Jeong Kyong Lee MD, Presenter: Nothing to Disclose

Eujean Kwag, Abstract Co-Author: Nothing to Disclose

Jin Sil Kim, Abstract Co-Author: Nothing to Disclose

To compare hepatobiliary phase of gadoxetic acid-enhanced MR and hepatobiliary scintigraphy (HBS) for the evaluation of cystic duct patency and gallbladder contractility in patients suspected of having acute cholecystitis or gallbladder dyskinesia.

Eighteen consecutive patients were enrolled in the prospective study. The inclusion criteria were (a) Patients clinically suspected of having acute cholecystitis from a sudden onset of right upper quadrant tenderness. (b) Patients that showed equivocal findings for acute cholecystitis by CT and/or US obtained at the time of pain onset and suspected of having the possibility of gallbladder dyskinesia. (c) Patients not having cystic and bile duct obstruction by a stone or mass at US and CT. (d) CT that showed no evidence of disease which causes tenderness in other organs and, (e) Patients who underwent gadoxetic acid-enhanced MR imaging and HBS on the same day. Cystic duct patency by the reflux of contrast and radiotracer into gallbladder, and diagnostic accuracy for acute cholecystitis were evaluated at MR and HBS. Gallbladder ejection fraction (GBEF) was compared to determine a significant difference between hepatobiliary phase of gadoxetic acid-enhanced MR and HBS using a fatty meal as a stimulant for gallbladder contraction. Patients were treated by either a cholecystectomy (n = 11) or by conservative treatment (n = 7) based on clinical decision.

The evaluation of cystic duct patency indicated that hepatobiliary phase of MR and HBS had 15 concordant and 3 discordant results without a significant difference (p = 1.0). Diagnostic accuracy for acute cholecystitis was 83% at MR and 78% at HBS. GBEF was calculated in 14 of 18 patients at hepatobiliary phase MR and in nine patients at HBS. GBEF could not be calculated at HBS due to non-visualization of gallbladder. GBEF was available in eight patients at both MR and HBS. No significant difference in GBEF was found between MR and HBS (p = 0.068).

Hepatobiliary phase of gadoxetic acid-enhanced MR may be an alternative to HBS for the functional evaluation of cystic duct patency and GBEF. The MR has the advantage of demonstrating the morphological and functional abnormality of gallbladder.

Hepatobiliary phase of gadoxetic acid-enhanced MR can benefit patients with equivocal findings for acute cholecystitis by avoiding the performance of multiple or repeated modalities.

Lee, J, Kwag, E, Kim, J, Comparison of the Hepatobiliary Phase of Gadoxetic Acid-Enhanced MR and Hepatobiliary Scintigraphy for the Evaluation of Patients Suspected of Having Acute Cholecystitis or Gallbladder Dyskinesia: A Preliminary Study.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12026656.html