Magnetic resonance cholangiography of biliary strictures after liver transplantation: A prospective double‐blind study

Abstract

Purpose:To compare magnetic resonance cholangiography (MRC) with endoscopic retrograde cholangiography (ERC) in quantitatively evaluating biliary strictures in liver transplant recipients. Materials and Methods:Eight liver transplant recipients with suspected biliary complications were referred for ERC and also underwent MRC within 24 hours using a combination of single-shot rapid acquisition with relaxation enhancement (SS-RARE) and three-dimensional (3D)-RARE sequences. The studies were independently interpreted by two blinded radiologists and a single blinded endoscopist who recorded the presence of a stricture and/or upstream dilatation, the ratio of recipient-to-donor duct diameters at the anastomosis, as well as the proximal duct diameter, length, and percent stenosis of any stricture detected.Results: Using ERC as the standard of reference, MRC had a sensitivity and negative predictive value of 100%, mean specificity of 83.3%, and mean positive predictive value of 92.9% in the detection of six strictures. Compared with ERC, MRC obtained accurate measurements of recipientto-donor duct diameter ratios (r, 0.91; P Ͻ 0.01), proximal duct diameters (r, 0.83, P Ͻ 0.05), stricture lengths (r, 0.58; P ϭ 0.06), and percent stenosis (r, 0.78; P ϭ 0.06). Conclusion:MRC can provide equivalent imaging to ERC and can reliably identify and quantitatively evaluate biliary strictures in post-orthotopic liver transplantation (OLT) patients.

Management issues in post living donor liver transplant biliary strictures

“…It has been shown that donor bile ducts do not respond to the distal obstruction by same extent of dilatation as the non transplant liver [27] . MRCP has a sensitivity and specificity of 85%-90% in diagnosing biliary strictures after transplant [28,29] . The phenomenon of limited dilatation of donor ducts further underestimates the diagnosis of strictures on MRCP imaging.…”

Magnetic resonance cholangiography in the assessment and management of biliary complications after OLT

“…Thus, the risk profile for diagnostic procedures of direct cholangiography seems not justifiable given the high diagnostic accuracy of MRC, which shows 97% sensitivity and 98% specificity for biliary obstruction according to a recent metanalysis [47] . Unfortunately, there is a relative paucity of studies [3,21,43,[48][49][50][51][52][53] investigating the role for MRC in the specific setting of …”

Minimal Invasive (Endovascular and Percutaneous) Treatment of Post Liver Transplantation Complications in Pediatrics

“…Biliary strictures may be present also in the absence of ductal dilatation (Berrocal et al, 2006). Some investigators have reported better sensitivities (80%-100%) when using MR cholangiography for the detection of biliary obstruction (Kitazono et al, 2007;Norton et al, 2001). However, in pediatric patients, deep sedation or general anesthesia is necessary during MR cholangiography and adds considerably to the cost of management; for this reason, MR cholangiography is not generally used as a screening modality in children.…”