Prospective assessment of dynamic CT and MR cholangiography in functional biliary pain

Jeff L. Fidler, John M. Knudsen, Douglas A. Collins, Kiaran Patrick McGee, Johnson L. Thistle, Brain Lahr, Mark Topazian

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective. The objectives of our study were to assess the feasibility of dynamic CT and MR cholangiography during gallbladder stimulation, to compare CT and MR cholangiography with biliary scintigraphy, and to identify morphologic differences between patients with functional biliary pain and healthy control subjects. SUBJECTS AND METHODS. In this prospective study, 30 patients with functional biliary pain underwent biliary scintigraphy, CT cholangiography, and MR cholangiography before and during 45-minute sincalide infusions. Thirty healthy control subjects also underwent MR cholangiography with sincalide infusion. IV contrast agents (iodipamide meglumine or gadobenate dimeglumine) were administered before scanning. CT and MR images were qualitatively and quantitatively analyzed. Results. Diagnostic images were obtained of all participants. There was good agreement for gallbladder ejection fraction (EF) at 40 minutes by all three methods (Lin's concordance correlation coefficient = 0.6). Gallbladder contraction and refilling occurred more promptly by CT and MR cholangiography than scintigraphy. CT and MR cholangiography showed previously undiagnosed gallstones in two patients (7%). Gallbladder shape was categorized as straight, curved, or folded; a folded gallbladder was present in 37% and 23% of patients at baseline and 40 minutes, respectively, versus in 3% of control subjects at both times (p = 0.004). Asymmetric patterns of gallbladder contraction occurred in 10 patients (33%) and four control subjects (13%) (p = 0.13). Conclusion. Dynamic CT cholangiography and MR cholangiography performed during pharmacologic stimulation accurately measure gallbladder EFs and detect missed gallstones. Gallbladder shape before and during contraction differs between patients with functional biliary pain and healthy control subjects. Dynamic CT cholangiography and MR cholangiography are promising techniques that might improve selection of patients to undergo cholecystectomy for functional biliary pain.

Original languageEnglish (US)
JournalAmerican Journal of Roentgenology
Volume201
Issue number2
DOIs
StatePublished - Aug 2013

Fingerprint

Cholangiography
Gallbladder
Pain
Radionuclide Imaging
Sincalide
Healthy Volunteers
Gallstones
Cholecystectomy
Patient Selection
Contrast Media
Prospective Studies

Keywords

  • Abdominal pain
  • Bile duct
  • Cholelithiasis
  • Dyskinesia
  • Ejection fraction
  • Gallbladder

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Prospective assessment of dynamic CT and MR cholangiography in functional biliary pain. / Fidler, Jeff L.; Knudsen, John M.; Collins, Douglas A.; McGee, Kiaran Patrick; Thistle, Johnson L.; Lahr, Brain; Topazian, Mark.

In: American Journal of Roentgenology, Vol. 201, No. 2, 08.2013.

Research output: Contribution to journalArticle

Fidler, Jeff L. ; Knudsen, John M. ; Collins, Douglas A. ; McGee, Kiaran Patrick ; Thistle, Johnson L. ; Lahr, Brain ; Topazian, Mark. / Prospective assessment of dynamic CT and MR cholangiography in functional biliary pain. In: American Journal of Roentgenology. 2013 ; Vol. 201, No. 2.
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abstract = "Objective. The objectives of our study were to assess the feasibility of dynamic CT and MR cholangiography during gallbladder stimulation, to compare CT and MR cholangiography with biliary scintigraphy, and to identify morphologic differences between patients with functional biliary pain and healthy control subjects. SUBJECTS AND METHODS. In this prospective study, 30 patients with functional biliary pain underwent biliary scintigraphy, CT cholangiography, and MR cholangiography before and during 45-minute sincalide infusions. Thirty healthy control subjects also underwent MR cholangiography with sincalide infusion. IV contrast agents (iodipamide meglumine or gadobenate dimeglumine) were administered before scanning. CT and MR images were qualitatively and quantitatively analyzed. Results. Diagnostic images were obtained of all participants. There was good agreement for gallbladder ejection fraction (EF) at 40 minutes by all three methods (Lin's concordance correlation coefficient = 0.6). Gallbladder contraction and refilling occurred more promptly by CT and MR cholangiography than scintigraphy. CT and MR cholangiography showed previously undiagnosed gallstones in two patients (7{\%}). Gallbladder shape was categorized as straight, curved, or folded; a folded gallbladder was present in 37{\%} and 23{\%} of patients at baseline and 40 minutes, respectively, versus in 3{\%} of control subjects at both times (p = 0.004). Asymmetric patterns of gallbladder contraction occurred in 10 patients (33{\%}) and four control subjects (13{\%}) (p = 0.13). Conclusion. Dynamic CT cholangiography and MR cholangiography performed during pharmacologic stimulation accurately measure gallbladder EFs and detect missed gallstones. Gallbladder shape before and during contraction differs between patients with functional biliary pain and healthy control subjects. Dynamic CT cholangiography and MR cholangiography are promising techniques that might improve selection of patients to undergo cholecystectomy for functional biliary pain.",
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AU - Fidler, Jeff L.

