Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid as an intrabiliary contrast agent: preliminary assessment.

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 (chi(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.

[1]  J Roche,et al.  Relaxivity of Gd‐EOB‐DTPA in the normal and biliary obstructed guinea pig , 1998, Journal of magnetic resonance imaging : JMRI.

[2]  D. Catovsky,et al.  Eovist Injection and Resovist Injection: two new liver-specific contrast agents for MRI. , 2000 .

[3]  J. Olsen,et al.  Theory versus practice: a review of 'willingness-to-pay' in health and health care. , 2001, Health economics.

[4]  V. Runge.  A comparison of two MR hepatobiliary gadolinium chelates: Gd-BOPTA and Gd-EOB-DTPA. , 1998, Journal of computer assisted tomography.

[5]  H. Ohishi,et al.  Optimal dose of hepatobiliary contrast agent for MR cholangiography: Experimental study in rats , 1998, Journal of magnetic resonance imaging : JMRI.

[6]  A L Baert,et al.  MR imaging evaluation of liver enhancement by Gd-EOB-DTPA in selective and total bile duct obstruction in rats: correlation with serologic, microcholangiographic, and histologic findings. , 1994, Radiology.

[7]  M. Hori,et al.  Influence of paramagnetic contrast on single-shot MRCP image quality , 2000, Abdominal Imaging.

[8]  A. Sanyal,et al.  Primary sclerosing cholangitis: evaluation with MR cholangiography-a case-control study. , 2000, Radiology.

[9]  R. Wiesner,et al.  Primary sclerosing cholangitis: findings on cholangiography and pancreatography. , 1983, Radiology.

[10]  K Yoshimitsu,et al.  Pitfalls in MR cholangiopancreatographic interpretation. , 2001, Radiographics : a review publication of the Radiological Society of North America, Inc.

[11]  R Felix,et al.  Clinical Significance of Magnetic Resonance Cholangiopancreatography (MRCP) Compared to Endoscopic Retrograde Cholangiopancreatography (ERCP) , 1997, Endoscopy.

[12]  D. Mitchell,et al.  Biliary dilatation: differentiation of benign from malignant causes--value of adding conventional MR imaging to MR cholangiopancreatography. , 2000, Radiology.

[13]  H. Honda,et al.  Optimal MR cholangiopancreatographic sequence and its clinical application. , 1998, Radiology.

[14]  H. Hussain,et al.  Biliary imaging with Gd-EOB-DTPA: is a 20-minute delay sufficient? , 2002, Academic radiology.

[15]  M A Turner,et al.  Half-Fourier RARE MR cholangiopancreatography: experience in 300 subjects. , 1998, Radiology.

[16]  K. Blumenschein,et al.  On hypothetical bias and calibration in cost-benefit studies. , 2000, Health policy.

[17]  Y. Takehara.  Fast MR imaging for evaluating the pancreaticobiliary system. , 1999, European journal of radiology.

[18]  B. O'brien,et al.  Willingness to Pay , 1994, Medical decision making : an international journal of the Society for Medical Decision Making.

[19]  D. Bluemke,et al.  New MR imaging contrast agents. , 1999, Magnetic resonance imaging clinics of North America.

[20]  N. Rofsky,et al.  Volumetric mangafodipir trisodium-enhanced cholangiography to define intrahepatic biliary anatomy. , 2001, AJR. American journal of roentgenology.

[21]  F. Terrier,et al.  Choledocholithiasis and bile duct stenosis: diagnostic accuracy of MR cholangiopancreatography. , 1997, Radiology.

[22]  J. Soto,et al.  Magnetic resonance cholangiography: comparison with endoscopic retrograde cholangiopancreatography. , 1996, Gastroenterology.