Complex postcholecystectomy biliary disorders: preliminary experience with evaluation by means of breath-hold MR cholangiography

Abstract

Purpose: To assess preliminary experience with breath-hold single-shot fast spin-echo magnetic resonance (MR) cholangiography in complex postcholecystectomy biliary disorders.

Materials and methods: MR cholangiography was performed in 17 consecutive patients referred for specialist surgical evaluation of suspected complex postcholecystectomy biliary disorders. Two readers, unaware of surgical, histopathologic, or other imaging findings, independently reviewed the MR cholangiographic images to assess the presence of biliary occlusion, peribiliary lesions, nonspecific biliary dilatation (biliary dilatation without an abrupt transition in caliber and without a visible underlying cause), bile duct stones, or biliary fistulas. Final diagnoses were established with surgery (n = 9), imaging other than MR (n = 6), and histopathologic review of the initial surgical specimen (n = 2).

Results: Final diagnoses were biliary occlusion (n = 8), peribiliary lesions (n = 3), nonspecific biliary dilatation (n = 3), bile duct stones (n = 2), and biliary-colonic fistula (n = 1). The two readers correctly categorized these diagnoses in 15 (88%) and 13 (76%) of the 17 cases, with excellent interobserver agreement (kappa = 0.82).

Conclusion: Single-shot fast spin-echo MR cholangiography is an accurate, noninvasive modality for the assessment of complex postcholecystectomy biliary disorders.