W84 AJR:189, August 2007 AJR 2007; 189:W84–W89 0361–803X/07/1892–W84 © American Roentgen Ray Society Erden et al. MR Cholangiopancreatography of Hydatid Cyst Hepatobiliary Imaging • Clinical Observations Intrabiliary Rupture of Hepatic Hydatid Cysts: Diagnostic Accuracy of MR Cholangiopancreatography Ayşe Erden 1 Necati Örmeci 2 Suat Fitoz 1 İlhan Erden 1 Sumru Tanju 1 Yasemin Genç 3 Erden A, Örmeci N, Fitoz S, Erden İ , Tanju S, Genç Y Keywords: hydatid cyst, liver, MR cholangiopancreatography DOI:10.2214/AJR.07.2068 Received November 23, 2006; accepted after revision March 26, 2007. 1 Department of Radiology, Ankara University School of Medicine, Talatpaşa Bulvarı, Sıhhiye, 06100, Ankara, Turkey. Address correspondence to A. Erden (ayse.erden@medicine.ankara.edu.tr). 2 Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey. 3 Department of Biostatistics, Ankara University School of Medicine, Talatpaşa Bulvarı, Sıhhiye, 06100, Ankara, Turkey. WEB This is a Web exclusive article. OBJECTIVE. The purpose of this study was to establish the role of MR cholangiopancre- atography (MRCP) in the diagnosis of biliary rupture in hepatic hydatid disease. We sought to determine whether the morphologic features of cysts and bile duct abnormalities detected on MRCP are specific enough for identification of intrabiliary rupture. CONCLUSION. If one of the following MRCP findings of apparent connection between hy- datid cyst and biliary system, deformation of cyst, focal defect in cyst wall, or beaklike projection extending from cyst wall was present in a patient with hepatic hydatid cyst, the sensitivity of MRCP was 91.7% and the specificity was 82.8% for identification of intrabiliary rupture. ne of the most frequent complica- tions of hepatic hydatid disease is rupture of cysts into the bile ducts. The communication between the biliary tree and the hydatid cyst can be frank or occult. The most common clinical manifes- tations of frank intrabiliary rupture are colicky right hypochondrial pain and obstruc- tive jaundice accompanied by fever and chills [1, 2]. Occult rupture, on the other hand, usu- ally has no clinical signs, and the most com- mon symptom, if present, is abdominal pain. Occult cystobiliary communication can cause postoperative biliary fistulas unless the open- ing in the bile duct is detected and properly sutured during the surgery [2]. Laboratory in- vestigations show an elevated WBC count and serum bilirubin level and cholestasis [2] in patients with positive results of serologic tests. The diagnosis can be suspected in the presence of these clinical findings and labora- tory data [1, 2]. Imaging, however, is needed for detection of the hydatid cyst and prompt localization of the intrabiliary rupture, which necessitates early surgical intervention [1, 2]. ERCP is the reference standard in the diagno- sis of many biliary tract abnormalities and prob- ably is the most reliable preoperative imaging method for visualization of biliary rupture [3]. Galati et al. [4] reported that preoperative ERCP is useful in the care of patients with cystobiliary fistula because it allows visualization of the fis- tula and drainage of the biliary tree and is asso- ciated with an 11.1% to 7.6% reduction in the incidence of postoperative complications. MR cholangiopancreatography (MRCP) is rapidly replacing diagnostic ERCP in the man- agement of various biliary diseases. MRCP is a promising tool in the detection of cystobiliary communication and provides complementary information about the entire region affected by the hydatid cyst [5]. However, the diagnostic accuracy of MRCP in patients with intrabiliary rupture has not been quantified, to our knowl- edge. Most of the MR cholangiographic infor- mation about biliary rupture has been provided in the form of isolated case reports [6, 7] de- scribing frank communication. There remains a poor understanding of the indirect MRCP find- ings. Therefore, we aimed to establish the role of MRCP in the diagnosis of biliary rupture as- sociated with hepatic hydatid disease. We also sought to determine whether the morphologic features of the cysts and bile duct abnormalities detected on MRCP are specific enough for identification of intrabiliary rupture. Materials and Methods Study Group Fifty-four patients (39 females and 15 males; mean age, 46.7 years) with liver hydatid disease diag- nosed on the basis of results of serologic tests and ab- dominal sonography were referred for MRCP to ex- clude biliary tract involvement. Eighteen of the patients had undergone surgery. No data regarding postoperative complications, such as the possibility of communication with the biliary system, were present in their records. Twenty-nine of the 54 patients with symptoms and laboratory results suggesting biliary involvement un- O Downloaded from www.ajronline.org by 52.73.204.196 on 05/16/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved