Detection of active bile leak with Gd-EOB-DTPA enhanced MR cholangiography: comparison of 20-25 min delayed and 60-180 min delayed images.

OBJECTIVES: The purpose of this study was to assess the value of contrast-enhanced magnetic resonance cholangiography (MRC) performed in different time delays after injection of gadoxetic acid disodium (Gd-EOB-DTPA) for the diagnosis of active bile leak. METHODS: This retrospective analysis included Gd-EOB-DTPA enhanced MR images of 34 patients suspected of bile leak. Images were acquired 20-25 min after Gd-EOB-DTPA injection. If there was inadequate contrast in the bile ducts then delayed images after 60-90 min and 150-180 min were obtained. Results were correlated with intraoperative findings, ERCP results, clinical data, laboratory tests, and follow-up examinations. RESULTS: Gd-EOB-DTPA enhanced MRC yielded an overall sensitivity of 96.4%, specificity of 100% and accuracy of 97.1% for the diagnosis of an active bile leak. The sensitivity of 20-25 min delayed MR images was 42.9%, of combined 20-25 min and 60-90 min delayed images was 92.9% and of combined 20-25 min, 60-90 min and 150-180 min delayed images was 96.4%. CONCLUSIONS: Gd-EOB-DTPA enhanced MRC utilizing delayed phase images was effective for detecting the presence and location of active bile leaks. The images acquired 60-180 min post-injection enabled identification of bile leaks even in patients with a dilated biliary system or moderate liver dysfunction.

[Embolotherapy of recanalized symptomatic pulmonary arteriovenous malformations in a patient with Rendu-Osler-Weber syndrome: a case report and review of literature]. / Powtórna embolizacja objawowych przetok tetniczo-zylnych pluc u pacjentki z choroba Rendu-Oslera-Webera: opis przypadku i przeglad pismiennictwa.

Rendu-Osler-Weber disease is a genetic disorder resulting in mucosal and celiac angiodysplastic lesions. We present a case of a 47-year-old woman with Rendu-Osler-Weber disease manifesting with telangiectasias on the skin and mucosa of the face and pulmonary and hepatic arteriovenous malformations (AVMs). Due to cardiovascular and neurological (recurrent brain abscess) complications of pulmonary AVMs, the patient was qualified for the embolization of a recanalized AVM in the right lung. Endovascular embolotherapy is the method of choice in treatment of pulmonary AVMs allowing for avoidance of complications and prolonged survival. Due to the risk of recanalization of embolized AVMs, a long-term follow up is necessary.