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

Abstract

ObjectiveTo assess the value of gadoxetate disodium for characterization and staging of central bile duct stenosis (CBDS). Materials and methodsThis 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, 120min 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. ResultsCBDS 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). ConclusionsBy 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.