Biliary adverse events following orthotopic liver transplantation (OLT) are relatively common and continue to be serious causes of morbidity, mortality, and transplant dysfunction or failure. The development of these ...Biliary adverse events following orthotopic liver transplantation (OLT) are relatively common and continue to be serious causes of morbidity, mortality, and transplant dysfunction or failure. The development of these adverse events is heavily influenced by the type of anastomosis during surgery. The low specificity of clinical and biologic findings makes the diagnosis challenging. Moreover, direct cholangiographic procedures such as endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography present an inadmissible rate of adverse events to be utilized in clinically low suspected patients. Magnetic resonance (MR) maging with MR cholangiopancreatography is crucial in assessing abnormalities in the biliary system after liver surgery, including liver transplant. MR cholangiopancreatography is a safe, rapid, non-invasive, and effective diagnostic procedure for the evaluation of biliary adverse events after liver transplantation, since it plays an increasingly important role in the diagnosis and management of these events. On the basis of a recent systematic review of the literature the summary estimates of sensitivity and specificity of MR cholangiopancreatography for diagnosis of biliary adverse events following OLT were 0.95 and 0.92, respectively. It can provide a non-invasive method of imaging surgical reconstruction of the biliary anastomoses as well as adverse events including anastomotic and non-anastomotic strictures, biliary lithiasis and sphincter of Oddi dysfunction in liver transplant recipients. Nevertheless, conventional T2-weighted MR cholangiography can be implemented with T1-weighted contrast-enhanced MR cholangiography using hepatobiliary contrast agents (in particular using Gd-EOB-DTPA) in order to improve the diagnostic accuracy in the adverse events’ detection such as bile leakage and strictures, especially in selected patients with biliary-enteric anastomosis.展开更多
OBJECTIVE: To evaluate the predictive value of magnetic resonance cholangiography (MRC) in selected patients before laparoscopic cholecystectomy (LC). METHODS: Patients with risk factors for common bile duct (CBD) sto...OBJECTIVE: To evaluate the predictive value of magnetic resonance cholangiography (MRC) in selected patients before laparoscopic cholecystectomy (LC). METHODS: Patients with risk factors for common bile duct (CBD) stones scheduled for elective LC from March 1999 to May 2001, underwent MRC followed by endoscopic retrograde cholangiography (ERC) to detect the stones and the accuracy of MRC. Selection of suspected patients was based on clinical, ultrasonographic, and laboratory criteria. RESULTS: During a 26-month period, a total of 267 patients were studied. Seventy-eight MRC identified patients were found to have CBD stones by ERC or laparoscopic cholangiography in the study. Seven of 78 patients were misdiagnosed as having CBD stones by MRC. In this study, MRC had a sensitivity of 100%, a specificity of 96.3%, a positive predictive value of 91.8%, and a negative predictive value of 100% for the detection of common bile duct stones. CONCLUSIONS: With the use of LC, ERC is frequently performed before LC to detect CBD stones; but it is invasive with a well-documented complication rate. MRC is a simple non-invasive method for preoperative screening for CBD stones in at-risk patients. In this study if ERC had been limited to patients with a positive MRC, it would have reduced the need for ERC by 68.2%, and the complications of preoperative examination would be minimized significantly.展开更多
BACKGROUND:Magnetic resonance cholangiography (MRC)is a non-invasive method for imaging biliary ducts.When used to exclude common bile duct(CBD) stones,MRC may obviate the need for intra-operative cholangiography(IOC)...BACKGROUND:Magnetic resonance cholangiography (MRC)is a non-invasive method for imaging biliary ducts.When used to exclude common bile duct(CBD) stones,MRC may obviate the need for intra-operative cholangiography(IOC).In this prospective study,MRC and IOC were compared for the diagnosis of suspected stones of the CBD. METHODS:Thirty patients with gallstones and suspected CBD lithiasis(abnormal serum liver tests and CBD>7 mm on ultrasound)had MRC followed by open cholecystectomy and IOC.MR imaging was done using a 1.5-T whole body scanner(Signa,General Electric Medical Systems).A torso phased-array coil with a 4-channel receiver was used for data acquisition. RESULTS:Over a period of 18 months,30 patients(average age 53.9±13.3 years;range 38-76 years)were enrolled in this study.Eleven patients were male(36.7%)and 19 female(63.3%).MRC revealed CBD stones in 19 patients, while IOC revealed CBD stones in 22.The sensitivity of MRC in detecting CBD stones was 81.8%,and the specificity was 87.5%.The positive predictive value was 94.7%,and the negative predictive value was 63.3%. CONCLUSIONS:Pre-operative MRC may obviate the need for IOC.MRC reduces operative time,is less invasive, and may also alleviate damage to the CBD that can occurduring IOC.MRC can identify CBD stones pre-operatively and can help surgeons plan safe procedures.Pre-operative MRC should be done routinely in patients whose clinical or biochemical findings suggest the possibility of CBD stones.展开更多
