磁共振胆管成像对原位肝移植术后胆道相关并发症的随访和诊断价值

Diagnostic and follow up value of magnetic resonance cholangiography in biliary complications after orthotopic liver transplantation

目的探讨磁共振胆管成像(MRC)对原位肝移植术后胆道相关并发症的随访及诊断价值。方法连续收集在浙江大学医学院附属第一医院行 MRC 检查的166例原位肝移植术后患者。综合分析3D 薄层原始图像、2D 厚层单次激发图像和 MIP 重建图像。并将 MRC 诊断结果与诊断标准进行比较。结果 MRC 对166例原位肝移植术后胆道相关并发症诊断的敏感性为98.4%,特异性为81.6%,诊断符合率为87.9%,阳性预测值为76.5%,阴性预测值为98.8%。无临床异常的104例随访组中,MRC 显示正常和异常分别为73例和31例。出现临床异常的62例随访组中,MRC 显示正常和异常分别为12例和50例。MRC 诊断吻合口狭窄41例,节段性非吻合口狭窄8例,胆道结石和胆泥淤积12例,胆漏2例,胆管炎3例,胆道外压性改变4例。MRC 显示11例原位肝移植术后汇管区水肿。结论 MRC 能够很好显示原位肝移植术后多种类型的胆道相关并发症,为原位肝移植术后的随访监测、早期发现和指导治疗提供重要的影像学信息。

Objective To evaluate the diagnostic and follow up value of magnetic resonance cholangiography （MRC） in biliary complications after orthotopic liver transplantation （OLT）. Methods MRC was performed, using 1.5 T scanner on 166 consecutive OLT recipients. The MRC results were analyzed and compared with the confirmed diagnosis criteria （direct cholangiography, laparotomy, and liver puncture）. Results The sensitivity, specificity, accuracy, and positive and negative predictive value of MRC in diagnosis of biliary complications were 98.4%, 81.6%, 87.9%, 76.5% and 98.8%. 104 clinically normal cases and 62 symptomatic cases showed 31 and 50 MRC abnormal findings respectively. MRC totally showed 70 cases of suspected biliary complications following OLT, including 41 cases with anastomotie stricture, 8 with focal non-anastomotie stricture, and 12 with stones or debris formation, 2 with bile leak, 3 with cholangitis and 4 with oppressive changes of biliary tract. MRC also showed periportal edema in 11 cases. Conclusion A good imaging modality to show both periportal edema and biliary abnormality of various patterns, MRC provides important information for post-operational follow up and early detection of biliary complications in OLT recipients.