Gadobutrol-enhanced, three-dimensional, dynamic MR imaging with MR cholangiography for the preoperative evaluation of bile duct cancer

Purpose:To evaluate the diagnostic performance of 1.0-M gadobutrol-enhanced, 3-dimensional (3D), dynamic MR images with 3D-MR cholangiography (MRC) in the preoperative evaluation of bile duct cancer staging and resectability. Materials and Methods:Our institutional review board approved this retrospective study. Sixty patients (46 male, 14 female; mean age 65.9 years; range, 45-77 years) with surgically and pathologically proven bile duct cancers, were included in this study. Two gastrointestinal radiologists evaluated the biliary MR images, including 3D-MRC and gadobutrol-enhanced, dynamic images, using a 3D-gradient echo (GRE) technique, regarding the longitudinal tumor extent, vascular involvement of the bile duct cancer, lymph node metastasis, and tumor resectability. The results were compared with the surgical and pathology findings used as the reference standards. Results: The area under the receiver operating characteristic curve (Az) of the 2 reviewers was 0.95 and 0.93, respectively, for evaluation of the involvement of both secondary biliary confluences and 0.85 and 0.84, respectively, for assessment of the intrapancreatic duct. For determining the tumor resectability, the overall accuracy was 0.93 and 0.88, respectively, whereas for assessment of the vascular involvement, the Az values were 0.92 for reviewer 1 and 0.70 for reviewer 2 for the portal vein evaluation, and 0.99 for reviewer 1 and 0.76 for reviewer 2 for the hepatic artery evaluation. In the assessment of lymph node metastasis, the overall accuracy was approximately 0.77 for each reviewer. Conclusion: One-molar, gadobutrol-enhanced, dynamic imaging, using a 3D-GRE technique with isotropic 3D-MRC showed excellent diagnostic capability for assessing the longitudinal extent and tumor resectability of bile duct cancer, although it generally underestimated the tumor involvement of vessels and lymph nodes.