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

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), nonanastomotic 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

Suboptimal hepatobiliary phase image in gadoxetic acid-enhanced liver MRI for the evaluation of the HCC: Predictive factors

“…In addition, it has the advantage of being able to provide comprehensive information on the biliary tract based on the characteristics of biliary excretion. [8,9]…”

“…In addition, it has the advantage of being able to provide comprehensive information on the biliary tract based on the characteristics of biliary excretion. [8,9] However, if hepatocyte uptake, renal excretion, or both are reduced, a large amount of contrast medium may remain in the blood vessels or extracellular space and absorption into hepatocytes may become insufficient. In such cases, HBP imaging may be suboptimal for detecting and characterizing focal liver lesions.…”