Impact of magnetic resonance cholangiography in managing liver-transplanted patients: preliminary results of a clinical decision-making study

Cereser, Lorenzo; Girometti, Rossano; Como, Giuseppe; Molinari, Cristina; Toniutto, Pierluigi; Bitetto, Davide; Zuiani, Chiara; Bazzocchi, Massimo

doi:10.1007/s11547-011-0707-4

Cited by 11 publications

(5 citation statements)

References 37 publications

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“…Magnetic resonance cholangiography provides a panoramic and detailed representation of the bile ducts, which is not achievable by other techniques. Accuracy of MRI in detecting posttransplant biliary strictures is as high as 92.3% (35) .…”

Section: Pre-and Postoperative Liver Evaluationmentioning

confidence: 99%

Indications for abdominal imaging: When and what to choose?

Caraiani

Petresc

et al. 2020

J Ultrason

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Imaging has a very important role in evaluating abdominal pathology. A good knowledge of indications is of crucial importance in the management of the patient with abdominal pathology. Ultrasound, which on its own can lead to an accurate diagnosis, plays a pivotal role in the management of abdominal pathology. The use of ultrasound contrast agents has significantly improved ultrasound diagnostic capacities in both hepatic and non-hepatic pathology. The use of computed tomography should be limited due to the potential harmful side effects of ionizing radiation, but it has established roles in evaluating severe abdominal traumatic and non-traumatic emergencies as well as in staging oncologic patients. Magnetic resonance imaging has very limited utility in abdominal emergencies due to difficulty of accessing the scanner and the long duration of the examination compared to computed tomography or ultrasound. However, magnetic resonance imaging has well-established clinical roles particularly for evaluating diffuse or focal hepatic pathology, benign and malignant bile duct pathology, pancreatic tumors, inflammatory bowel disease and rectal tumors. The aims of the following paper are to familiarize the clinician with the indications for imaging in abdominal pathology, to guide the clinician and radiologist in choosing the correct technique for a particular clinical situation, to prevent the overuse of imaging techniques and to prevent misdiagnosis of disease and incorrect therapy resulting from inappropriate imaging.

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Section: Pre-and Postoperative Liver Evaluationmentioning

confidence: 99%

Indications for abdominal imaging: When and what to choose?

Caraiani

Petresc

et al. 2020

J Ultrason

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“… 6 - 23 However, most of the earlier studies have included a heterogeneous group of patients, which for example have included bile leak, anastomotic as well as non-anastomotic BS including ischemic BS, and/or included small number of patients precluding any definite conclusions. 9 - 11 , 14 - 23 Furthermore, the vast majority of the published studies did not use the ideal reference standard of ERCP consistently when assessing MRCP accuracy. 9 - 11 , 14 - 23 An updated meta-analysis that was published in 2013 have noted most of the studies have used clinical follow-up, surgery and other imaging modalities when reporting results of MRCP accuracy.…”

Section: Discussionmentioning

confidence: 99%

“… 9 - 11 , 14 - 23 Furthermore, the vast majority of the published studies did not use the ideal reference standard of ERCP consistently when assessing MRCP accuracy. 9 - 11 , 14 - 23 An updated meta-analysis that was published in 2013 have noted most of the studies have used clinical follow-up, surgery and other imaging modalities when reporting results of MRCP accuracy. 7 Some did not use the same reference standard for positive and negative MRCP results.…”

Section: Discussionmentioning

confidence: 99%

Role of MRCP in Diagnosing Biliary Anastomotic Strictures After Liver Transplantation: A Single Tertiary Care Center Experience

Ali

Tran

Nair

et al. 2018

Transplantation Direct

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BackgroundBiliary strictures (BS) are common complication after liver transplantation. We aimed to determine the accuracy of magnetic resonance cholagiopancreatography (MRCP) in diagnosing BS in liver transplant recipients (LTRs) when compared to direct cholangiographic methods (endoscopic resonance cholagiopancreatography [ERCP] and/or percutaneous transhepatic cholangiography [PTC]).MethodsRetrospective chart review of 910 LTRs (July 2008 to April 2015) was performed, and a total of 39 patients with duct-to-duct anastomosis (22 males; 56.4%; mean age, 52.8 ± 8.3 years) were included who had an MRCP followed by either ERCP and/or PTC within 4 weeks. A cholangiographic narrowing (on ERCP and/or PTC) that required balloon dilation and/or stent placement was considered a BS and was considered clinically significant if the intervention resulted in at least 30% improvement of bilirubin within 2 weeks. Sensitivity, specificity, accuracy, positive predictive values and negative predictive values of MRCP in diagnosing BS were calculated.ResultsMagnetic resonance cholagiopancreatography showed anastomotic BS in 17 of 39 patients, and subsequent ERCP and/or PTC revealed a total of 25 BS (positive predictive value of 0.94). Nine BS on cholangiography (ERCP, 8; PTC, 1) were not detected on earlier MRCP (sensitivity, 0.64; 95% CI, 0.45-0.82); 2 were clinically significant BS and 6 of the remaining 7 had no improvement in their liver function test with biliary intervention. Thirteen LTRs had no BS on either modality (specificity, 0.93; 95% CI, 0.66-0.99). The negative predictive value of MRCP was 0.59 for cholangiographic BS. The overall accuracy of MRCP is 0.74 (exact 95% CI, 0.58-0.87). Inclusion of age, race, and alanine aminotransferase level improved the predictive value of MRCP (area under the curve = 0.94, 95% CI: 0.86-1.00).ConclusionsMagnetic resonance cholagiopancreatography has high specificity but low sensitivity in diagnosing cholangiographic BS in LTRs, although the predictive value further improved with inclusion of age, race, and alanine aminotransferase. Clinical significance of BS in LTRs not identified on MRCP is questionable because ERCP with intervention did not improve their liver function tests in the vast majority.

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“…Magnetic resonance cholangiography (MRC) can be used to obtain detailed images of the whole biliary tract, and its sensitivity and specificity for the diagnosis of AS are both ≥ 90% [30,31]. In addition, the performance of unnecessary interventions can be reduced due to the high negative predictive value of MRC findings [32].…”

Section: Imaging Evaluationmentioning

confidence: 99%

Endoscopic management of anastomotic stricture after living-donor liver transplantation

Lee

Han

2019

Korean J Intern Med

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The most effective and fundamental treatment for end-stage liver disease is liver transplantation. Deceased-donor liver transplantation has been performed for many of these cases. However, living-donor liver transplantation (LDLT) has emerged as an alternative because it enables timely procurement of the donor organ. The success rate of LDLT has been improved by development of the surgical technique, use of immunosuppressant drugs, and accumulation of post-transplantation care experience. However, the occurrence of biliary stricture after LDLT remains a problem. This article reviews the pathogenesis, diagnosis, endoscopic management, and long-term outcomes of post-liver transplantation biliary stricture, with a focus on anastomotic stricture.

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Impact of magnetic resonance cholangiography in managing liver-transplanted patients: preliminary results of a clinical decision-making study

Abstract: MRC significantly increased the diagnostic confidence, irrespective of the concordance between pre- and posttest diagnoses. Moreover, MRC determined a change in patient management in a significant proportion of cases, leading to clinical benefits.

Cited by 11 publications

References 37 publications

Indications for abdominal imaging: When and what to choose?

Indications for abdominal imaging: When and what to choose?

Role of MRCP in Diagnosing Biliary Anastomotic Strictures After Liver Transplantation: A Single Tertiary Care Center Experience

Endoscopic management of anastomotic stricture after living-donor liver transplantation

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