AU - Knudsen, John M.

AU - Collins, Douglas A.

AU - McGee, Kiaran Patrick

AU - Thistle, Johnson L.

AU - Lahr, Brain

AU - Topazian, Mark

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N2 - Objective. The objectives of our study were to assess the feasibility of dynamic CT and MR cholangiography during gallbladder stimulation, to compare CT and MR cholangiography with biliary scintigraphy, and to identify morphologic differences between patients with functional biliary pain and healthy control subjects. SUBJECTS AND METHODS. In this prospective study, 30 patients with functional biliary pain underwent biliary scintigraphy, CT cholangiography, and MR cholangiography before and during 45-minute sincalide infusions. Thirty healthy control subjects also underwent MR cholangiography with sincalide infusion. IV contrast agents (iodipamide meglumine or gadobenate dimeglumine) were administered before scanning. CT and MR images were qualitatively and quantitatively analyzed. Results. Diagnostic images were obtained of all participants. There was good agreement for gallbladder ejection fraction (EF) at 40 minutes by all three methods (Lin's concordance correlation coefficient = 0.6). Gallbladder contraction and refilling occurred more promptly by CT and MR cholangiography than scintigraphy. CT and MR cholangiography showed previously undiagnosed gallstones in two patients (7%). Gallbladder shape was categorized as straight, curved, or folded; a folded gallbladder was present in 37% and 23% of patients at baseline and 40 minutes, respectively, versus in 3% of control subjects at both times (p = 0.004). Asymmetric patterns of gallbladder contraction occurred in 10 patients (33%) and four control subjects (13%) (p = 0.13). Conclusion. Dynamic CT cholangiography and MR cholangiography performed during pharmacologic stimulation accurately measure gallbladder EFs and detect missed gallstones. Gallbladder shape before and during contraction differs between patients with functional biliary pain and healthy control subjects. Dynamic CT cholangiography and MR cholangiography are promising techniques that might improve selection of patients to undergo cholecystectomy for functional biliary pain.

AB - Objective. The objectives of our study were to assess the feasibility of dynamic CT and MR cholangiography during gallbladder stimulation, to compare CT and MR cholangiography with biliary scintigraphy, and to identify morphologic differences between patients with functional biliary pain and healthy control subjects. SUBJECTS AND METHODS. In this prospective study, 30 patients with functional biliary pain underwent biliary scintigraphy, CT cholangiography, and MR cholangiography before and during 45-minute sincalide infusions. Thirty healthy control subjects also underwent MR cholangiography with sincalide infusion. IV contrast agents (iodipamide meglumine or gadobenate dimeglumine) were administered before scanning. CT and MR images were qualitatively and quantitatively analyzed. Results. Diagnostic images were obtained of all participants. There was good agreement for gallbladder ejection fraction (EF) at 40 minutes by all three methods (Lin's concordance correlation coefficient = 0.6). Gallbladder contraction and refilling occurred more promptly by CT and MR cholangiography than scintigraphy. CT and MR cholangiography showed previously undiagnosed gallstones in two patients (7%). Gallbladder shape was categorized as straight, curved, or folded; a folded gallbladder was present in 37% and 23% of patients at baseline and 40 minutes, respectively, versus in 3% of control subjects at both times (p = 0.004). Asymmetric patterns of gallbladder contraction occurred in 10 patients (33%) and four control subjects (13%) (p = 0.13). Conclusion. Dynamic CT cholangiography and MR cholangiography performed during pharmacologic stimulation accurately measure gallbladder EFs and detect missed gallstones. Gallbladder shape before and during contraction differs between patients with functional biliary pain and healthy control subjects. Dynamic CT cholangiography and MR cholangiography are promising techniques that might improve selection of patients to undergo cholecystectomy for functional biliary pain.

KW - Abdominal pain

KW - Bile duct

KW - Cholelithiasis

KW - Dyskinesia

KW - Ejection fraction

KW - Gallbladder

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