 had moderate dilatation, and 19 had no appreciable dilatation; 38 patients had persistent signal on b700 images. In the unobstructed group, 23 patients had no dilatation and 3 had moderate dilatation; 4 patients had persistent signal on b700 images. Correlation was found between degree of bile-duct dilatation, bilirubin levels, persistence of b700 signal, and ADC map values. The calculated ADC map cutoff value (353 10–6 mm2/s) was able to differentiate the obstructed and unobstructed groups with 92.3% sensitivity, 81% specificity, and 91.9% accuracy.

Conclusions

DWI is able to distinguish patients with obstructed versus unobstructed bile ducts, regardless of the degree of dilatation, correlating with clinical and laboratory findings.

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Abbreviations

ERCP:

Endoscopic retrograde cholangiopancreatography

MRCP:

Magnetic resonance cholangiopancreatography

MRI:

Magnetic resonance Imaging

SNR:

Signal-to-noise ratio

DWI:

Diffusion-weighted imaging

ADC:

Apparent diffusion coefficient

ROI:

Region-of-interest imaging

NOG:

Unobstructed group

OG:

Obstruction group

TR:

Repetition time

TE:

Echo time

FOV:

Field of view

CSF:

Cerebrospinal fluid

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Acknowledgements

This study was financed in part by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil (funding code 001).

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Authors and Affiliations

  1. Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP, 04024-002, Brazil

    Eliane Donato Leite Paro, Andrea Puchnick, Jacob Szejnfeld & Suzan Menasce Goldman

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  1. Eliane Donato Leite Paro
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Correspondence to Eliane Donato Leite Paro.

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Paro, E.D.L., Puchnick, A., Szejnfeld, J. et al. Use of diffusion-weighted imaging in the noninvasive diagnostic of obstructed biliary ducts. Abdom Radiol 46, 268–279 (2021). https://doi.org/10.1007/s00261-020-02636-x

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