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Isolation of Neonatal Extrahepatic Cholangiocytes
Published on: June 5, 2014
Gadopentetate dimeglumine-enhanced MR cholangiopancreatography in infants with cholestasis
Mi-Jung Lee1, Myung-Joon Kim, Choon-Sik Yoon
1Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University, College of Medicine, 250 Seongsanno (134 Sinchon-dong), Seodaemun-gu, Seoul, 120-752, South Korea.
Insights
Gadolinium-enhanced MRCP improves diagnostic confidence for identifying the absence of the common bile duct (CBD) in infants with neonatal cholestasis. This technique enhances accuracy and agreement among radiologists evaluating biliary atresia (BA).
Area of Science:
- Medical Imaging
- Pediatric Radiology
- Gastroenterology
Background:
- Biliary atresia (BA) is a neonatal condition requiring early surgical intervention for optimal outcomes.
- Magnetic Resonance Cholangiopancreatography (MRCP) is a valuable diagnostic tool for neonatal cholestasis, but T2-weighted sequences can be affected by surrounding signal intensities.
- Improving image quality in MRCP is crucial for accurate diagnosis of BA.
Purpose of the Study:
- To assess the impact of gadolinium contrast on reducing background signal intensity in T2-weighted MRCP.
- To evaluate the qualitative enhancement of the common bile duct (CBD) depiction in infants undergoing MRCP for neonatal cholestasis.
- To determine if gadolinium-enhanced MRCP improves diagnostic confidence for BA.
Main Methods:
- A prospective study involving 49 infants (0-12 months) with neonatal cholestasis, diagnosed with BA (28 cases) or non-BA (21 cases).
- MRCP was performed using a 1.5-T scanner, with and without gadopentetate dimeglumine contrast.
- Quantitative analysis of signal intensities and qualitative assessment of CBD visualization confidence by four radiologists were conducted.
Main Results:
- Gadolinium contrast significantly decreased signal-to-noise ratios in the liver and pancreatic head (P < 0.0001).
- Diagnostic confidence scores for the presence of the CBD decreased in the BA group post-contrast (0.9 to 0.5, P < 0.0001).
- Intra- and interobserver agreement improved after contrast administration (P = 0.046).
Conclusions:
- Gadopentetate dimeglumine-enhanced MRCP increases diagnostic confidence in the absence of the CBD in cholestatic infants.
- The enhancement improves diagnostic accuracy and agreement among radiologists, particularly in differentiating BA.
- This technique offers a valuable improvement for evaluating neonatal cholestasis using MRCP.
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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