From the Guidelines
Hepatobiliary contrast agents, such as those with biliary excretion, are given during Magnetic Resonance Cholangiopancreatography (MRCP) to provide functional assessment of the biliary tree and detect bile leaks with high accuracy 1.
Key Points
- MRCP is considered the "gold standard" for a complete morphological evaluation of the biliary tree, as it is noninvasive and provides excellent anatomical information 1.
- The use of hepatocyte-selective contrast agents with biliary excretion, such as mangafodipir trisodium, allows for the functional assessment of the biliary tree and detection of bile leaks 1.
- Contrast-enhanced MRCP (CE-MRCP) using 3D and 2D T1-weighted images acquired at the hepatobiliary phase after hepato-specific contrast agent injection improves the accuracy of bile anatomy depiction and bile leak detection 1.
- The optimal timing for hepatobiliary phase acquisitions with CE-MRCP appears to range between 60 and 90 min when looking for bile leaks 1.
Contrast Agents
- Hepatobiliary contrast agents, such as mangafodipir trisodium, are primarily excreted via bile and can be used to diagnose bile leaks and identify the source of the leak by direct visualization of contrast material extravasation into fluid collections 1.
- Other hepatobiliary contrast agents may also be used, but mangafodipir trisodium is specifically mentioned in the evidence as being useful for diagnosing bile leaks 1.
From the Research
Type of Contrast Used in MRCP
- The type of contrast given during Magnetic Resonance Cholangiopancreatography (MRCP) is a negative oral contrast agent 2, 3, 4.
- This negative oral contrast agent is used to suppress the signal from the gastrointestinal tract, allowing for better visualization of the bile and pancreatic ducts 2, 4.
- Examples of negative oral contrast agents used in MRCP include ferumoxsil 4 and pineapple juice 4, which contains manganese that helps to suppress the signal in the gastrointestinal tract.
Characteristics of Negative Oral Contrast Agents
- Negative oral contrast agents work by reducing the signal intensity of the gastrointestinal tract on T2-weighted images, making it easier to visualize the bile and pancreatic ducts 2, 4.
- The effectiveness of a negative oral contrast agent can depend on its composition, with some agents being more effective than others 4.
- The use of a negative oral contrast agent can improve the quality of MRCP images and help to reduce artifacts caused by signal from the gastrointestinal tract 2, 4.
Administration of Contrast Agents
- Negative oral contrast agents are typically administered orally, 20-30 minutes before the MRCP procedure 2.
- The agent is usually given in a volume of 300-600 ml, depending on the specific agent and the patient's needs 2.
- The use of a negative oral contrast agent can help to improve the diagnostic accuracy of MRCP and reduce the need for additional imaging procedures 2, 4.