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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 
 PEDIATRIC RADIOLOGY, Vol.41(4) : 488-494, 2011 
Journal Title
Issue Date
Biliary Atresia/diagnosis* ; Cholangiopancreatography, Magnetic Resonance/methods* ; Cholestasis/diagnosis* ; Contrast Media* ; Female ; Gadolinium DTPA* ; Humans ; Image Interpretation, Computer-Assisted ; Infant ; Infant, Newborn ; Male ; Predictive Value of Tests ; Prospective Studies ; Sensitivity and Specificity ; Statistics, Nonparametric
Cholestasis ; Biliary atresia ; MRI ; MR cholangiopancreatography ; Gadolinium ; Infant
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.
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1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Koh, Hong(고홍) ORCID logo https://orcid.org/0000-0002-3660-7483
Kim, Myung Joon(김명준) ORCID logo https://orcid.org/0000-0002-4608-0275
Yoon, Choon Sik(윤춘식) ORCID logo https://orcid.org/0000-0003-2010-6710
Lee, Mi-Jung(이미정) ORCID logo https://orcid.org/0000-0003-3244-9171
Chung, Yong Eun(정용은) ORCID logo https://orcid.org/0000-0003-0811-9578
Han, Seok Joo(한석주) ORCID logo https://orcid.org/0000-0001-5224-1437
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