Direct magnetic resonance cholangiography of the common bile duct after surgery for choledocholithiasis

Objective. To test the technique of direct magnetic resonance (MR) cholangiography by introducing an MR contrast agent into the drainages of the common bile duct to determine patency.

Materials and methods. Magnetic resonance imaging (MRI) of the abdominal cavity, performed on a Siemens Amira 1.5T MR tomograph, in 3 patients who underwent surgical treatment of choledocholithiasis with subsequent injection of a contrast agent in the form of 20 ml of a paramagnetic agent (gadodiamide) diluted in 50 ml of saline solution into the common bile duct drainage tubes.

Results. To increase the volume of a traditional MRI contrast agent for subsequent injection into the common bile duct drainage, a bottle of paramagnetic agent (gadodiamide 20 ml) was diluted in 50 ml of saline solution. Subsequent analysis of the images showed no noticeable deterioration in the paramagnetic properties of the diluted gadodiamide. The excellent rheological properties of gadodiamide compared with the contrast agents used for direct X-ray cholangiography did not prevent the passage of the paramagnetic agent into the duodenum. The technique does not require additional equipment or software for MR tomography. The patency of the biliary tract based on the fixation of the paramagnetic nerve introduced into the common bile duct drainage in the duodenum was confirmed by subsequent endoscopic examination. No complications were observed within 10 days after the procedure.

Conclusions. The technique of direct MR cholangiography with the introduction of a paramagnetic solution into the common bile duct drainage can be added to postoperative MRI of the abdomen to determine the patency of the bile ducts.

1. Bagnenko SF, Korolkov AYu, Popov DN, Shatalov SA, Logvin LA. Obstructive jaundice: routing, diagnostics, treatment tactics. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2023;28(4):24-31. https://doi.org/10.16931//1995-5464.2023-4-24-31 (In Russ.).

2. Rinchinov VB, Plekhanov AN, Ludupova EYu. Various endoscopic transpapilary interventions for choledocholithiasis. Pirogov Russian Journal of Surgery. 2019;(6):60-64. (In Russ.) https://doi.org/10.17116/hirurgia201906160

3. Tseimakh AЕ, Shtofin SG, Shoykhet IaN, Tseimakh EA. Antegrade methods of bile ducts decompression for complex treatment of patients with choledocholithiasis complicated by mechanical jaundice. Bulletin of Medical Science. 2023; 1(29): 60-66. (In Russ.).

4. Alsnova KD, Bayramov NYu, Rustam AM. Complications of surgical treatment of cholecystocholedocholithiasis by various techniques, their prevention and treatment. Biomedicine. 2017;2:40-46..

5. Tomimaru Y, Tanaka K, Noguchi K, Noura SO, Imamura H, Iwazawa T, Dono K. Significance of fistulography findings to the healing time of postoperative pancreatic fistula after pancreaticoduodenectomy. Surg Today. 2020 Jun;50(6):577-584. doi: 10.1007/s00595-019-01932-4.

6. Reinhart WH, Näf G, Werth B. Viscosity of human bile sampled from the common bile duct. Clin Hemorheol Microcirc. 2010;44(3):177-82. doi: 10.3233/CH-2010-1272.