The Use of MRI With Double-Dose Eovist for the Detection of Bile Leaks

Background and objectives Bile leaks are serious complications that can occur after liver transplant, hepatobiliary surgery, and abdominal trauma and can be challenging to diagnose. Noninvasive diagnostic studies for bile leaks are limited. In this study, we aimed to evaluate the efficacy of MRI with a double-dose of Eovist (gadoxetate disodium) in comparison with other imaging modalities for detecting biliary leaks. Methods This study involved a retrospective review of patients who underwent MRI with double-dose Eovist (dEovist) to evaluate suspected bile leakage from 2016 to 2022. Indications for evaluation included suspected bile leak after recent hepatobiliary surgery or penetrating right upper quadrant trauma. Once the dEovist study was performed and a bile leak was suspected, confirmation with endoscopic retrograde cholangiopancreatography (ERCP) was obtained. These results were statistically analyzed to determine the sensitivity and specificity of MRI with dEovist in detecting biliary leakage, and ERCP was used as the confirmatory test. Results A total of 19 patients were included. dEovist detected biliary leakage in five of 19 patients. All patients with concern for bile leak after MRI underwent ERCP for confirmation of the findings; four of these patients were confirmed as true positives, and one was determined to be a false positive. The remaining 14 patients with negative MRI findings with dEovist were followed clinically, and all had clinical courses that were not suggestive of bile leak. Six of these patients underwent ERCP, which also confirmed the absence of biliary leakage. The sensitivity of MRI with dEovist for detecting bile leaks in this study was 100% (95% confidence interval (CI): 39%, 100%), and the specificity was 93% (95% CI: 66%, 100%). Conclusions Prompt identification and early intervention are crucial for preventing the complications associated with bile leaks. The use of MRI with dEovist has shown promising results as a noninvasive imaging modality with high sensitivity and specificity in the detection of bile leaks.