Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany.
Eur J Radiol. 2011 Nov;80(2):e20-8. doi: 10.1016/j.ejrad.2010.06.003. Epub 2010 Jun 26.
Two different forms of biliary anastomosis can be created in patients undergoing liver transplantation: (a) bilio-digestive anastomoses or (b) choledocho-choledochostomy. Aim of this study was to assess the accuracy of MR cholangiopancreatography (MRCP) for the depiction of biliary stenoses in liver transplant patients depending on the type of biliary anastomosis.
24 liver transplant patients with clinical suspicion of biliary stenosis were studied (each 12 with bilio-digestive anastomosis/choledocho-choledochostomy). MRCP was performed on a 1.5 T scanner (Magnetom Avanto, Siemens) including 2D single shot RARE, 2D T2w HASTE, TrueFISP and 3D high-resolution navigator corrected sequences. Presence of (a) anastomotic stenoses (AST) and (b) NAS (non-anastomotic strictures) were assessed. Percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangiopancreatography (ERCP) were performed within 48h after MRCP and served as the standard of reference.
In patients with bilio-digestive anastomoses sensitivities of MRCP for the detection of AST and NAS amounted to 50% and 67%, respectively with specificity values of 83% and 50%. In patients with choledocho-chledochostomy sensitivities (AST: 100%, NAS: 100%) and specificities (AST: 100%, NAS: 88%) were significantly higher.
Biliary strictures after liver transplantation can be accurately detected by MRCP in patients after choledocho-chledochostomy. However, the diagnostic value of MRCP is lower if liver transplantation was performed in combination with a bilio-digestive anastomosis. This may be due to the less exact depiction of the anastomosis in the bowel wall. Thus, it is crucial to know the type of biliary anastomosis before choosing a diagnostic procedure.
在接受肝移植的患者中，可以创建两种不同形式的胆道吻合术：（a）胆肠吻合术或（b）胆总管-胆总管吻合术。本研究的目的是评估磁共振胆胰管成像（MRCP）在肝移植患者中对胆道狭窄的描述准确性，取决于胆道吻合术的类型。
对 24 例有胆道狭窄临床怀疑的肝移植患者进行了研究（每例 12 例胆肠吻合术/胆总管-胆总管吻合术）。MRCP 在 1.5T 扫描仪（西门子 Magnetom Avanto）上进行，包括 2D 单次激发 RARE、2D T2w HASTE、TrueFISP 和 3D 高分辨率导航校正序列。评估（a）吻合口狭窄（AST）和（b）NAS（非吻合口狭窄）的存在。MRCP 后 48 小时内行经皮经肝穿刺胆道造影（PTC）或内镜逆行胰胆管造影（ERCP），并作为参考标准。
在胆肠吻合术患者中，MRCP 检测 AST 和 NAS 的敏感度分别为 50%和 67%，特异性分别为 83%和 50%。在胆总管-胆总管吻合术患者中，敏感度（AST：100%，NAS：100%）和特异性（AST：100%，NAS：88%）明显更高。
在胆总管-胆总管吻合术患者中，MRCP 可准确检测肝移植后胆道狭窄。然而，如果肝移植与胆肠吻合术相结合，MRCP 的诊断价值较低。这可能是由于在肠壁中对吻合术的描绘不够精确。因此，在选择诊断程序之前，了解胆道吻合术的类型至关重要。