AIM: To compare the value of endoscopic retrograde cholangiography (ERC) and standard T2-weighted magnetic resonance cholangiography (MRC) in the evaluation process as adult-to-adult right lobe living donor liver tran...AIM: To compare the value of endoscopic retrograde cholangiography (ERC) and standard T2-weighted magnetic resonance cholangiography (MRC) in the evaluation process as adult-to-adult right lobe living donor liver transplantation (LDLTx) demands a successful outcome, and exact knowledge of the biliary tree is implicated to avoid biliary complications, postoperatively.METHODS: After starting the LDLTx program, 18 liver transplant candidates were selected for LDLTx by a stepwise evaluation process. ERC and standard T2-weighted MRC were performed to evaluate the biliary system of the donor liver. The anatomical findings of ERC and MRC mapping were compared using the Ohkubo classification. RESULTS: ERC allowed mapping of the whole biliary system in 15/15 (100%) cases, including 14/15 (93.3%) with biliary variants while routine MRC was only accurate in 2/13 (15.4%) cases. MRC was limited in depicting the biliary system proximal of the hepatic bifurcation. Postoperative biliary complications occurred in 2 donors and 8 recipients. Biliary complications were associated with Ohkubo type C, E or G in 6/8 recipients, and 2/3 recipients with biliary leak received a graft with multiple (≥2) bile ducts. CONCLUSION: Pretransplant ERC is safe and superior over standard MRC for detection of biliary variations that occur with a high frequency. However, precise knowledge of biliary variants did not reduce the incidence of postoperative biliary complications.展开更多
Despite advances in patient and graft management,biliary complications(BC)still represent a challenge both in the early and delayed period after orthotopic liver transplantation(OLT).Because of unspecific clinical pre...Despite advances in patient and graft management,biliary complications(BC)still represent a challenge both in the early and delayed period after orthotopic liver transplantation(OLT).Because of unspecific clinical presentation,imaging is often mandatory in order to diagnose BC.Among imaging modalities,magnetic resonance cholangiography(MRC)has gained widespread acceptance as a tool to represent the reconstructed biliary tree noninvasively,using both the conventional technique(based on heavily T2-weighted sequences)and contrast-enhanced MRC(based on the acquisition of T1-weighted sequences after the administration of hepatobiliary contrast agents).On this basis,MRC is generally indicated to:(1)avoid unnecessary procedures of direct cholangiography in patients with a negative examination and/or identify alternative complications;and(2)provide a road map for interventional procedures or surgery.As illustrated in the review,MRC is accurate in the diagnosis of different types of biliarycomplications,including anastomotic strictures,nonanastomotic strictures,leakage and stones.展开更多
AIM:To establish the role of magnetic resonance cholangiography(MRC)in diagnosis of biliary anatomy in living-donor liver transplantation(LDLT)donors.METHODS:A systematic review was performed by searching electronic b...AIM:To establish the role of magnetic resonance cholangiography(MRC)in diagnosis of biliary anatomy in living-donor liver transplantation(LDLT)donors.METHODS:A systematic review was performed by searching electronic bibliographic databases prior to March 2013.Studies with diagnostic results and fulfilled inclusion criteria were included.The methodological quality of the studies was assessed.Sensitivity,specificity and other measures of the accuracy of MRC for diagnosis of biliary anatomy in LDLT donors were summarized using a random-effects model or a fixed-effects model.Summary receiver operating characteristic(SROC)curves were used to summarize overall test performance.Publication bias was assessed using Deek’s funnel plot asymmetry test.Sensitivity analysis was adopted to explore the potential sources of heterogeneity.RESULTS:Twelve studies involving 869 subjects were eligible to the analysis.The scores of Quality Assessment of Diagnostic Accuracy Studies for the included studies ranged from 11 to 14.The summary estimates of sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic OR of MRC in diagnosis of biliary anatomy in LDLT donor were 0.88(95%CI:0.84-0.92),0.95(95%CI:0.93-0.97),15.33(95%CI:10.70-21.95),0.15(95%CI:0.11-0.20)and 130.77(95%CI:75.91-225.27),respectively.No significant heterogeneity was detected in all the above four measures.Area under SROC curve was 0.971.Little publication bias was noted across the studies(P=0.557).Sensitivity analysis excluding a study with possible heterogeneity got a similar overall result,which suggested the little influence of this study on the overall results.CONCLUSION:Our results suggest that MRC is a high specificity but moderate sensitivity technique in diagnosis of biliary anatomy in LDLT donors.展开更多
