肝移植术后胆道并发症的磁共振评价

Assessment of biliary complications after orthotopic liver transplantation with magnetic resonance imaging

目的:探讨磁共振胰胆管成像(MRCP)联合MR断面图像在诊断肝移植术后胆道并发症中的应用价值.方法:对57例肝移植术后怀疑有胆道并发症的患者行MR检查,分析其表现,并与手术、胆道造影、肝脏活检和,临床随访结果进行对照.比较MRCP和MRCP联合MR断面图像对胆道并发症诊断的确诊率.结果:57例患者胆道并发症发生率64.9%(37/57).其中吻合口狭窄患者14例,非吻合口狭窄8例.孤立性胆道结石或胆泥淤积5例,胆管炎及胆管周围炎3例,胆汁湖/胆汁瘤3例,供体-受体胆总管不匹配3例,肝外胆管吻合后过长1例.对胆道并发症诊断的准确率,MRCP为75.7%(28/37),MRCP联合MRI断面图像为94.6%(35/37),两者差别有统计学意义(P<0.05).结论:MRCP联合MR断面图像能提高胆道并发症诊断的准确性.

AIM： To analyze the MR findings of early and late biliary complications after orthotopic liver transplantation （OLT） and to evaluate the clinical value of MR cholangiopancreatography （MRCP） combined with MR cross-sectional images in diagnosing biliary complications after OLT. METHODS： Fifty-seven consecutive patients with clinical suspicion of biliary complications after receiving OLT were evaluated on the basis of MRCP and MR cross-sectional images, the latter including TIW axial unenhanced and Gadolinum-enhanced sequences, Gadolinumenhanced VIBE sequences, unenhanced T2W axial images and coronal True-FISP sequences. The diagnostic accuracy rates were compared between MRCP and MRCP combined with MR cross-sectional images. RESULTS： The incidence of biliary complications after OLT was 64.9% （37/57）. The final diagnoses were as follows anastomotic stricture （n = 14）, nonanastomotic stricture （n = 8）, solitary biliary stone or sludge （n= 5）, cholangitis and periangiocholitis （n = 3）, biloma （n = 3）, donorto-recipient common bile duct disproportion （n = 3）, and elongation of extrahepatic biliary duct （n = 1）. In 37 cases of biliary complications, the accuracies of MRCP and MRCP combined with MR cross-sectional images were 75.7% （28/37） and 94.6% （35/37）, respectively. The difference was statistically significant （P 〈 0.05）. CONCLUSION： MRCP combined with MR cross-sectional images can improve the diagnostic accuracy of biliary complications, especially the diagnosis of biloma, cholangitis and perian- giocholitis.