Original ArticleHepatobiliary phase of gadoxetic acid-enhanced MR in patients suspected of having gallbladder dyskinesia: comparison with hepatobiliary scintigraphy
Introduction
Hepatobiliary scintigraphy (HBS) has been an unchallenged modality for the functional evaluation of the gallbladder. In the clinical evaluation of a patient presenting with right upper quadrant tenderness and equivocal imaging findings for acute cholecystitis, HBS has played an important role by demonstrating the functional evaluation of cystic duct patency and gallbladder contractility [1], [2]. The functional information of gallbladder is useful for the diagnosis of acute cholecystitis and other functional gallbladder diseases such as gallbladder dyskinesia that frequently manifests as biliary colic mimicking acute cholecystitis and has traditionally been evaluated by assessment of gallbladder contractility based on the ejection fraction [3], [4], [5]. Magnetic resonance (MR) cholangiography using mangafodipir trisodium for the evaluation of cystic duct patency and gallbladder contractility measurement by ultrasound (US) have been reported [5], [6] however not widely accepted. Recently, commercial availability of hepatobiliary specific gadolinium-based MR contrast agent has been increasing, and MR using a gadolinium agent with a higher rate of hepatobiliary excretion has shown promise as an alternative to HBS for the functional evaluation of gallbladder [7], [8], [9]. MR including the hepatobiliary phase may be able to provide functional and morphological information on the gallbladder simultaneously. In this study, we prospectively compared the hepatobiliary phase of gadoxetic acid-enhanced MR with HBS for the evaluation of cystic duct patency and gallbladder contractility in patients suspected of having gallbladder dyskinesia.
Section snippets
Patients
This study was approved by our institutional review board, and written informed consent was obtained from all participants prior to entering the study. Between April 2008 and December 2010, 18 consecutive patients (8 men and 10 women; age range, 16–83 years; mean age, 50.6 years) were enrolled in this study prospectively. The inclusion criteria were as follows: (a) Patients that had a sudden onset of right upper quadrant tenderness, (b) patients that showed equivocal findings for acute
Diagnostic performance of MR and HBS
All patients showed biliary and duodenal excretion at the hepatobiliary phase of gadoxetic acid-enhanced MR and did not show cystic or common duct obstruction at T2-weighed MR. In total, 15 patients demonstrated concordant results at the hepatobiliary phase MR and HBS (Table 2). Of these, five showed no reflux of contrast and radiotracer into the gallbladder at the hepatobiliary phase MR and HBS, respectively. Two of the five improved by conservative treatment. Three patients underwent a
Discussion
Gallbladder dyskinesia refers to the clinical entity of right upper quadrant symptoms of biliary colic and abnormal GBEF in the absence of gallstones or sludge [3]. Terminology can be confusing and numerous other names have been used for this entity (i.e., chronic acalculous cholecystitis, cystic duct syndrome, functional gallbladder disease, and so on) [10]. The functional biliary pain is most often attributed to abnormal gallbladder motility [4]. The diagnosis and treatment of gallbladder
Acknowledgments
This research was supported by Research Grant of Bayer Korea Ltd. (ISS#13658).
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