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Early Biliary Complications of Laparoscopic Cholecystectomy: Evaluation on T2-Weighted MR Cholangiography in Conjunction with Mangafodipir Trisodium-Enhanced T1-Weighted MR Cholangiography

Mi-Suk Park1,2, Ki Whang Kim1, Jeong-Sik Yu1, Myeong-Jin Kim1, Kyoung Won Kim3, Joon Suk Lim1, Eun-Suk Cho1, Dong-Sup Yoon4, Tae Kyoung Kim3, Sung In Lee5, Jong Du Lee6, Woo Jung Lee4, Hyun Kwon Ha3, Jong Tae Lee1 and Hyung Sik Yoo1

1 Department of Diagnostic Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea.
2 Department of Radiology, YongDong Severance Hospital, 146-92 Dokok-Dong, Kangnam-Ku, Seoul 135-270, South Korea.
3 Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
4 Department of General Surgery, Yonsei University College of Medicine, Seoul, South Korea.
5 Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
6 Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea.



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  		Fig. 1A. —56-year-old man with abdominal pain and jaundice for 3 days after laparoscopic cholecystectomy. Coronal MR cholangiogram obtained before mangafodipir trisodium (MnDPDP) enhancement with thin-section half-Fourier RARE sequence shows disconnected common bile duct (thin arrows) with abnormal fluid collection (thick arrow).

 


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  		Fig. 1B. —56-year-old man with abdominal pain and jaundice for 3 days after laparoscopic cholecystectomy. Coronal 3D volumetric interpolated T1-weighted gradient-echo image obtained 30 min after injection of MnDPDP shows enhanced intrahepatic and common hepatic duct (thin arrow) with extravasation of contrast agent (thick arrow). Contrast agent has not filled in common bile duct.

 


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  		Fig. 1C. —56-year-old man with abdominal pain and jaundice for 3 days after laparoscopic cholecystectomy. On RARE image (as in A) obtained after MnDPDP administration, high signal intensity in proximal part of disconnected common bile duct and abnormal fluid collection in A and B are lost, suggesting presence of contrast agent opacification in those areas. However, signal persists in distal part of disconnected common bile duct (arrow), suggesting absence of contrast agent opacification and complete obstruction of extrahepatic duct.

 


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  		Fig. 1D. —56-year-old man with abdominal pain and jaundice for 3 days after laparoscopic cholecystectomy. ERCP image shows common bile duct (arrow) with complete obstruction. Proximal portion of obstruction site is not opacified.

 


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  		Fig. 2A. —35-year-old man with abdominal pain and fever for 10 days after laparoscopic cholecystectomy. Coronal MR cholangiogram obtained before mangafodipir trisodium (MnDPDP) enhancement with thin-section half-Fourier RARE sequence shows narrowing of common bile duct (thin arrow) with abnormal fluid collection (thick arrow).

 


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  		Fig. 2B. —35-year-old man with abdominal pain and fever for 10 days after laparoscopic cholecystectomy. Coronal 3D volumetric interpolated T1-weighted gradient-echo image obtained 30 min after injection of MnDPDP shows enhanced extrahepatic duct, in spite of presence of narrowing segment (thin arrow), with extravasation of contrast agent (thick arrow).

 


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  		Fig. 2C. —35-year-old man with abdominal pain and fever for 10 days after laparoscopic cholecystectomy. ERCP image shows partial stricture (thin arrow) of common bile duct with bile leakage (thick arrow).

 


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  		Fig. 3A. —60-year-old man with abdominal pain for 7 days after laparoscopic cholecystectomy. Coronal MR cholangiogram obtained before mangafodipir trisodium (MnDPDP) enhancement with thick-slice half-Fourier RARE sequence shows normal extrahepatic duct with fluid collection (arrow).

 


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  		Fig. 3B. —60-year-old man with abdominal pain for 7 days after laparoscopic cholecystectomy. Coronal 3D volumetric interpolated T1-weighted gradient-echo image obtained 30 min after injection of MnDPDP shows extravasation of contrast agent (arrow) with normal opacification of extrahepatic duct, suggesting bile leakage from cystic duct stump.

 


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  		Fig. 3C. —60-year-old man with abdominal pain for 7 days after laparoscopic cholecystectomy. ERCP image shows bile leak (arrow) from cystic duct stump without bile duct injury.

 


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  		Fig. 4A. —56-year-old man with mild abdominal discomfort for 21 days after laparoscopic cholecystectomy. Coronal MR cholangiogram obtained before mangafodipir trisodium (MnDPDP) enhancement with thick-slice half-Fourier RARE sequence shows mildly dilated and disconnected right posterior duct (arrow).

 


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  		Fig. 4B. —56-year-old man with mild abdominal discomfort for 21 days after laparoscopic cholecystectomy. Maximum-intensity-projection image from coronal 3D volumetric interpolated T1-weighted gradient-echo image obtained 30 min after injection of MnDPDP shows opacification of right posterior duct (arrow). We interpreted findings on MR cholangiography as partial ligation of aberrant right posterior duct.

 


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  		Fig. 4C. —56-year-old man with mild abdominal discomfort for 21 days after laparoscopic cholecystectomy. ERCP image does not show right posterior duct.

 


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  		Fig. 4D. —56-year-old man with mild abdominal discomfort for 21 days after laparoscopic cholecystectomy. Hepatobiliary scintigram obtained 90 min after injection of iminodiacetic acid, 2 months after A–C, shows photon-defect area (arrows) in right lobe of liver.

 


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  		Fig. 5. —Diagram shows algorithm for imaging of biliary complications after cholecystectomy. MnDPDP = mangafodipir trisodium.

 

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