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Kontrastverstärkte MR-Cholangiographie mit Gadolinium-EOB-DTPA

Erste Erfahrungen und klinische Einsatzmöglichkeiten

Contrast-enhanced magnetic resonance cholangiography using gadolinium-EOB-DTPA. Preliminary experience and clinical applications

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Zusammenfassung

Die Magnetresonanz-Cholangio-Pankreatikographie (MRCP) mit stark T2-gewichteten RARE- und HASTE-Sequenzen hat sich in den letzten Jahren als nichtinvasives Verfahren zur morphologischen Darstellung der Gallenwege etabliert und sich in der klinischen Routine bewährt. Für die funktionelle Beurteilung der Gallenwege wurden bislang die endoskopische retrograde Cholangio-Pankreatikographie (ERCP) bzw. die endoskopische Manometrie, also invasive Methoden mit entsprechender Morbidität und Mortalität, eingesetzt. Die Choleszintigraphie, die sekretinstimulierte MRCP und die endoskopische Sonographie nach Sekretingabe konnten sich aufgrund ihrer schlechten Korrelation mit der Manometrie in der Praxis bisher nicht durchsetzen. Die kontrastverstärkte Magnetresonanzcholangiographie (contrast-enhanced MRC, CE-MRC) mit Hepatozyten-spezifischen Kontrastmitteln, die biliär sezerniert werden, könnte in Zukunft die nichtinvasive, funktionelle Diagnostik des hepatobiliären Systems bereichern. Hierbei handelt es sich um sog. T1-Kontrastmittel, die eine Darstellung des biliären Gangsystems mit T1-gewichteten MR-Sequenzen ermöglichen. Die vorliegende Arbeit gibt einen Überblick über erste Erfahrungen und mögliche Indikationen der CE-MRC mit Gd-EOB-DTPA. Darüber hinaus verschafft sie eine Übersicht über bisherige Arbeiten, in denen ein möglicher Nutzen der CE-MRC unter Verwendung anderer hepatobiliärer Kontrastmittel, insbesondere Mangafodipir Trisodium, untersucht wurde.

Abstract

Magnetic resonance cholangiopancreaticography (MRCP) with heavily T2-weighted RARE and HASTE sequences has become an important imaging modality for the morphologic evaluation of intra- and extrahepatic bile ducts. However, for the diagnosis of functional biliary disorders, cholangiopancreaticography (ERCP) and endoscopic manometry, two invasive techniques with considerable morbidity and mortality, remain the standard. Biliary scintigraphy, secretin-stimulated MRCP, and secretin-stimulated endoscopic ultrasound have not proven to be sufficient to replace these techniques as they lack diagnostic accuracy and correlate poorly with manometry results. Contrast-enhanced magnetic resonance cholangiography (CE-MRC) uses hepatocyte-selective contrast agents that are eliminated by the biliary system. Therefore, these substances can serve as biliary contrast agents in T1-weighted MR imaging. This method makes a noninvasive functional evaluation of the hepatobiliary system possible. In the present article, our preliminary experience with Gd-EOB-DTPA-enhanced MRC is summarized and potential clinical applications of this method are discussed. Additionally, the article reviews publications evaluating a possible benefit of CE-MRC with other hepatobiliary contrast agents such as mangafodipir trisodium.

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Authors and Affiliations

  1. II.Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland

    C. Prinz

  2. Institut für Röntgendiagnostik, Klinikum rechts der Isar der Technischen Universität, Ismaninger Str. 22, 81675 , München, Deutschland

    K. Holzapfel, C. Breitwieser, E. J. Rummeny & J. Gaa

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  1. K. Holzapfel
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  2. C. Breitwieser
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  3. C. Prinz
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  4. E. J. Rummeny
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Correspondence to K. Holzapfel.

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Holzapfel, K., Breitwieser, C., Prinz, C. et al. Kontrastverstärkte MR-Cholangiographie mit Gadolinium-EOB-DTPA. Radiologe 47, 536–544 (2007). https://doi.org/10.1007/s00117-006-1444-x

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