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La radiologia medica

, Volume 116, Issue 8, pp 1250–1266 | Cite as

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

  • L. CereserEmail author
  • R. Girometti
  • G. Como
  • C. Molinari
  • P. Toniutto
  • D. Bitetto
  • C. Zuiani
  • M. Bazzocchi
Abdominal Radiology / Radiologia Addominale

Abstract

Purpose

This study was performed to assess the role of magnetic resonance cholangiography (MRC) in the clinical decision-making process of referring physicians when managing liver-transplanted patients.

Materials and methods

Over a 6-month period, 21 liver-transplanted patients with a suspected biliary complication were referred for MRC. Referring physicians were asked to prospectively state, before and after MRC, the leading diagnosis; the level of confidence (on a 0–100% scale); the most appropriate diagnostic/therapeutic plan. Data analysis assessed was the diagnostic yield of MRC; the proportion of change in the leading diagnosis; the therapeutic efficacy (i.e. proportion of change in the initial diagnostic/therapeutic plan); the diagnostic thinking efficacy (i.e., gain in diagnostic confidence). Statistical significance was assessed with the Mann-Whitney U test. MRC accuracy was also calculated.

Results

Data analysis showed a diagnostic yield of 85.7%; a proportion of change in leading diagnosis of 19.0%; a therapeutic efficacy of 42.8%; a diagnostic thinking efficacy for concordant and discordant leading diagnoses of 18.8% and 78.7%, respectively (p<0.01). MRC accuracy was 92.3%.

Conclusions

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.

Keywords

Liver transplantation Magnetic resonance imaging Magnetic resonance cholangiography Biliary complications Clinical decision making 

Impatto della colangiografia in risonanza magnetica (CRM) nella gestione dei pazienti trapiantati di fegato: risultati preliminari di uno studio di clinical decision-making

Riassunto

Obiettivo

Scopo del presente lavoro è stato definire il ruolo della colangiografia in risonanza magnetica (CRM) nei pazienti trapiantati di fegato, nel processo di clinical decision-making dei clinici di riferimento.

Materiali e metodi

In un periodo di sei mesi, 21 pazienti trapiantati di fegato con sospette complicanze biliari sono stati inviati alla CRM. In modo prospettico, ai clinici di riferimento è stato richiesto di indicare, prima e dopo la CRM: la diagnosi presuntiva; il livello di confidenza (su scala 0%–100%); il piano diagnostico/terapeutico più appropriato. L’analisi dei dati ha valutato: la resa diagnostica; la proporzione di diagnosi presuntive modificate; l’efficacia terapeutica (vale a dire, proporzione di piani diagnostico/terapeutici modificati); l’efficacia diagnostica presuntiva (vale a dire, guadagno in confidenza diagnostica). La significatività statistica è stata valutata con test U di Mann-Whitney. È stata inoltre calcolata l’accuratezza della CRM.

Risultati

L’analisi dei dati ha dimostrato: una resa diagnostica del 85,7%; una proporzione di diagnosi presuntive modificate del 19,0%; un’efficacia terapeutica del 42,8%; un’efficacia diagnostica presuntiva rispettivamente pari a 18,8% e 78,7% per diagnosi presuntive concordanti e discordanti (p<0,01). L’accuratezza della CRM è stata del 92,3%.

Conclusioni

La CRM ha incrementato significativamente la confidenza diagnostica, indipendentemente dalla concordanza tra la diagnosi pre- e post-test. La CRM ha inoltre determinato una modifica nella gestione dei pazienti in una proporzione significativa di casi, portando ad un beneficio clinico grazie alla sua elevata accuratezza.

Parole chiave

Trapianto di fegato Risonanza magnetica Colangiografia in risonanza magnetica Complicanze biliari Diagnosi 

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Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • L. Cereser
    • 1
    Email author
  • R. Girometti
    • 1
  • G. Como
    • 1
  • C. Molinari
    • 1
  • P. Toniutto
    • 2
  • D. Bitetto
    • 2
  • C. Zuiani
    • 1
  • M. Bazzocchi
    • 1
  1. 1.Institute of Diagnostic RadiologyUniversity of Udine33100Italy
  2. 2.DPMSC Medical Liver Transplantation Unit, Internal MedicineUniversity of UdineUdineItaly

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