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Ascites relative enhancement during hepatobiliary phase after Gd-BOPTA administration: a new promising tool for characterising abdominal free fluid of unknown origin

  • Matteo BonattiEmail author
  • Riccardo Valletta
  • Giulia A. Zamboni
  • Fabio Lombardo
  • Maria Senoner
  • Mariachiara Simioni
  • Guenther Schifferle
  • Giampietro Bonatti
Magnetic Resonance
  • 17 Downloads

Abstract

Objectives

To correlate the degree of ascites enhancement during hepatobiliary phase after gadobenate dimeglumine (Gd-BOPTA) administration with ascites aetiology.

Methods

IRB-approved retrospective study, need for informed consent was waived. We included 74 consecutive ascitic patients who underwent Gd-BOPTA-enhanced liver MRI including hepatobiliary phase (HBP) images between January 2014 and December 2017. Ascites appearance on unenhanced and HBP images was classified as hypo-, iso- or hyperintense in comparison to paraspinal muscles. Ascites signal intensity on unenhanced and HBP images was measured using round ROIs and was normalised to paraspinal muscles (NSI). Normalised relative enhancement (NRE) between native phase and HBP was calculated. The results were related to ascites aetiology using Wilcoxon and Mann-Whitney tests.

Results

On native images, ascites appeared hypointense in 95.9% of the cases and isointense in 4.1%, whereas on HBP images, it appeared hyperintense in 59.4% of the cases, isointense in 36.5% and hypointense in 4.1%. Mean ascites NSI was 0.52 on unenhanced images and 1.50 on HBP ones (p < 0.0001). Mean ascites NRE was 201 ± 133%. Ascites of non-malignant aetiology showed mean NRE of 210 ± 134%, whereas malignant ascites showed mean NRE of 92 ± 20% (p = 0.001). ROC analysis showed that a NRE < 112.5% correlates with malignant aetiology with 100% sensitivity and 83.4% specificity (LR = 5.667). NRE did not show any significant correlation with ascites thickness, eGFR and time interval between contrast administration and HBP acquisition (p > 0.05).

Conclusions

Ascites NRE in HBP after Gd-BOPTA administration is significantly lower in patients with ascites secondary to peritoneal carcinomatosis than in patients with non-malignant ascites.

Key Points

• Ascites enhancement in the hepatobiliary phase after Gd-BOPTA administration may determine false positive findings when looking for biliary leaks.

• Ascites enhancement in the hepatobiliary phase after Gd-BOPTA administration is lower in patients with peritoneal carcinomatosis than in patients with portal hypertension or congestive heart failure.

• None of the patients with peritoneal carcinomatosis showed an ascites enhancement of more than 112% as compared with unenhanced images.

Keywords

Magnetic resonance imaging Ascites Gadobenate dimeglumine Peritoneal neoplasms Liver 

Abbreviations and acronyms

HBP

Hepatobiliary phase

NRE

Normalised relative enhancement

NSI

Normalised signal intensity

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Dr. Matteo Bonatti.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Dr. Fabio Lombardo) has significant statistical expertise. No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• multicenter study

