Boraschi Piero, Donati Francescamaria, Gigoni Roberto, Salemi Simonetta, Urbani Lucio, Filipponi France, Falaschi Fabio, Bartolozzi Carlo
Second Department of Radiology, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy.
Can Assoc Radiol J. 2008 Dec;59(5):259-63.
To evaluate a comprehensive magnetic resonance imaging (MRI) protocol as noninvasive diagnostic modality for simultaneous detection of parenchymal, biliary, and vascular complications after liver transplantation.
Fifty-two liver transplant recipients suspected to have parenchymal, biliary, and (or) vascular complications underwent our MRI protocol at 1.5T unit using a phased array coil. After preliminary acquisition of axial T1w and T2w sequences, magnetic resonance cholangiography (MRC) was performed through a breath-hold, thin- and thick-slab, single-shot T2w sequence in the coronal plane. Contrast-enhanced magnetic resonance angiography (CEMRA) was obtained using a 3-dimensional coronal spoiled gradient-echo sequence, which enabled acquisition of 32 partitions 2.0 mm thick. A fixed dose of 20 ml gadobenate dimeglumine was administered at 2 mL/s. A post-contrast T1w sequence was also performed. Two observers in conference reviewed source images and 3-dimensional reconstructions to determine the presence of parenchymal, biliary, and vascular complications. MRI findings were correlated with surgery, endoscopic retrograde cholangiography (ERC), biopsy, digital subtraction angiography (DSA), and imaging follow-up.
MRI revealed abnormal findings in 32 out of 52 patients (61%), including biliary complications (anastomotic and nonanastomotic strictures, and lithiasis) in 31, vascular disease (hepatic artery stenosis and thrombosis) in 9, and evidence of hepatic abscess and hematoma in 2. ERC confirmed findings of MRC in 30 cases, but suggested disease underestimation in 2. DSA confirmed 7 magnetic resonance angiogram (MRA) findings, but suggested disease overestimation in 2.
MRI combined with MRC and CEMRA can provide a comprehensive assessment of parenchymal, biliary, and vascular complications in most recipients of liver transplantation.
评估一种综合磁共振成像（MRI）方案作为无创诊断方法，用于同时检测肝移植术后的实质、胆道和血管并发症。
52例怀疑有实质、胆道和（或）血管并发症的肝移植受者在1.5T设备上使用相控阵线圈接受我们的MRI方案检查。在初步采集轴位T1加权和T2加权序列后，通过在冠状面屏气、薄层和厚层、单次激发T2加权序列进行磁共振胆管造影（MRC）。使用三维冠状面扰相梯度回波序列获得对比增强磁共振血管造影（CEMRA），该序列能够采集32个2.0毫米厚的层面。以2毫升/秒的速度静脉注射固定剂量的20毫升钆贝葡胺。同时还进行了对比剂增强后的T1加权序列。两名会诊的观察者回顾原始图像和三维重建图像，以确定是否存在实质、胆道和血管并发症。MRI检查结果与手术、内镜逆行胆管造影（ERC）、活检、数字减影血管造影（DSA）及影像学随访结果进行对照。
52例患者中有32例（61%）MRI显示异常结果，其中31例为胆道并发症（吻合口和非吻合口狭窄及结石），9例为血管疾病（肝动脉狭窄和血栓形成），2例有肝脓肿和血肿迹象。ERC证实了30例MRC的检查结果，但有2例提示疾病评估过低。DSA证实了7例磁共振血管造影（MRA）的检查结果，但有2例提示疾病评估过高。
MRI联合MRC和CEMRA能够对大多数肝移植受者的实质、胆道和血管并发症进行全面评估。
