Biliary complications after liver transplantation: The role of MR imaging using different hydrographic sequences in patients with biliary-enteric and duct-to-duct biliary anastomosis.

Background: To aim of this study was to assess the diagnostic performance of the state-of-the-art magnetic resonance cholangiography (MRC) comprising several 2D and 3D hydrographic sequences in patients after liver transplantation with biliary-enteric and duct-to-duct biliary anastomosis.

Material And Methods: Retrospective analysis included MRC examinations of 42 patients (21 men, 21 women) performed from 18 days to 86 months (average, 18.9 months) after liver transplantation. Studies were carried out on 1.5 T units, using 4 hydrographic (turbo spin echo, TSE) sequences. The analysis included accuracy of MRC in detecting biliary complications, as well as frequency of specific complications in patients with biliary-enteric anastomosis (n=15) and duct-to-duct biliary anastomosis (n=27). In 34 patients the results were correlated with endoscopic retrograde cholangiopancreatography ERCP (n=9), ERCP and CT (n=5), ERCP and percutaneous cholangiography (n=2), ERCP and T-tube cholangiography (n=1), ERCP, PTC, and histopathology (n=1), PTC (n=1), PTC and CT (n=1), PTC and histopathology (n=1), T-tube cholangiography (n=4), T-tube cholangiography and CT (n=1), fistulography (n=1), CT (n=4), and histopathology (n=3). In the remaining 8 patients other imaging studies (US, CT, follow-up MRC), laboratory liver function tests, and clinical status were the standard of reference. Results MRC yielded 94.6% sensitivity in detecting biliary complications in patients after liver transplantation. In patients with biliary-enteric anastomosis, disseminated biliary strictures were more frequent than in patients with duct-to-duct biliary anastomosis (20% vs. 7%). Less frequently, the biliary-enteric anastomosis was accompanied by anastomotic strictures (40% vs. 56%) and the presence of stones/sludge (20% vs. 37%), but the differences did not show statistical significance.

Conclusions: MRC allowed accurate diagnosis of biliary complications in patients after liver transplantation and therefore can be used as a safe alternative to invasive diagnostic procedures such as ERCP and PTC, especially in patients with biliary-enteric anastomosis, in which invasive diagnostic procedures are technically challenging. The main limitation of MR hydrography is its low accuracy in distinguishing bilomas from other fluid collections.