Elsevier

Transplantation Proceedings

Volume 36, Issue 9, November 2004, Pages 2744-2747
Transplantation Proceedings

Ischemic-type biliary lesions in liver transplant recipients: Evaluation with magnetic resonance cholangiography

https://doi.org/10.1016/j.transproceed.2004.09.038Get rights and content

Abstract

We assessed the diagnostic value of magnetic resonance cholangiography (MRC) when evaluating ischemic-type biliary lesions in the follow-up of liver transplant patients. We retrospectively reviewed magnetic resonance imaging and MRC of 28 liver transplant recipients with ischemic changes of the biliary tree. The MR examinations were performed at 1.5 T. After the acquisition of axial T1w and T2w sequences, MRC involved a coronal respiratory-triggered, fat-suppressed, two-dimensional, thin-slab, heavily T2w fast spin-echo sequence, and/or a coronal breath-hold, thin- and thick-slab, single-shot T2w sequence. Eleven patients underwent either surgical reconstruction of the biliary system (n = 4) or liver retransplantation (n = 7); the pathologic specimens were employed as standard of reference. The final diagnosis was obtained through direct cholangiography in the remaining cases. Without knowledge of the surgical, pathologic, and cholangiographic findings, two experienced investigators evaluated in conference the MR images to determine the presence of biliary tract abnormalities. MRC demonstrated strictures involving the hepatic bifurcation and the extrahepatic bile duct of the graft in 26 patients; a concomitant thickening of the biliary wall was described in 18 out of these 26 subjects. MRC also showed sludge or stones formation in the donor common bile duct in 16 out of these patients. In conclusion, MRC allows noninvasive, reliable, assessment of ischemic-type biliary lesions in liver transplant recipients.

Section snippets

Materials and methods

From January 1997 to June 2003, a series of 28 patients (20 men and 8 women; age range: 32 to 63 years; mean age: 49.5 ± 9.6 years) prospectively underwent magnetic resonance-imaging (MRI) and cholangiography (MRC) between 3 and 12 months after OLT. During this period, some subjects were examined more than once in case of both graft and patient survival. The MR examinations were performed for abnormal liver function tests and/or biliary ductal dilation at ultrasound. A written informed consent

Results

MRC studies were considered to be diagnostic by the two reviewers in 28 of the 28 patients. All diagnostic examinations well exhibit the biliary anatomy and the ductal anastomosis, that is an end-to-end choledococholedocostomy. MRC demonstrated strictures involving the hepatic bifurcation and the extrahepatic bile duct of the graft in 25 patients; a concomitant thickening of the biliary wall was described in 18 out of these 25 subjects.

MRC also showed sludge or stones formation in the donor

Discussion

The early diagnosis and correct management of biliary complications are important elements for ensuring graft and patient survival after OLT, and the diagnostic workup has been repeatedly reviewed in an attempt to reach the most accurate strategy.8, 9, 10

The main imaging examinations used for this purpose are ultrasound and T-tube cholangiography. However, after the removal of a T-tube (if used), the only mean of directly visualizing the biliary system in the past was to use invasive

References (18)

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