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Role of magnetic resonance cholangiography in biliary complications of orthotopic liver transplantation

Ruolo della colangiografia a risonanza magnetica nelle complicanze biliari del trapianto ortotopico di fegato

  • Abdominal Radiology / Radiologia Addominale
  • Published:
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Abstract

Purpose

The aim of this study was to evaluate the role of magnetic resonance cholangiography (MRC) in the detection of biliary complications following orthotopic liver transplantation (OLT).

Materials and methods

Seventy-eight transplant patients with clinically suspected biliary complications were evaluated with 1.5-T magnetic resonance imaging (MRI) using a surface coil. All patients were imaged with the following sequences: axial T1-weighted and axial and coronal T2-weighted, 2D spin echo (SE) breath-hold radial cholangiography, and coronal 3D single-shot turbo spin echo (SS-TSE) with respiratory triggering. Patients with negative MRI underwent clinical and sonographic followup. When biliary complications were present, diagnostic confirmation was obtained by endoscopic retrograde cholangiopancreatography (ERCP) (n=13), percutaneous transhepatic cholangiography (PTC) (n=20), ultrasonography (n=10) or computed tomography (CT) (n=2). In 11 cases, surgical confirmation was also obtained.

Results

MRC detected biliary complications in 44/78 patients, in particular, 42 biliary strictures (37 anastomotic and five intrahepatic), 40 of which were confirmed by other imaging modalities. In 25/37 cases of anastomotic stricture, preanastomotic dilatation of the biliary tract was also demonstrated. Other MRC-detected biliary complications were biliary sludge (n=4), biloma (n=5), and biliary stones (n=3). In four cases, PTC revealed biliary complications that had not been detected with MRC (false negative results). In two cases, MRC showed unconfirmed strictures of the intrahepatic ducts and biliodigestive anastomosis (false positive results). The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and diagnostic accuracy of MRC were 93.5%, 94.4%, 96.7%, 89.5% and 93.9%, respectively.

Conclusions

Our results confirm that MRC is a reliable technique for depicting biliary anastomoses and detecting biliary complications after OLT. The high diagnostic accuracy of MRC indicates that this examination should be routinely employed in all OLT patients with clinically suspected biliary complications.

Riassunto

Obiettivo

Scopo del nostro lavoro è stato valutare il ruolo della colangio-risonanza magnetica (RM) nell’identificazione delle complicanze biliari nel paziente sottoposto a trapianto ortotopico di fegato (OLT).

Materiali e metodi

Settantotto pazienti sottoposti a OLT con sospetto clinico di complicanza biliare sono stati sottoposti a studio RM del fegato mediante magnete a 1,5 T con bobina di superficie. In tutti i pazienti sono state eseguite sequenze assiale T1 pesate, assiali e coronali T2 pesate, sequenza colangiografica radiale 2D-spin echo (SE) in apnea e sequenza 3D-turbo spin echo (TSE) single shot (SS) sul piano coronale triggerata con il respiro. Quando l’esame RM è risultato negativo i pazienti sono stati sottoposti a follow-up clinico-ecografico. Le complicanze identificate all’esame RM sono state confermate mediante colangiografia retrogada endoscopica (13 casi), colangiografia percutanea transepatica (20 casi), ecografia (10 casi), tomografia computerizzata (TC) (2 casi). In 11 casi si è avuta anche conferma chirurgica.

Risultati

In 44/78 pazienti l’esame RM ha evidenziato una complicanza chirurgica, in particolare 42 stenosi biliari (37 anastomotiche e 5 intraepatiche), 40 delle quali confermate dalle altre metodiche. In 25/37 casi di stenosi dell’anastomosi la RM ha evidenziato anche la presenza di dilatazione della via biliare pre-anastomotica. Le altre complicanze biliari identificate alla colangio-RM sono state: fango e detriti biliari (4 casi), bilomi (5 casi) e calcoli biliari (3 casi). In 4 casi la colangiografia trans epatica ha mostrato la presenza di complicanze biliari non individuate alla RM. In 2 casi la RM ha evidenziato stenosi intraepatiche e dell’anastomosi bilio-digestiva non confermate dalle altre metodiche. Sensibilità, specificità, valore predittivo positivo e negativo della colangio-RM sono stati: 93,5%, 94,4%, 96,7%, 89,5% and 93,9%.

Conclusioni

I nostri risultati hanno confermato che la colangio-RM è una metodica ottimale per la visualizzazione della sede di anastomosi e per identificare eventuali complicanze biliari nel paziente sottoposto a OLT. Sulla base dell’accuratezza diagnostica riscontrata la colangio-RM dovrebbe essere considerata metodica di impiego routinario nel paziente trapiantato con sospetto clinico di complicanza biliare.

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Authors and Affiliations

  1. Dipartimento Integrato dei Servizi Diagnostici e per Immagine, Università degli Studi di Modena e Reggio Emilia, Policlinico via del Pozzo 71, 41100, Modena, Italy

    A. Pecchi, M. De Santis, M. Gibertini & P. Torricelli

  2. Dipartimento di Chirurgia, Università degli Studi di Modena e Reggio Emilia, Policlinico via del Pozzo 71, 41100, Modena, Italy

    F. Di Benedetto & G. Gerunda

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  1. A. Pecchi
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  2. M. De Santis
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  3. F. Di Benedetto
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  4. M. Gibertini
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  5. G. Gerunda
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  6. P. Torricelli
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Correspondence to A. Pecchi.

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Pecchi, A., De Santis, M., Di Benedetto, F. et al. Role of magnetic resonance cholangiography in biliary complications of orthotopic liver transplantation. Radiol med 115, 1065–1079 (2010). https://doi.org/10.1007/s11547-010-0563-7

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  • DOI: https://doi.org/10.1007/s11547-010-0563-7

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