Oral effervescent agent improving magnetic resonance cholangiopancreatography

Heon-Ju Kwon; Kyoung Won Kim; Kyung A Kang; Mi Sung Kim; So Yeon Kim; Taeyong Park; Jeongjin Lee

doi:10.21037/qims-22-219

Oral effervescent agent improving magnetic resonance cholangiopancreatography

Quant Imaging Med Surg. 2022 Sep;12(9):4414-4423. doi: 10.21037/qims-22-219.

Authors

Heon-Ju Kwon¹, Kyoung Won Kim², Kyung A Kang¹, Mi Sung Kim¹, So Yeon Kim², Taeyong Park³, Jeongjin Lee³

Affiliations

¹ Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
² Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
³ School of Computer Science and Engineering, Soongsil University, Seoul, Republic of Korea.

Abstract

Background: The purpose of our study was to validate the oral effervescent agent improving magnetic resonance cholangiopancreatography (MRCP) in patients with suspicious pancreatobiliary disease.

Methods: One hundred and eleven consecutive patients with alleged or suspected pancreatobiliary tree problems who had undergone two-dimensional (2D) MRCP imaging both before and after oral effervescent enhancement (conventional-MRCP and enhanced-MRCP) were included. Two radiologists independently scored overall image quality, visualization of ten ductal segments, and gastroduodenal fluid signal intensity score. In consensus, they assessed the presence of gastroduodenal fluids and pancreatobiliary tree overlapping. The data were analyzed using Wilcoxon's signed-rank test, McNemar test, and paired t-test.

Results: The grades of overall image quality and individual biliary duct visualization for ten targeted ductal segments, and gastroduodenal fluid signal intensity scores increased significantly on enhanced-MRCP by both readers (P≤0.02), but there was no significant increase for pancreatic duct (PD) at head and tail. On enhanced-MRCP, gastroduodenal fluids except for gastric fundus were less detected rather than those on conventional-MRCP. Anatomic structures of gastroduodenal fluids overlapping extrahepatic bile duct were mainly gastric antrum, duodenal bulb, and 2nd portion on conventional-MRCP. However, these fluids were less overlapped on enhanced-MRCP (P<0.001). Gastric body and antrum were main anatomic structures of gastroduodenal fluids overlapping PD on conventional-MRCP, and fluid in these locations significantly less overlapped PD on enhanced-MRCP (P≤0.02).

Conclusions: Oral administration of effervescent agent provided effective elimination of gastroduodenal fluid overlapping pancreatobiliary ductal system at MRCP and can improve the quality of the examination in the patients with known or suspected pancreatobiliary disease.

Keywords: Oral effervescent agent; gastroduodenal fluid; image quality; magnetic resonance cholangiopancreatography (MRCP); pancreatobiliary duct (PD).