文摘Biliary adverse events following orthotopic liver transplantation (OLT) are relatively common and continue to be serious causes of morbidity, mortality, and transplant dysfunction or failure. The development of these adverse events is heavily influenced by the type of anastomosis during surgery. The low specificity of clinical and biologic findings makes the diagnosis challenging. Moreover, direct cholangiographic procedures such as endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography present an inadmissible rate of adverse events to be utilized in clinically low suspected patients. Magnetic resonance (MR) maging with MR cholangiopancreatography is crucial in assessing abnormalities in the biliary system after liver surgery, including liver transplant. MR cholangiopancreatography is a safe, rapid, non-invasive, and effective diagnostic procedure for the evaluation of biliary adverse events after liver transplantation, since it plays an increasingly important role in the diagnosis and management of these events. On the basis of a recent systematic review of the literature the summary estimates of sensitivity and specificity of MR cholangiopancreatography for diagnosis of biliary adverse events following OLT were 0.95 and 0.92, respectively. It can provide a non-invasive method of imaging surgical reconstruction of the biliary anastomoses as well as adverse events including anastomotic and non-anastomotic strictures, biliary lithiasis and sphincter of Oddi dysfunction in liver transplant recipients. Nevertheless, conventional T2-weighted MR cholangiography can be implemented with T1-weighted contrast-enhanced MR cholangiography using hepatobiliary contrast agents (in particular using Gd-EOB-DTPA) in order to improve the diagnostic accuracy in the adverse events’ detection such as bile leakage and strictures, especially in selected patients with biliary-enteric anastomosis.
文摘OBJECTIVE: To evaluate the predictive value of magnetic resonance cholangiography (MRC) in selected patients before laparoscopic cholecystectomy (LC). METHODS: Patients with risk factors for common bile duct (CBD) stones scheduled for elective LC from March 1999 to May 2001, underwent MRC followed by endoscopic retrograde cholangiography (ERC) to detect the stones and the accuracy of MRC. Selection of suspected patients was based on clinical, ultrasonographic, and laboratory criteria. RESULTS: During a 26-month period, a total of 267 patients were studied. Seventy-eight MRC identified patients were found to have CBD stones by ERC or laparoscopic cholangiography in the study. Seven of 78 patients were misdiagnosed as having CBD stones by MRC. In this study, MRC had a sensitivity of 100%, a specificity of 96.3%, a positive predictive value of 91.8%, and a negative predictive value of 100% for the detection of common bile duct stones. CONCLUSIONS: With the use of LC, ERC is frequently performed before LC to detect CBD stones; but it is invasive with a well-documented complication rate. MRC is a simple non-invasive method for preoperative screening for CBD stones in at-risk patients. In this study if ERC had been limited to patients with a positive MRC, it would have reduced the need for ERC by 68.2%, and the complications of preoperative examination would be minimized significantly.
文摘BACKGROUND:Magnetic resonance cholangiography (MRC)is a non-invasive method for imaging biliary ducts.When used to exclude common bile duct(CBD) stones,MRC may obviate the need for intra-operative cholangiography(IOC).In this prospective study,MRC and IOC were compared for the diagnosis of suspected stones of the CBD. METHODS:Thirty patients with gallstones and suspected CBD lithiasis(abnormal serum liver tests and CBD>7 mm on ultrasound)had MRC followed by open cholecystectomy and IOC.MR imaging was done using a 1.5-T whole body scanner(Signa,General Electric Medical Systems).A torso phased-array coil with a 4-channel receiver was used for data acquisition. RESULTS:Over a period of 18 months,30 patients(average age 53.9±13.3 years;range 38-76 years)were enrolled in this study.Eleven patients were male(36.7%)and 19 female(63.3%).MRC revealed CBD stones in 19 patients, while IOC revealed CBD stones in 22.The sensitivity of MRC in detecting CBD stones was 81.8%,and the specificity was 87.5%.The positive predictive value was 94.7%,and the negative predictive value was 63.3%. CONCLUSIONS:Pre-operative MRC may obviate the need for IOC.MRC reduces operative time,is less invasive, and may also alleviate damage to the CBD that can occurduring IOC.MRC can identify CBD stones pre-operatively and can help surgeons plan safe procedures.Pre-operative MRC should be done routinely in patients whose clinical or biochemical findings suggest the possibility of CBD stones.
