Misleading findings of liver-specific MR contrast agent for radiological diagnosis of cysto-biliary communication in hydatid cysts
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To investigate the effectiveness of gadoxetic acid-enhanced magnetic resonance cholangiopancreatography (CE-MRCP) and T2-weighted half-Fourier acquisition single-shot turbo spin-echo (T2W HASTE) sequences for diagnosis of cysto-biliary communication in hydatid cysts compared to surgical results.
Preoperative abdominal magnetic resonance imaging examinations of patients who underwent surgery for hepatic hydatid cysts were reviewed by two radiologists retrospectively. A total of 45 patients with hydatid cysts were included. Of 45, 27 also had CE-MRCPs. T2W HASTE sequences and CE-MRCPs were investigated separately for cysto-biliary communication. The relationship between radiological and surgical results was analyzed. The interobserver agreement was evaluated.
Of 45 hydatid cysts, there were surgically proven 21 cysts without biliary communications and 24 cysts with biliary communications. All cysts with biliary communications were shown on T2W HASTE sequences. There was no leakage of gadoxetic acid into these cysts (n = 24). Sensitivity, specificity, negative predictive value, positive predictive value (PPV), and accuracy of diagnosis of cyst with biliary communication on T2W HASTE sequences was 100%, 63.64%, 100%, 66.67%, and 78.95%, respectively. Specificity (77.78%), PPV (87.50%), and accuracy (91.30%) were increased in ≥ 10 cm cysts. There was almost perfect interobserver agreement (K = 0.81–1.00).
Leakage of gadoxetic acid inside the cyst indicates biliary communication. However, the lack of leakage does not rule out cysto-biliary communication. When biliary communication is clearly shown on T2W HASTE sequences, it should be reported as cysto-biliary communication even if there is no leakage of gadoxetic acid into the cyst on CE-MRCP.
KeywordsBiliary system Gadoxetic acid Hydatid cyst Magnetic resonance cholangiopancreatography
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Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
For this type of study formal consent is not required.
- 5.Bakdik S, Arslan S, Oncu F, Tolu I, Eryilmaz MA (2018) Percutaneous treatment of hepatic cystic echinococcosis: the success of alcohol as a single endocavitary agent in PAIR, catheterization, and modified catheterization techniques. Radiol Med 123(2):153–160. https://doi.org/10.1007/s11547-017-0820-0 CrossRefPubMedGoogle Scholar
- 6.Iannicelli E, Di Pietropaolo M, Marignani M, Briani C, Federici GF, DelleFave G, David V (2014) Gadoxetic acid-enhanced MRI for hepatocellular carcinoma and hypointense nodule observed in the hepatobiliary phase. Radiol Med 119(6):367–376. https://doi.org/10.1007/s11547-013-0364-x PubMedGoogle Scholar
- 8.Kantarci M, Pirimoglu B, Ogul H, Bayraktutan U, Eren S, Aydinli B, Ozturk G, Karaca L (2014) Can biliary-cyst communication be predicted by Gd-EOB-DTPA-enhanced MR cholangiography before treatment for hepatic hydatid disease? Clin Radiol 69(1):52–58. https://doi.org/10.1016/j.crad.2013.08.005 CrossRefPubMedGoogle Scholar
- 9.Schneider G, Altmeyer K, Kirchin MA, Seidel R, Grazioli L, Morana G, Saini S (2007) Evaluation of a novel time-efficient protocol for gadobenate dimeglumine (Gd-BOPTA)-enhanced liver magnetic resonance imaging. Invest Radiol 42:105–115. https://doi.org/10.1097/01.rli.0000251539.05400.06 CrossRefPubMedGoogle Scholar
- 13.Hammami A, Hellara O, Mnari W, Loussaief C, Bedioui F, Safer L, Golli M, Chakroun M, Saffar H (2015) Unusual presentation of severely disseminated and rapidly progressive hydatic cyst: malignant hydatidosis. World J Hepatol 7(3):633–637. https://doi.org/10.4254/wjh.v7.i3.633 CrossRefPubMedGoogle Scholar
- 18.Kantarcı M, Pirimoglu B, Karabulut N, Bayraktutan U, Ogul H, Ozturk G, Aydinli B, Kizrak Y, Eren S, Yilmaz S (2013) Non-invasive detection of biliary leaks using Gd-EOB-DTPA-enhanced MR cholangiography: comparison with T2-weighted MR cholangiography. Eur Radiol 23(10):2713–2722. https://doi.org/10.1007/s00330-013-2880-4 CrossRefPubMedGoogle Scholar
- 19.Cieszanowski A, Stadnik A, Lezak A, Maj E, Zieniewicz K, Rowinska-Berman K, Grudzinski IP, Krawczyk M, Rowiński O (2013) Detection of active bile leak with Gd-EOB-DTPA enhanced MR cholangiography: comparison of 20-25 min delayed and 60-180 min delayed images. Eur J Radiol 82(12):2176–2182. https://doi.org/10.1016/j.ejrad.2013.08.021 CrossRefPubMedGoogle Scholar