Does intravenous glucagon improve common bile duct visualisation during magnetic resonance cholangiopancreatography? Results in 42 patients

• Published in: European journal of radiology Vol. 49; no. 3; pp. 258 - 261
• Main Authors: Dalal, Paras U., Howlett, David C., Sallomi, David F., Marchbank, Nigel D., Watson, Gillian M.T., Marr, Amanda, Dunk, Arthur A., Smith, Alastair D.
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.03.2004; Elsevier Science
• Subjects: Adult; Aged; Aged, 80 and over; Ampulla; Ampulla of Vater; Biological and medical sciences; Cholangiopancreatography, Magnetic Resonance - methods; Choledocholithiasis - diagnosis; Cohort Studies; Common bile duct (CBD); Common Bile Duct - pathology; Diabetes. Impaired glucose tolerance; Digestive system; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Gastrointestinal Agents - administration & dosage; Gastrointestinal Agents - adverse effects; Glucagon; Glucagon - administration & dosage; Glucagon - adverse effects; Humans; Image Enhancement - methods; Injections, Intravenous - methods; Investigative techniques, diagnostic techniques (general aspects); Magnetic resonance cholangiopancreatography (MRCP); Male; Medical sciences; Middle Aged; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Sensitivity and Specificity; Glucagon; Magnetic resonance cholangiopancreatography (MRCP); Ampulla; Common bile duct (CBD); Endocrinopathy; Biliary tract; Pancreatic hormone; Intravenous administration; Liver; Hyperglycemic substances; Peptide hormone; Biliary tract disease; Vater ampulla; Diagnosis; Human; Cholangiopancreatography; Radiodiagnosis; Diabetes mellitus; Intensity; Spin echo; Method; Nuclear magnetic resonance imaging; Image quality; Symptomatology; Choledoch; Lithiasis; Digestive diseases; Antidote; Bibliographic review
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/S0720-048X(03)00084-6

Introduction: Magnetic resonance cholangiopancreatography (MRCP) has been demonstrated as a reliable, non-invasive means of biliary tract imaging among patients with suspected choledocholithiasis. The aim of this study was to establish the impact of intravenous glucagon administration (IVGA) upon visualisation of the common bile duct (CBD) and ampulla of Vater during MRCP. Materials and methods: Forty-two consecutive, non-diabetic subjects with a working diagnosis of symptomatic choledocholithiasis were scanned, pre- and post-IVGA using the half-Fourier, single shot, turbo-spin-echo (HASTE) sequence. Maximum intensity projections (optimised for the extra-hepatic biliary tree and ampulla of Vater) were reviewed blindly by three consultant radiologists. The CBD images were graded (0–3) according to the length of duct seen. The ampullary images were graded according to whether to it was visualised clearly (1), or not (0). Results: Following IVGA the CBD was visualised at grade 3 (75–100% of length seen) in 14 additional patients compared with images prior to IVGA. Furthermore, ampullary visualisation was considered diagnostic in 18 additional patients post-IVGA. No glucagon-associated adverse effects were observed. Conclusion: These results demonstrate that IVGA improved visualisation of the CBD and ampulla of Vater during magnetic resonance cholangiopanctreatography. This may reduce the requirement for repeat investigation or recourse to invasive diagnostic procedures (e.g. endoscopic retrograde cholangiopancreatography (ERCP)).