Bile duct leaks after laparoscopic cholecystectomy: value of contrast-enhanced MRCP

Background We assessed the role of mangafodipir-enhanced magnetic resonance (MR) cholangiography in the detection and location of bile duct leaks after laparoscopic cholecystectomy.Methods In a prospective study, 34 patients with clinical suspicion of bile duct leak after laparoscopic cholecystectomy underwent MR imaging. Our protocol included conventional heavily T2-weighted MR cholangiography and three-dimensional T1-weighted MR cholangiography after an intravenous bolus injection of mangafodipir trisodium. All studies were performed on a 1.5-T or 1-T scanner. Contrast-enhanced MR cholangiograms were evaluated for the presence and location of bile duct leaks. Correlation was obtained in all cases with surgery (n = 15), endoscopic retrograde cholangiography (n = 5), percutaneous drainage (n = 5), and clinical follow-up (n = 9).Results In 20 of 34 patients, bile duct leakage was proved by surgery, endoscopic retrograde cholangiography, or drainage. Contrast enhancement displayed the leakage in 19 of 20 patients and ruled out leaks in the other 14 patients (95% sensitivity, 100% specificity). The leak site was depicted in 14 patients and contrast-enhanced MR cholangiography successfully located the origin of the leak in 11 patients.Conclusions Contrast-enhanced MR cholangiography with intravenous mangafodipir trisodium can accurately diagnose the presence and location of bile duct leaks in patients who have undergone laparoscopic cholecystectomy.