Abstract
Purpose: Post liver transplant biliary strictures (PTBS) are a serious clinical problem. Up to now, indirect tools are unreliable for the diagnosis of PTBS. Endoscopic retrograde - (ERC) and percutaneous transhepatic cholangiography (PTC) represent the gold standard in diagnosing PTBS. Since these are invasive procedures they show a considerable complication rate. Therefore we evaluated the diagnostic value of non-invasive Magnetic resonance cholangiography (MRC) for PTBS compared with the gold standard of direct cholangiography. Methods: 17 patients with clinically suspected PTBS (median age 46 years (range 15-69); 9 female, 8 male) were included in this blinded prospective study. In all patients graft rejection was excluded by biopsy. 2 patients had living donor and 15 patients cadaveric liver transplantation. All patients received MRC shortly before direct cholangiography. 15 patients with duct-to-duct anastomosis received ERC, 2 with biliodigestive anastomosis received PTC. The results were interpreted independently by trained radiologists and gastroenterologists, respectively. The presence of strictures, their localisation and the presence of stones/cast were assessed. Results: ERC/PTC showed in relevant PTBS in 16/17 patients. 11/17 patients showed anastomotic strictures (AST), 6/17 patients ischemic type biliary lesions (ITBL) and 1/17 patients no relevant stricture. Epithelial cast was identified in 4/17, bile duct stones in additional two cases. MRC identified the presence of stenosis in 12/17 patients, the number of stenoses was estimated correctly in only 8/17 patients. 10/11 cases of AST were identified by MRCP as compared to 3/6 cases of ITBL. MRC suspected bile duct stones in two patients, this was not confirmed by ERC/PTC. In one patient bile duct stones were only diagnosed by ERC but not by MRC. Strictures of the common bile duct and duct-to-duct anastomosis were diagnosed well, but especially strictures of the hilar and peripheral bile ducts, as peculiar to ITBL, are easily missed or underestimated by MRC. The presence of epithelial cast was missed by MRC in all 4/16 patients. Conclusions: MRC can not substitute direct cholangiography in patients with suspected PTBS. MRC shows acceptable sensitivity in diagnosing strictures of the anastomotic region but not in peripheral bile ducts. Concomitant bile duct stones and epithelial casts are not well recognized. Therefore, MRC can be recommended only for non-invasive screening, but not for exact diagnosis in suspected PTBS.
Published Version
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