References

  1. 1.
    Kirchin MA, Lorusso V, Pirovano G (2015) Compensatory biliary and urinary excretion of gadobenate ion after administration of gadobenate dimeglumine (MultiHance(®)) in cases of impaired hepatic or renal function: a mechanism that may aid in the prevention of nephrogenic systemic fibrosis? Br J Radiol 88:20140526CrossRefGoogle Scholar
  2. 2.
    Fontarensky M, Montoriol PF, Buc E, Poincloux L, Petitcolin V, Da Ines D (2013) Advantages of gadobenate dimeglumine-enhanced MR cholangiography in the diagnosis of post-liver transplant bile leakage. Diagn Interv Imaging 94:443–452CrossRefGoogle Scholar
  3. 3.
    Francisco FA, de Araújo AL, Oliveira Neto JA, Parente DB (2014) Hepatobiliary contrast agents: differential diagnosis of focal hepatic lesions, pitfalls and other indications. Radiol Bras 47:301–309CrossRefGoogle Scholar
  4. 4.
    Frydrychowicz A, Lubner MG, Brown JJ et al (2012) Hepatobiliary MR imaging with gadolinium-based contrast agents. J Magn Reson Imaging 35:492–511CrossRefGoogle Scholar
  5. 5.
    Melamud K, LeBedis CA, Anderson SW, Soto JA (2014) Biliary imaging: multimodality approach to imaging of biliary injuries and their complications. Radiographics 34:613–623CrossRefGoogle Scholar
  6. 6.
    Scali EP, Walshe T, Tiwari HA, Harris AC, Chang SD (2017) A pictorial review of hepatobiliary magnetic resonance imaging with hepatocyte-specific contrast agents: uses, findings, and pitfalls of gadoxetate disodium and gadobenate dimeglumine. Can Assoc Radiol J 68:293–307CrossRefGoogle Scholar
  7. 7.
    Seale MK, Catalano OA, Saini S, Hahn PF, Sahani DV (2009) Hepatobiliary-specific MR contrast agents: role in imaging the liver and biliary tree. Radiographics 29:1725–1748CrossRefGoogle Scholar
  8. 8.
    Huang LL, Xia HH, Zhu SL (2014) Ascitic fluid analysis in the differential diagnosis of ascites: focus on cirrhotic ascites. J Clin Transl Hepatol 2:58–64PubMedPubMedCentralGoogle Scholar
  9. 9.
    Cárdenas A, Bataller R, Arroyo V (2000) Mechanisms of ascites formation. Clin Liver Dis 4:447–465CrossRefGoogle Scholar
  10. 10.
    Hou W, Sanyal AJ (2009) Ascites: diagnosis and management. Med Clin North Am 93:801–817Google Scholar
  11. 11.
    Tamsma JT, Keizer HJ, Meinders AE (2001) Pathogenesis of malignant ascites: Starling’s law of capillary hemodynamics revisited. Ann Oncol 12:1353–1357CrossRefGoogle Scholar
  12. 12.
    Abdel-Razik A, Mousa N, Elalfy H et al (2017) A novel combination of C-reactive protein and vascular endothelial growth factor in differential diagnosis of ascites. J Gastrointest Cancer 48:50–57CrossRefGoogle Scholar
  13. 13.
    Risson JR, Macovei I, Loock M, Paquette B, Martin M, Delabrousse E (2012) Cirrhotic and malignant ascites: differential CT diagnosis. Diagn Interv Imaging 93:365–370CrossRefGoogle Scholar
  14. 14.
    Brogna A, Bucceri AM, Catalano F, Ferrara R, Leocata V (1996) Ultrasound demonstration of gallbladder wall thickening as a method to differentiate cirrhotic ascites from other ascites. Invest Radiol 31:80–83CrossRefGoogle Scholar
  15. 15.
    Ciolina M, Di Martino M, Bruno O, Pommier R, Vilgrain V, Ronot M (2018) Peritoneal and pleural fluids may appear hyperintense on hepatobiliary phase using hepatobiliary MR contrast agents. Eur Radiol 7:3020–3031CrossRefGoogle Scholar
  16. 16.
    Cooper C, Silverman PM, Davros WJ, Zeman RK (1993) Delayed contrast enhancement of ascitic fluid on CT: frequency and significance. AJR Am J Roentgenol 161:787–790CrossRefGoogle Scholar
  17. 17.
    Benedetti N, Aslam R, Wang ZJ et al (2009) Delayed enhancement of ascites after i.v. contrast material administration at CT: time course and clinical correlation. AJR Am J Roentgenol 193:732–737CrossRefGoogle Scholar
  18. 18.
    Wise SW, DeMeo JH, Austin RF (1996) Enhancing ascites: an aid to CT diagnosis. Abdom Imaging 21:67–68CrossRefGoogle Scholar
  19. 19.
    Bozkurt M, Doganay S, Kantarci M et al (2011) Comparison of peritoneal tumor imaging using conventional MR imaging and diffusion-weighted MR imaging with different b values. Eur J Radiol 80:224–228CrossRefGoogle Scholar
  20. 20.
    Low RN, Sebrechts CP, Barone RM, Muller W (2009) Diffusion-weighted MRI of peritoneal tumors: comparison with conventional MRI and surgical and histopathologic findings--a feasibility study. AJR Am J Roentgenol 193:461–470CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Matteo Bonatti
    • 1
    Email author return OK on get
  • Riccardo Valletta
    • 1
    • 2
  • Giulia A. Zamboni
    • 2
  • Fabio Lombardo
    • 1
  • Maria Senoner
    • 1
  • Mariachiara Simioni
    • 1
    • 2
  • Guenther Schifferle
    • 1
  • Giampietro Bonatti
    • 1
  1. 1.Department of RadiologyBolzano Central HospitalBolzanoItaly
  2. 2.Department of RadiologyUniversity of VeronaVeronaItaly

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