Sonja Kinner MD, Presenter: Nothing to Disclose

Alexander Dechene, Abstract Co-Author: Nothing to Disclose

Andreas Paul, Abstract Co-Author: Nothing to Disclose

Lale Umutlu MD, Abstract Co-Author: Nothing to Disclose

Susanne C. Ladd MD, Abstract Co-Author: Nothing to Disclose

Guido Gerken, Abstract Co-Author: Nothing to Disclose

Thomas C. Lauenstein MD, Abstract Co-Author: Nothing to Disclose

Two different forms of biliary anastomosis can be created in patients undergoing liver transplantation: (a) bilio-digestive anastomoses (BDA) or (b) choledocho-choledochostomy (CC). 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 1.5T 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 48 hours 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. MRCP can be used as non-invasive diagnostic tool in transplant patients after CC, but cannot replace PTC in patients with BDA.

It is crucial to know the type of biliary anastomosis before choosing the diagnostic procedure.

Kinner, S, Dechene, A, Paul, A, Umutlu, L, Ladd, S, Gerken, G, Lauenstein, T, Stenoses of the Biliary Tract after Liver Transplantation: Is the Diagnostic Accuracy of MRCP Different Depending on the Type of Biliary Anastomosis?.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9007797.html