Value of Magnetic Resonance Cholangiopancreatography in Assessment of Nonanastomotic Biliary Strictures After Liver Transplantation

Abstract

BackgroundNonanastomotic biliary strictures (NAS) remain a frequent complication after orthotopic liver transplantation (OLT). The aim of this study was to evaluate whether magnetic resonance cholangiopancreatography (MRCP) could be used to detect NAS and to grade the severity of biliary strictures.MethodsIn total, 58 patients after OLT from 2 Dutch transplantation centers in whom endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography and MRCP were performed within less than 6 months apart were included in the study. Of these patients, 41 had NAS and 17 were without NAS based on endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography and follow-up. Four radiologists—2 from each center—used an adapted validated classification—termed “Leiden Biliary Stricture Classification” “(LBSC)—to evaluate the MRCP examinations independently. In this classification, NAS severity is assessed in 4 hepatobiliary regions. Interobserver agreement of the severity score for each region was calculated with the κ statistics.ResultsOptimal cutoff value of the LBSC to detect the presence of NAS with MRCP was calculated at 3 points or greater for all readers. Applying this cutoff sensitivity for each reader was greater than 90%, with a specificity of 50% to 82%, positive predictive value of 86% to 91%, and negative predictive value of 80% to 100%. The MRCP performance was better in evaluation of the intrahepatic than of the extrahepatic bile ducts. The additional value of MRCP for grading severity of NAS was limited.ConclusionsThe MRCP with the LBSC is a reliable tool to detect or exclude NAS after OLT. Currently, MRCP cannot be used to reliably grade the severity of these strictures.

Outcome of liver transplantation with grafts from brain-dead donors treated with dual hypothermic oxygenated machine perfusion, with particular reference to elderly donors

“…25 Biliary complications were diagnosed based on 3-month cholangiogram findings or by magnetic resonance cholangiopancreatography, which was performed if clinically indicated. The severity of ischemic cholangiopathy (IC) was graded on a scale from 0 to 15 using the Leiden biliary stricture classification, as proposed by den Dulk et al 26 Categorical variables are expressed as frequencies and percentages whereas quantitative variables are expressed as medians and interquartile ranges (IQRs). Study groups were compared using Mann-Whitney U and chi-squared tests, as appropriate.…”

Can ultrasonography differentiate anastomotic and non-anastomotic biliary strictures after orthotopic liver transplantation- a single‐center experience

“…Our results are consistent with the previous studies regarding MRCP findings of BS. MRCP appearance of NAS were characterized by multiple stenoses and skip dilatations of intrahepatic bile ducts, and lengthy stricture and wall thickening of hilar bile duct [16,[27][28][29][30][31]. AS typically presents as focal luminal narrowing at the biliary anastomosis with or without pre-anastomotic dilatation of the biliary system [17,32].…”

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

“…4 Also, because of the reported high accuracy of MRCP in diagnosing biliary pathology and its noninvasive nature, there has been an interest, over the years, to compare its accuracy with direct cholangiographic methods in post-LT settings. 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.…”