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Three-dimensional drip infusion CT cholangiography in patients with suspected obstructive biliary disease: a retrospective analysis of feasibility and adverse reaction to contrast material
Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Radiology in Linköping. Linköping University, Department of Medicine and Care, Medical Radiology.ORCID iD: 0000-0002-9446-6981
Department of Radiology, Hudiksvall Hospital, Sweden .ORCID iD: 0000-0002-4111-1693
Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Medical Radiology. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology in Linköping.ORCID iD: 0000-0002-7750-1917
Division of Radiology, Karolinska Institutet, Sweden .
2006 (English)In: BMC Medical Imaging, ISSN 1471-2342, E-ISSN 1471-2342, Vol. 6, no 1Article in journal (Refereed) Published
Abstract [en]

Background

Computed Tomography Cholangiography (CTC) is a fast and widely available alternative technique to visualise hepatobiliary disease in patients with an inconclusive ultrasound when MRI cannot be performed. The method has previously been relatively unknown and sparsely used, due to concerns about adverse reactions and about image quality in patients with impaired hepatic function and thus reduced contrast excretion. In this retrospective study, the feasibility and the frequency of adverse reactions of CTC when using a drip infusion scheme based on bilirubin levels were evaluated.

Methods

The medical records of patients who had undergone upper abdominal spiral CT with subsequent three-dimensional rendering of the biliary tract by means of CTC during seven years were retrospectively reviewed regarding serum bilirubin concentration, adverse reaction and presence of visible contrast media in the bile ducts at CT examination. In total, 153 consecutive examinations in 142 patients were reviewed.

Results

Contrast media was observed in the bile ducts at 144 examinations. In 110 examinations, the infusion time had been recorded in the medical records. Among these, 42 examinations had an elevated bilirubin value (>19 umol/L). There were nine patients without contrast excretion; 3 of which had a normal bilirubin value and 6 had an elevated value (25–133 umol/L). Two of the 153 examinations were inconclusive. One subject (0.7%) experienced a minor adverse reaction – a pricking sensation in the face. No other adverse effects were noted.

Conclusion

We conclude that drip infusion CTC with an infusion rate of the biliary contrast agent iotroxate governed by the serum bilirubin value is a feasible and safe alternative to MRC in patients with and without impaired biliary excretion.

In this retrospective study the feasibility and the frequency of adverse reactions when using a drip infusion scheme based on bilirubin levels has been evaluated.

Place, publisher, year, edition, pages
2006. Vol. 6, no 1
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-34913DOI: 10.1186/1471-2342-6-1Local ID: 24035OAI: oai:DiVA.org:liu-34913DiVA: diva2:255761
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Volume imaging of the abdomen: three-dimensional visualisation of tubular structures in the body with CT and MRI
Open this publication in new window or tab >>Volume imaging of the abdomen: three-dimensional visualisation of tubular structures in the body with CT and MRI
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overwhelming amount of image-based information in modem medicine makes it crucial to develop methods to handle and analyze images and make them comprehensible for users. The aim of this thesis was to study the radiological practice of three-dimensional (3D) visualization of tubular structures in the body with CT and MRI. All the studies cancern 3D imaging of tubular structures with camputed tomography (CT) and magnetic resonance imaging (MRI). The first three studies examine the abdominal aorta; the two later ones the, bile ducts.

Study I compared measurements of aorta diameters taken from MR images presented using two visualization methods - maximum intensity projection (MlP) and volume rendering (VRT) - with invasive angiography (DSA) and CT as reference methods. Mean diameters of MR images were smaller than those from DSA and CT when MlP was used, but in general not when VRT was used.

Study II evaluated the dependence on the observer and the choice of method and settings during rendering using the same material as in Study 1. In both MlP and VRT, the choice of settings had significant influence on the results. With DSA as the reference method, VRT gave larger measurement errors than MIP when the rendering parameters were set to fixed values, but not if the user was allowed to select the settings freely.

Study III evaluated three new techniques for standardizing VRT protocols for MRA. Inter-reader variability and agreement with DSA were studied by comparing diameter measurements of the abdominal aorta obtained by the three new techniques, by VRT with freely chosen parameters and by MlP. All three new methods were significantly better than MlP and VRT with freely chosen parameters conceming inter-observer agreement. Agreement with DSA was significantly better for one of the methods. Standardized protocols seem to have a potential to make VRT a clinically useful alternative to MlP for MR angiography measurements.

Study IV evaluated CT imaging of the bile ducts after drip intravenous infusion of the contrast medium iotroxate (CT cholangiography) in terms of adverse effects and visibility. With infusion time adjusted for individual variation in serum bilirubin concentration, a total side-effect frequency of less than 1% was found. A systematic review of previously published studies indicated a frequency of 2.3%. Good contrast excretion and visualization of bile ducts even in patients with elevated bilirubin levels were noted.

Study V evaluated the diagnostic benefits of the same imaging method by comparing it with findings from surgery and endoscopic retrograde cholangiopancreatography (ERCP). The consensus sensitivity and specificity for diagnosing biliary stones was 88% and 94%, respectively. The use of VRT improved diagnostic certainty in 14% of the evaluatians, and the visualization of ductal stones was improved in 38% of the positive cases.

In conclusion, volume rendering technique with standardized parameters may become a clinically useful tool in the clinical MRI environment. DIC-CT with bilirubin-governed infusion time and volume rendering post-processing produces detailed images of the biliary tree, resulting in good sensitivity and specificity. Moreover the safety is acceptable.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2005. 103 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 912
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-29581 (URN)14957 (Local ID)91-85299-25-1 (ISBN)14957 (Archive number)14957 (OAI)
Public defence
2005-10-07, Berzeliussalen, plan 09, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2013-10-21Bibliographically approved

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Persson, AndersDahlström, NilsSmedby, Örjan

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Center for Medical Image Science and Visualization (CMIV)Faculty of Health SciencesDepartment of Radiology in LinköpingMedical RadiologyDepartment of Radiology in Linköping
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BMC Medical Imaging
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