活体肝移植后磁共振胰胆管造影对胆系并发症的评估及与直接胆管造影的比较

Evaluation of biliary complications on magnetic resonance cholangiopancreatography and comparison with direct cholangiography after living-donor liver transplantation.

作者信息

Garg B, Rastogi R, Gupta S, Rastogi H, Garg H, Chowdhury V

机构信息

Department of Radiology, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi 110027, India.

出版信息

Clin Radiol. 2017 Jun;72(6):518.e9-518.e15. doi: 10.1016/j.crad.2016.12.019. Epub 2017 Jan 21.

DOI:10.1016/j.crad.2016.12.019

PMID:28118992

Abstract

AIM

To evaluate the imaging characteristics of biliary complications following liver transplantation on magnetic resonance cholangiopancreatography (MRCP) and its diagnostic accuracy in comparison with direct cholangiography.

MATERIAL AND METHODS

In this prospective study, 34 patients being evaluated for possible biliary complications after living-donor liver transplantation (LDLT) with abnormal MRCP findings were followed up for information regarding direct cholangiography either endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) within 7 days of MRCP. Twenty-nine patients underwent ERCP and five patients underwent PTC.

RESULTS

Compared to findings at direct cholangiography, MRCP presented 96.9% sensitivity, 96.9% positive predictive value, and 94.1% accuracy for the detection of biliary complications. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detection of anastomotic strictures, biliary leak, and biliary stone or sludge on MRCP was found to be 100%, 84.6%, 91.3%, 100% and 94.1%; 72.7%, 95.7%, 88.9%, 88% and 88.2%; 80%, 100%, 100%, 96.7% and 97.1%, respectively.

CONCLUSION

MRCP is a reliable non-invasive technique to evaluate the biliary complications following LDLT. MRCP should be the imaging method of choice for diagnosis in this setting and direct cholangiography should be reserved for cases that need therapeutic interventions.

摘要

目的

评估肝移植术后胆道并发症在磁共振胰胆管造影（MRCP）上的成像特征及其与直接胆管造影相比的诊断准确性。

材料与方法

在这项前瞻性研究中，对34例活体肝移植（LDLT）术后可能存在胆道并发症且MRCP检查结果异常的患者进行随访，在MRCP检查后7天内获取有关直接胆管造影的信息，即内镜逆行胰胆管造影（ERCP）或经皮肝穿刺胆管造影（PTC）。29例患者接受了ERCP检查，5例患者接受了PTC检查。

结果

与直接胆管造影的结果相比，MRCP检测胆道并发症的敏感性为96.9%，阳性预测值为96.9%，准确性为94.1%。MRCP检测吻合口狭窄、胆漏以及胆石或胆泥的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为100%、84.6%、91.3%、100%和94.1%；72.7%、95.7%、88.9%、88%和88.2%；80%、100%、100%、96.7%和97.1%。