磁共振胰胆管成像对肝移植术后胆系的评价(英文)

Evaluating the biliary system after liver transplantation by magnetic resonance cholangiopancreatography

背景:由于肝移植术后患者出现胆道并发症时,没有特征性体征,此种并发症很难发现。MRI特别是磁共振胰胆管成像是一种具有安全、准确、非侵袭性特点,可用于综合评估移植后肝脏功能和并发症的有效手段。目的:评估磁共振胰胆管成像对肝移植术后胆系的显示以及诊断胆管并发症的价值。设计:对比观察。单位:南方医科大学南方医院影像中心。对象:于2003-01/2005-01在南方医科大学南方医院影像中心接受影像学检查肝移植患者13例,均为男性,年龄40-58岁。术前临床诊断为原发性肝癌2例,重症肝硬化11例。10例行原位经典式肝移植,3例行背驮式原位肝移植术,所有胆管吻合方式为胆总管端-端吻合。移植后至首次MR检查时间15d-1年。所有患者对检测项目均知情同意。方法:13例原位肝移植患者术后均用磁共振快速自选回波序列及快速小角度激发梯度回波序列常规扫描、磁共振胰胆管成像、钆喷替酸葡甲胺动态增强检查,分析各序图像特点。主要观察指标:磁共振胰胆管成像对重建胆道和胆道并发症的显示。结果:3例患者胆管管径正常,吻合口无狭窄。1例厚层磁共振胰胆管成像胆管未显影。胆管扩张8例;胆管狭窄5例;胆总管结石2例;胆囊管残端黏液囊肿2例;T管拔管后胆漏1例;排斥反应2例。结论:磁共振胰胆管成像不仅可显示肝移植术后外科重建胆道的影像,而且可准确、快速诊断肝移植术后胆道并发症。

BACKGROUND： Biliary complications are the common complication of liver transplantation. However, it is difficult to find the complications, since no obvious characteristic signs on the patients. Magnetic resonance imaging （MRI）, especially, magnetic resonance cholangiopancreatography （MRCP） may provide a comprehensive evaluation of the functions and complications of the transplanted liver as a safe, noninvasive and exact technique. OBJECTIVE： To evaluate the manifestation of biliary system after liver transplantation by MRCP and its value of diagnosis of biliary complications. DESIGN： Comparative observation. SETTING： Medical Imaging Center, Nanfang Hospital, Southern Medical University. PARTICIPANTS： A total of 13 male liver transplantation patients aged from 40-58 years, who received imaging examination at Medical Imaging Center, Nanfang Hospital, Southern Medical University from January 2003 to January 2005, were enrolled. Original causes of liver failure included cirrhosis （n =11 ） and primal hepatic carcinoma （n =2）. Ten received orthotopic liver transplantation, while 3 received piggyback orthotopic liver transplantation. Anastomotic mode of bile duct was common bile duct end-to-end anastomosis. The interval between transplantation and MRI examination ranged from 15 days to 1 year. All patients knew the items of examination and agreed to participate in the expenment. METHODS： Thirteen patients with orthotopic liver transplantation underwent turbo spin-echo （TSE） and fast low angle shot （FLASH）, MRCP, Gd-DTPA enhanced MRI to analyze the characteristics of each imaging after liver transplantation. MAIN OUTCOME MEASURES ： The imaging findings of the reestablished bile duct and complications of bile duct at MRCP. RESULTS： The diameters of bile duct and caliber were normal, no stricture on anastomotic stoma in 3 patients. Thick-section planes of MRCP did not develop biliary duct of one case. Biliary dilation occurred in 8 patients. There were 5 cases of biliary strictures and 2 cases of choledochus stone. Mucocele of bile duct remnant was identified in 2 cases. Bile leakage occurred in 1 case after T-tube was removed. Rejection reaction occurred in 2 cases. CONCLUSION ： MRCP not only can display the image of reestablished biliary tract after liver transplantation, but also can exactly diagnose complications rapidly.