Korean J Radiol.  2013 Dec;14(6):914-917. 10.3348/kjr.2013.14.6.914.

Biliary Peritonitis after Radiofrequency Ablation Diagnosed by Gadoxetic Acid-Enhanced MR Imaging

• Furuta A
• Isoda H
• Koyama T
• Todo G
• Osaki Y
• Togashi K

• KMID: 1711457
• DOI: http://doi.org/10.3348/kjr.2013.14.6.914

Abstract

This study describes the first case of biliary peritonitis after radiofrequency ablation diagnosed by magnetic resonance (MR) imaging with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA), a hepatocyte-specific MR imaging contrast agent. The image acquired 300 minutes after the administration of Gd-EOB-DTPA was useful to make a definite diagnosis and to identify the pathway of bile leakage. It is important to decide on the acquisition timing with consideration of the predicted location of bile duct injury.

Keyword

MRI; Gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid; Radiofrequency ablation; Biliary peritonitis

MeSH Terms

Aged, 80 and over
Bile Duct Diseases/*diagnosis/etiology
Carcinoma, Hepatocellular/diagnosis/surgery
Catheter Ablation/*adverse effects
Contrast Media/diagnostic use
Diagnosis, Differential
Follow-Up Studies
Gadolinium DTPA/*diagnostic use
Hepatectomy/adverse effects/methods
Humans
Liver Neoplasms/diagnosis/*surgery
Magnetic Resonance Imaging/*methods
Male
Peritonitis/*diagnosis/etiology
Contrast Media
Gadolinium DTPA

Figure

• 

  Fig. 1 Dynamic contrast-enhanced CT before RFA, contrast-enhanced CT after RFA, and Gd-EOB-DTPA-enhanced MRI two months after RFA in 80-year-old woman. Dynamic contrast-enhanced CT images show 3-cm hepatic mass in segment VIII, which has marked enhancement in arterial phase (A) and low attenuation compared to liver parenchyma in portal venous phase (B) before RFA. Contrast-enhanced CT obtained seven days after RFA reveals ablated tumor with sufficient margin (C). Two months after RFA, enhanced T1-weighted images were acquired at 20 minutes (D), 60 minutes (E), and 300 minutes (F) after administration of Gd-EOB-DTPA. Enhanced T1-weighted MR imaging acquired at 300 minutes shows increased signal intensity in fluid collection around liver than that acquired at 20 and 60 minutes (arrowheads). Linear high signal areas to match RFA puncture route are also demonstrated in enhanced T1-weighted MR imaging at 300 minutes (arrows). RFA = radiofrequency ablation, Gd-EOB-DTPA = adolinium ethoxybenzyl diethylenetriaminepentaacetic acid

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