Presentation
Cholestatic liver function test (LFT) results for evaluation.
Patient Data
The gallbladder is insufficiently distended with a gallstone seen within (COR, AX).
Note: This patient was unable to adhere to the default breath-hold sequences for optimal images, hence leading to poor image quality showing diaphragmatic drift. According to department protocol, respiratory-gated sequences would then replace the breath-hold sequences at this point. However, as per the case discussion, these sequences were only performed as preliminary tests to determine the gallbladder volume and were hence not repeated.
Case Discussion
In this magnetic resonance cholangiopancreatography (MRCP) case, the patient had presented to the department having only fasted for 2.5 hours instead of the recommended 4 hours 1,2 as per department protocol. The patient recalled eating a small slice of sweet potato, with the misconception that a small amount of food would not affect the diagnostic quality of the images.
Due to the patient's poor social circumstances, the radiographers attempted to scan the first few sequences of the MRCP protocol, hoping that the gallbladder would still be sufficiently distended.
The two sequences (i.e. COR HASTE T2, AX HASTE T2) obtained were sent to the department's picture archiving and communication system (PACS) for a radiologist to review. The images depicted the gallbladder still in a postprandial state and were deemed fruitless in answering the clinical question. The scan was hence aborted, with the patient instructed to fast for a longer 6-hour window the next time they returned for another MRCP.
These images highlight the consequences of insufficient fasting preparation to all healthcare professionals involved in gallbladder imaging. This case emphasizes the importance of patient preparation before examinations for the hepatobiliary system.
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