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Added value of gadoxetic acid-enhanced T1-weighted magnetic resonance cholangiography for the diagnosis of post-transplant biliary complications

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Biliary complications after liver transplantation (LT) are common. This study aimed to ascertain the value of gadoxetic acid-enhanced T1-weighted (T1w) magnetic resonance cholangiography (MRC) to evaluate anastomotic strictures (AS), non-anastomotic strictures (NAS) and biliary casts (BC).

Methods

Sixty liver-transplanted patients with suspicion of biliary complications and T2w-MRCP and T1w-MRC followed by endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) were analysed. Two readers reviewed the MRCs and rated image quality (IQ) and likelihood for AS/NAS/BC on Likert scales. Sensitivity, specificity and predictive values were calculated, ROC curve analysis performed, and inter-reader variability assessed. The subjective added value of T1w-MRC was rated.

Results

IQ was high for all sequences without significant differences (2.83–2.88). In 39 patients ERCP/PTC detected a complication. Sensitivity and specificity for AS were 64–96 using T2w-MRCP, increasing to 79–100 using all sequences. Use of all sequences increased the sensitivity of detecting NAS/BC from 72–92% to 88–100% and 67–89% to 72–94%, respectively. Kappa values were substantial (0.45–0.62). T1w-MRC was found to be helpful in 75–83.3%.

Conclusions

Combining T1w-MRC and T2w-MRCP increased sensitivity and specificity and diagnostic confidence in patients after LT with suspected biliary complications. T1w-MRC is a valuable tool for evaluating post-transplant biliary complications.

Key Points

• T1w-MRC is a valuable tool for evaluating post-transplant biliary complications.

• Adding T1w-MRC to T2w-MRC increases diagnostic confidence for detection of biliary complications.

• A combination of T1w-MRC and T2w-MRCP leads to the best results.

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Abbreviations

AS:

Anastomotic stricture

BC:

Biliary cast

BEA:

Bilioenteric anastomosis

CC:

Choledocho-choledochostomy

ERCP:

Endoscopic retrograde cholangiopancreatography

IQ:

Image quality

LT:

Liver transplantation

MIP:

Maximum intensity projection

MRC:

Magnetic resonance cholangiography

MRCP:

Magnetic resonance cholangiopancreatography

NAS:

Non-anastomotic stricture

PSC:

Primary sclerosing cholangitis

PTC:

Percutaneous transhepatic cholangiography

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Author information

Authors and Affiliations

  1. Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave., Madison, WI, 53792-3252, USA

    Sonja Kinner, Tilman B. Schubert & Scott B. Reeder

  2. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany

    Sonja Kinner

  3. Clinic of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland

    Tilman B. Schubert

  4. Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA

    Adnan Said & Scott B. Reeder

  5. Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA

    Joshua D. Mezrich

  6. Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA

    Scott B. Reeder

  7. Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA

    Scott B. Reeder

  8. Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA

    Scott B. Reeder

Authors
  1. Sonja Kinner
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  2. Tilman B. Schubert
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  3. Adnan Said
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  4. Joshua D. Mezrich
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  5. Scott B. Reeder
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Corresponding author

Correspondence to Sonja Kinner.

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Guarantor

The scientific guarantor of this publication is Professor Scott B Reeder, sreeder@wisc.edu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of this article.

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The authors state that this work has not received any funding.

Statistics and biometry

One of the authors has significant statistical expertise.

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Institutional Review Board approval was obtained.

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Written informed consent was waived by the Institutional Review Board.

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Methodology

• retrospective

• case-control study

• performed at one institution

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Kinner, S., Schubert, T.B., Said, A. et al. Added value of gadoxetic acid-enhanced T1-weighted magnetic resonance cholangiography for the diagnosis of post-transplant biliary complications. Eur Radiol 27, 4415–4425 (2017). https://doi.org/10.1007/s00330-017-4797-9

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  • DOI: https://doi.org/10.1007/s00330-017-4797-9

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