Biliary complications following orthotopic liver transplantation: May contrast-enhanced MR Cholangiography provide additional information?

Abstract

PurposeTo assess whether contrast-enhanced T1-weighted MR Cholangiography may provide additional information in the evaluation of biliary complications in orthotopic liver transplant recipients.Material and methodsEighty liver transplant patients with suspicion of biliary adverse events underwent MR imaging at 1.5 T scanner. After acquisition of axial T1-/T2-weighted images and conventional T2-weighted MR Cholangiography (image set 1), 3D gradient-echo T1-weighted fat-suppressed LAVA (Liver Acquisition with Volume Acceleration) sequences were obtained about 30 min after intravenous infusion of mangafodipir trisodium (Mn-DPDP,Teslascan®) (image set 2). The diagnostic value of mangafodipir trisodium-enhanced MR Cholangiography in the detection of biliary complications was tested by separate analysis results of image set 1 alone and image set 1 and 2 together. MRI results were correlated with direct cholangiography in 46 patients, surgery in 14 and/or clinical-radiological follow-up in the remaining 20 cases.ResultsThe level of confidence in the assessment of biliary adverse events was significantly increased by the administration of mangafodipir trisodium (p < 0.05). Particularly, contrast-enhanced T1-weighted LAVA sequences tended to out-perform conventional T2-weighted MR Cholangiography in the delineation of anastomotic and non-anastomotic biliary strictures and in the diagnosis of biliary leak.ConclusionsContrast-enhanced T1-weighted MR Cholangiography may improve the level of diagnostic confidence provided by conventional T2-weighted MR Cholangiography in the evaluation of biliary complications after orthotopic liver transplantation.

Imaging features of COVID-19-associated secondary sclerosing cholangitis on magnetic resonance cholangiopancreatography: a retrospective analysis

“…Our findings showed only a very low prevalence of intrabiliary casts on imaging. We hypothesize that the low prevalence of intrabiliary casts on MRCP in our study could be related to the fact that MRCP could potentially be missing the presence of smaller casts, especially in cases of non-dilated ducts, involvement of the smaller intrahepatic bile ducts and lack of associated T1-hyperintensity [ 38 ]. Although the presence of biliary casts has been described to be characteristic for non-COVID-19-related SSC-CIP (occurring in up to 87%), our findings indicate that lack thereof does not exclude it [ 5 ].…”

Can ultrasonography differentiate anastomotic and non-anastomotic biliary strictures after orthotopic liver transplantation- a single‐center experience

“…They are nonanastomotic intra-or extrahepatic multiple and focal bile duct necrosis, fibrotic strictures and dilatation (due to the obstruction by the necrosis) [24][25][26], which explain the skipped and irregular intrahepatic bile ductal dilatation. Moreover, most (87.5 %-100 %) NAS cases involves hilar bile duct, which is a prevalent localization of ischemic injures after OLT [17,24,[27][28][29]. Therefore, lengthy fibrotic stricture of bile ducts and necrosis of biliary epithelium account for poorly visualized or non-visible hilar bile duct luminal contour in NAS cases.…”

“…MRCP appearance of NAS were characterized by multiple stenoses and skip dilatations of intrahepatic bile ducts, and lengthy stricture and wall thickening of hilar bile duct [16,[27][28][29][30][31]. AS typically presents as focal luminal narrowing at the biliary anastomosis with or without pre-anastomotic dilatation of the biliary system [17,32]. However, there was no report about reliable ultrasonic features in the differential diagnosis of these two types of BS.…”

“…Cholangiography is the gold standard for diagnosis but is limited by its invasiveness. MRCP has demonstrated comparable diagnostic accuracy [14][15][16][17], however, it is not cost-effective and has limited availability for liver recipients who needs repeated, non-invasive, convenient imaging modality for follow up.…”

Biliary Complications Following Orthotopic Liver Transplantation: the Place of Surgical Reconstruction in the Minimally-Invasive Era

“…Furthermore, MRI provides cross-sectional imaging of the liver and intraabdominal structures, allowing the detection of a variety of postoperative problems. MRI with cholangiography is the most effective non-invasive imaging modality for the assessment of BC after LT, with a sensitivity and specificity for the diagnosis ≥ 90% (28,35,42). Treatment strategies for BC are based on the type and severity of the complication and the biliary reconstruction technique applied at the time of LT. A MI management, PTC or ERC, is currently the first-line approach (1,4,34,43).…”