Gadopentetate dimeglumine-enhanced MR cholangiopancreatography in infants with cholestasis

Mi Jung Lee, Myung Joon Kim, Choon Sik Yoon, Yong Eun Chung, Seok Joo Han, Hong Koh

Research output: Contribution to journalArticle

8 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)488-494
Number of pages7
JournalPediatric Radiology
Volume41
Issue number4
DOIs
Publication statusPublished - 2011 Apr 1

Fingerprint

Biliary Atresia
Gadolinium DTPA
Cholestasis
Common Bile Duct
Contrast Media
Hepatic Portoenterostomy
Liver
Research Ethics Committees
Gadolinium
Signal-To-Noise Ratio
Bile Ducts
Gallbladder
Newborn Infant
Prospective Studies
Injections
Therapeutics

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Pediatrics, Perinatology, and Child Health

Cite this

Lee, Mi Jung ; Kim, Myung Joon ; Yoon, Choon Sik ; Chung, Yong Eun ; Han, Seok Joo ; Koh, Hong. / Gadopentetate dimeglumine-enhanced MR cholangiopancreatography in infants with cholestasis. In: Pediatric Radiology. 2011 ; Vol. 41, No. 4. pp. 488-494.
@article{ba237bc40ab74a9f90df49f893218dd5,
title = "Gadopentetate dimeglumine-enhanced MR cholangiopancreatography in infants with cholestasis",
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.",
author = "Lee, {Mi Jung} and Kim, {Myung Joon} and Yoon, {Choon Sik} and Chung, {Yong Eun} and Han, {Seok Joo} and Hong Koh",
year = "2011",
month = "4",
day = "1",
doi = "10.1007/s00247-010-1911-4",
language = "English",
volume = "41",
pages = "488--494",
journal = "Pediatric Radiology",
issn = "0301-0449",
publisher = "Springer Verlag",
number = "4",

}

Gadopentetate dimeglumine-enhanced MR cholangiopancreatography in infants with cholestasis. / Lee, Mi Jung; Kim, Myung Joon; Yoon, Choon Sik; Chung, Yong Eun; Han, Seok Joo; Koh, Hong.

In: Pediatric Radiology, Vol. 41, No. 4, 01.04.2011, p. 488-494.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Gadopentetate dimeglumine-enhanced MR cholangiopancreatography in infants with cholestasis

AU - Lee, Mi Jung

AU - Kim, Myung Joon

AU - Yoon, Choon Sik

AU - Chung, Yong Eun

AU - Han, Seok Joo

AU - Koh, Hong

PY - 2011/4/1

Y1 - 2011/4/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=79953833615&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79953833615&partnerID=8YFLogxK

U2 - 10.1007/s00247-010-1911-4

DO - 10.1007/s00247-010-1911-4

M3 - Article

VL - 41

SP - 488

EP - 494

JO - Pediatric Radiology

JF - Pediatric Radiology

SN - 0301-0449

IS - 4

ER -