Total Bilirubin Levels as a Predictor of Suboptimal Image Quality of the Hepatobiliary Phase of Gadoxetic Acid-Enhanced MRI in Patients with Extrahepatic Bile Duct Cancer: Correspondence

We would like to share ideas on the article titled “Total Bilirubin Level as a Predictor of Suboptimal Image Quality of the Hepatobiliary Phase of Gadoxetic Acid-Enhanced MRI in Patients with Extrahepatic Bile Duct Cancer” [1]. Hwang et al. [1] concluded in their study that “Serum total bilirubin before acquisition of gadoxetic acid-enhanced MRI may help predict suboptimal HBP image quality in patients with EHD cancer”. Indeed, the use of gadoxeticacid-enhanced MRI for extrahepatic bile duct cancer imaging investigation is presently used in many settings. In our setting in Southeast Asia, where cholangiocarcinoma is very common, the investigation is still applicable, despite the fact that the patients have very high background bilirubin levels. However, the interpretation requires experienced radiologists, and it is necessary to evaluate the result based on patient clinical features [2]. We should recognize that gadoxetic acid-enhanced MRI has limitations in the diagnosis of hepatic cancer in this setting. Furthermore, the use of hepatic extracellular contrast-enhanced MR might help increase diagnostic accuracy [3].