Suk Kim MD, Abstract Co-Author: Nothing to Disclose

Geewon Lee MD, Presenter: Nothing to Disclose

Nam Kyung Lee MD, Abstract Co-Author: Nothing to Disclose

Jun Woo Lee MD, Abstract Co-Author: Nothing to Disclose

Dae Hwan Kang, Abstract Co-Author: Nothing to Disclose

Gwang Ha Kim, Abstract Co-Author: Nothing to Disclose

Jeong Heo, Abstract Co-Author: Nothing to Disclose

 In healthy volunteers, washout of contrast material in the portal vein (PV) is seen within the enhanced hepatic parenchyma at a 20-minute delay after gadoxetic acid injection. In some hepatobiliary phase, we have observed prolonged PV enhancement. The purpose of this study is to determine the frequency and relevance of the prolonged PV enhancement sign in the hepatobiliary phase MR obtained with gadoxetic acid.

 We evaluated 1289 patients who underwent gadoxetic acid enhanced MR. The prolonged PV enhancement sign was defined as the presence of prolonged PV enhancement greater than that of the surrounding liver on the hepatobiliary phase at a 30-minute delay. Two readers who were blinded to serum biochemical tests and clinical findings retrospectively reviewed MR scans in consensus with respect to the presence of prolonged PV enhancement sign and visualization of contrast in the bile duct. The frequency of the prolonged PV enhancement sign was evaluated. The association between the prolonged PV enhancement sign and various parameters including serum biochemical tests (AST, ALT, ALP, LDH, total and direct bilirubin) and visualization of contrast filling in the bile duct were assessed. We performed a stepwise forward logistic regression to identify which variables significantly associated with the prolonged PV enhancement sign. Optimal cutoff values for the prediction of the prolonged PV enhancement sign were obtained with ROC analysis.  

 Two hundred thirty-six of 1289 patients were excluded. The prolonged PV enhancement sign was seen in 158 (15%) patients who underwent gadoxetic acid enhanced MR. In multivariate logistic analysis, the serum direct bilirubin level and lack of visualization of contrast in the bile duct are significant associated with prolonged PV enhancement sign in the hepatobiliary phase MR. Optimum cutoff values for the prediction of the prolonged PV enhancement sign were 2.18 mg/dL (sensitivity, 81%; specificity, 97%) for the serum direct bilirubin level.  

 The prolonged PV enhancement sign in the hepatobiliary phase MR obtained with gadoxetic acid is significantly correlated with serum direct bilirubin level, but was not specific for differentiation between extrahepatic and intrahepatic causes of cholestatic jaundice.

 Prolonged PV enhancement can be a suggestive finding of extra- and intrahepatic causes of cholestatic jaundice.

Kim, S, Lee, G, Lee, N, Lee, J, Kang, D, Kim, G, Heo, J, Frequency and Relevance of the “Prolonged Portal Vein Enhancement Sign” in the Hepatobiliary Phase MR Imaging Obtained with Gadoxetic Acid.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8008282.html