Biliary Obstruction Essay

Evaluation of biliary obstruction for its nature is common clinical problem. (Frances Tse) There are many imaging modalities used to investigate in patient with suspected biliary abnormality such as transabdominal ultrasound, endoscopic ultrasound (EUS), ERCP, CT, MRI or percutaneous transhepatic cholangiography (PTC). MRI has now been increasing use and can reduce the requirement of ERCP or PTC due to its accuracy for evaluation of most biliary condition. (O’Connor) Magnetic resonance imaging has now been increasingly used in a wide variety of clinical application. Magnetic resonance imaging has developed new techniques for evaluation of biliary tract such as magnetic resonance cholangiopancreatography (MRCP) and diffusion-weighted imaging (DWI). (Stroszczynski, Blechacz&Gore, Adamek, Suthar)
Study shows that MRCP has high sensitivity and specificity in terms of identifying presence and level of obstruction but is less helpful when it comes to differentiating
(Rania A. Maarouf, Yoo, Cui) But no added value of DWI to conventional contrast-enhanced MRI/MRCP is observed. (Yoo,
It is very helpful agent but also have its adverse effect, some is rare but can be fatal and without treatment (nephrogenic systemic fibrosis aka NSF) especially in patient with poor renal function. (FDA Drug Safety Communication: New warnings for using gadolinium-based contrast agents in patients with kidney dysfunction 12/2010) Additional contrast agent means increased cost of imaging modality. And also there are research showing possible deposition of Gadolinium-based contrast agent in dentate nucleus and globus pallidus in patient who underwent previous MRI with Gadolinium-based contrast administration. (Kanda) So consideration the use of Gadolinium-based contrast agent should not be lightly