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Detection and Localization of Bile Duct Leaks After Cholecystectomy Using Gd-EOB-DTPAEnhanced MR Cholangiography: Retrospective Study of 16 Patients

Ratcliffe, Gregory E. MD*; Kirkpatrick, Iain D. MD; Anik Sahni, V. MD; Greenberg, Howard M. MD*; Henderson, Blair MD*; Radulovic, Dejana MD§; Mottola, Jeffrey C. MD*

Journal of Computer Assisted Tomography: July/August 2014 - Volume 38 - Issue 4 - p 518–525
doi: 10.1097/RCT.0000000000000083
Abdominal Imaging

Objective: To determine if gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) cholangiography can detect and localize bile duct leaks in postcholecystectomy patients.

Material and Methods: Four blinded independent radiologists performed a retrospective review of 16 consecutive patients who underwent MR cholangiography with intravenous Gd-EOB-DTPA for the evaluation of possible biliary leak. Image quality, ductal opacification, and presence and location of any bile leak were evaluated. An independent observer determined the criterion standard using a consensus of all chart, clinical, and imaging findings.

Results: All 6 bile leaks confirmed at endoscopic retrograde cholangiopancreatography were diagnosed by all reviewers (sensitivity, 100%). Of the 10 patients with no leak, only one reader incorrectly diagnosed a bile leak in a single case (specificity, 98%). The accuracy for detection of the site of leak with Gd-EOB-DTPA-enhanced MR cholangiography was 80%.

Conclusion: Gadolinium-EOB-DTPA–enhanced MR can detect bile leaks with a high sensitivity and specificity.

*From the Diagnostic Radiology, The Health Sciences Center, University of Manitoba, Winnipeg, Manitoba, Canada; †Diagnostic Radiology, MRI Department, St. Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada; ‡Division of Abdominal Imaging and Intervention, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; and §Diagnostic Radiology, CT Department, St. Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.

Received for publication October 25, 2013; accepted January 29, 2014.

Reprints: Gregory E. Ratcliffe, MD, Postgraduate Year Four, Diagnostic Radiology Residency, University of Manitoba, Department of Radiology, GA216-820 Sherbrook St, Winnipeg, MB R2J 2J8, Canada (e-mail: umratclg@cc.umanitoba.ca).

The authors declare no conflict of interest.

© 2014 by Lippincott Williams & Wilkins