文摘AIM: To compare the value of endoscopic retrograde cholangiography (ERC) and standard T2-weighted magnetic resonance cholangiography (MRC) in the evaluation process as adult-to-adult right lobe living donor liver transplantation (LDLTx) demands a successful outcome, and exact knowledge of the biliary tree is implicated to avoid biliary complications, postoperatively.METHODS: After starting the LDLTx program, 18 liver transplant candidates were selected for LDLTx by a stepwise evaluation process. ERC and standard T2-weighted MRC were performed to evaluate the biliary system of the donor liver. The anatomical findings of ERC and MRC mapping were compared using the Ohkubo classification. RESULTS: ERC allowed mapping of the whole biliary system in 15/15 (100%) cases, including 14/15 (93.3%) with biliary variants while routine MRC was only accurate in 2/13 (15.4%) cases. MRC was limited in depicting the biliary system proximal of the hepatic bifurcation. Postoperative biliary complications occurred in 2 donors and 8 recipients. Biliary complications were associated with Ohkubo type C, E or G in 6/8 recipients, and 2/3 recipients with biliary leak received a graft with multiple (≥2) bile ducts. CONCLUSION: Pretransplant ERC is safe and superior over standard MRC for detection of biliary variations that occur with a high frequency. However, precise knowledge of biliary variants did not reduce the incidence of postoperative biliary complications.
文摘Despite advances in patient and graft management,biliary complications(BC)still represent a challenge both in the early and delayed period after orthotopic liver transplantation(OLT).Because of unspecific clinical presentation,imaging is often mandatory in order to diagnose BC.Among imaging modalities,magnetic resonance cholangiography(MRC)has gained widespread acceptance as a tool to represent the reconstructed biliary tree noninvasively,using both the conventional technique(based on heavily T2-weighted sequences)and contrast-enhanced MRC(based on the acquisition of T1-weighted sequences after the administration of hepatobiliary contrast agents).On this basis,MRC is generally indicated to:(1)avoid unnecessary procedures of direct cholangiography in patients with a negative examination and/or identify alternative complications;and(2)provide a road map for interventional procedures or surgery.As illustrated in the review,MRC is accurate in the diagnosis of different types of biliarycomplications,including anastomotic strictures,nonanastomotic strictures,leakage and stones.
文摘AIM:To establish the role of magnetic resonance cholangiography(MRC)in diagnosis of biliary anatomy in living-donor liver transplantation(LDLT)donors.METHODS:A systematic review was performed by searching electronic bibliographic databases prior to March 2013.Studies with diagnostic results and fulfilled inclusion criteria were included.The methodological quality of the studies was assessed.Sensitivity,specificity and other measures of the accuracy of MRC for diagnosis of biliary anatomy in LDLT donors were summarized using a random-effects model or a fixed-effects model.Summary receiver operating characteristic(SROC)curves were used to summarize overall test performance.Publication bias was assessed using Deek’s funnel plot asymmetry test.Sensitivity analysis was adopted to explore the potential sources of heterogeneity.RESULTS:Twelve studies involving 869 subjects were eligible to the analysis.The scores of Quality Assessment of Diagnostic Accuracy Studies for the included studies ranged from 11 to 14.The summary estimates of sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic OR of MRC in diagnosis of biliary anatomy in LDLT donor were 0.88(95%CI:0.84-0.92),0.95(95%CI:0.93-0.97),15.33(95%CI:10.70-21.95),0.15(95%CI:0.11-0.20)and 130.77(95%CI:75.91-225.27),respectively.No significant heterogeneity was detected in all the above four measures.Area under SROC curve was 0.971.Little publication bias was noted across the studies(P=0.557).Sensitivity analysis excluding a study with possible heterogeneity got a similar overall result,which suggested the little influence of this study on the overall results.CONCLUSION:Our results suggest that MRC is a high specificity but moderate sensitivity technique in diagnosis of biliary anatomy in LDLT donors.
