Characterization and staging of central bile duct stenosis—Evaluation of the hepatocyte specific contrast agent gadoxetate disodium

• Published in: European journal of radiology Vol. 81; no. 11; pp. 3028 - 3034
• Main Authors: Ringe, Kristina I, Ringe, Bastian P, Bektas, Hüseyin, Opherk, Jan P, Reichelt, Angela, Lotz, Joachim, Wacker, Frank, Meyer, Bernhard C
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.11.2012
• Subjects: Adult; Aged; Aged, 80 and over; Cholangiocarcinoma; Cholestasis - pathology; Contrast Media; Female; Gadolinium DTPA; Gadoxetate disodium; Gd-EOB-DTPA; Hepatocytes - pathology; Humans; Klatskin tumor; Magnetic Resonance Imaging - methods; Male; Middle Aged; Radiology; Reproducibility of Results; Sensitivity and Specificity; Gadoxetate disodium; Gd-EOB-DTPA; Cholangiocarcinoma; Klatskin tumor
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2012.03.030

Abstract Objective To assess the value of gadoxetate disodium for characterization and staging of central bile duct stenosis (CBDS). Materials and methods This prospective HIPAA-compliant study was IRB approved. 14 patients (8 male, 6 female; 36–80 years) with clinical suspicion of CBDS underwent preoperative MRI. To estimate the value of hepatocyte phase images (10, 20, 120 min p.i.), only T2w images (T2), only post-contrast images (CM), or both image datasets were assessed in three reading sessions by 3 readers. Agreement of each reading session with the intraoperative findings in terms of CBDS etiology and tumor extension (weighted kappa statistic) was calculated. Results CBDS was caused by hilar cholangiocarcinoma ( n = 9), gallbladder carcinoma ( n = 4) and pancreatic carcinoma ( n = 1). Characterization of CBDS etiology was correct by use of: T2w images in 57%, 64%, 50%; CM images in 64%, 57%, 50%; both in 71%, 64%, 64%. Agreement comparing reading sessions and intraoperative findings regarding tumor extension was fair up to moderate ( κ -range = 0.21–0.54) as a result of common underestimation. Interobserver agreement for tumor extension was fair ( κ -range = 0.31–0.33). Conclusions By means of combined evaluation of T2 and CM images a more reliable characterization of CBDS was possible. Even though CBDS tended to be underestimated assessment of exact tumor extension was improved by contrast administration.