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1 Department of Radiology, MRI Section, University of Michigan Medical Center,
1500 E. Medical Center Dr., Ann Arbor, MI 48109-0300.
2 Department of Diagnostic Imaging, Rhode Island Hospital—Brown University
School of Medicine, 593 Eddy St., Providence RI 02912-9706.
OBJECTIVE. We assessed the added efficacy of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (gadolinium-EOB) in depicting biliary structures compared with T2-weighted MR cholangiopancreatography (T2-MRCP) and measured reviewer preference and willingness-to-pay for the added value of biliary contrast.
SUBJECTS AND METHODS. Ten patients prospectively underwent T2-MRCP and gadolinium-EOB—enhanced MR cholangiography (EOB-MRC). Three radiologists reviewed the unpaired, then the paired, examinations, rating biliary visualization using a 5-point scale. The common bile, right and left hepatic ducts, and second-order branches were evaluated. Improved biliary visualization using paired over unpaired tests indicated the added value of contrast media. Kappa values measured interobserver reliability. A regression model controlling for fixed effects due to reviewer and subject correlation quantified improvement in ratings attributable to paired review.
RESULTS. Average visualization ratings for unpaired review of
EOB-MRC were the following: common bile duct, 3.3; right hepatic duct, 2.7;
left hepatic duct, 2.5; second-order branches, 1.4. Average visualization
ratings for unpaired review of T2-MCRP were the following: common bile duct,
3.4; right hepatic duct, 1.8; left hepatic duct, 2.2; second-order branches,
0.9. Ratings improved using paired tests over EOB-MRC and T2-MRCP for all
structures (p < 0.001) except for T2-MRCP common bile duct ratings
(p > 0.05). Agreement was moderate to good except for EOB-MRC
common bile duct ratings. Paired review improved ratings (
2
< 0.0001) over T2-MRCP alone by 1.05 and over EOB-MRC alone by 0.68.
Despite significant improvement, reviewers preferred unpaired T2-MRCP (53%)
over unpaired EOB-MRC (17%) or paired tests (30%). Reviewers were willing to
pay $25 (median) for gadolinium-EOB.
CONCLUSION. Combining T2-MRCP and EOB-MRC significantly improved biliary visualization over each test alone. However, improvement was small, and the perceived added value of gadolinium-EOB was modest.
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