Abstract
Expanding bile leaks after blunt liver trauma require more aggressive treatment than contained bile leaks. In this retrospective study approved by institution review board, we analyzed if non-invasive contrast-enhanced magnetic resonance cholangiography (CEMRC) using hepatocyte-specific contrast agent (gadoxetic acid disodium) could detect and characterize traumatic bile leaks. Between March 2012 and December 2014, written informed consents from 22 included patients (17 men, 5 women) with a median age of 24.5 years (IQR 21.8, 36.0 years) were obtained. Biliary tree visualization and bile leak detection on CEMRC acquired at 10, 20, 30, 90 minutes time points were independently graded by three radiologists on a 5-point Likert scale. Intraclass Correlation (ICC) was computed as estimates of interrater reliability. Accuracy was measured by area under receiver operating characteristic curves (AUROC). Biliary tree visualization was the best on CEMRC at 90 minutes (score 4.30) with excellent inter-rater reliability (ICC = 0.930). Of 22 CEMRC, 15 had bile leak (8 expanding, 7 contained). The largest AUROC of bile leak detection by three radiologists were 0.824, 0.914, 0.929 respectively on CEMRC at 90 minutes with ICC of 0.816. In conclusion, bile leaks of blunt liver trauma can be accurately detected and characterized on CEMRC.
Highlights
Biliary injuries can occur at the time of blunt liver trauma[1,2,3,4,5]
All had recent major blunt liver trauma ≥grade III injuries according to scoring scheme of American Association for the Surgery of Trauma (AAST)
With the advent of magnetic resonance imaging, the diagnostic performance of T2-weighted magnetic resonance cholangiography which capitalizes on the long T2-relaxation property of bile is comparable to that of endoscopic retrograde cholangiography for biliary cancer, biliary stone and biliary anomaly[24]
Summary
Biliary injuries can occur at the time of blunt liver trauma[1,2,3,4,5]. Its frequency has been reported to range from 3% in low grade liver trauma to about 15% in high grade trauma[1,3,4,5,6,7,8,9,10]. Complicated biliary injuries often require further diagnostic work up as well as complex therapeutic surgical or endoscopic treatment procedures[4,5,6,7,12,13,14]. Intrahepatic fluid accumulation can be aspirated and analyzed for bile content, or it can be contrasted by percutaneous cavitography for evaluation if the intrahepatic fluid communicates with biliary tree[17,18] All these invasive procedures can pose additional risks to recently injured patients. About 50% of the intravenously injected hepatocyte-specific MRI contrast agent such as gadoxetic acid disodium is excreted by hepatocytes into biliary system shortening the T1 effect of bile on MRI19,20 Extravasation of this biliary contrast medium from biliary tree to the intrahepatic or perihepatic biloma is readily detected and differentiated from other fluid collections[21]. Our purpose is to analyze the diagnostic performance of CEMRC for traumatic bile leak and to compare different characteristics of bile leak (expanding or contained) with clinical parameters, specific treatment and complication
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