Ann Hepatobiliary Pancreat Surg.  2021 Feb;25(1):39-45. 10.14701/ahbps.2021.25.1.39.

Clinical usefulness of T1-weighted MR cholangiography with Gd-EOB-DTPA for the evaluation of biliary complication after liver transplantation

Affiliations
  • 1Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

Abstract

Backgrounds/Aims
Biliary complications continue to be the major morbidity and mortality causes following living donor liver transplantation (LT). Endoscopic retrograde cholangiopancreatography (ERCP) has been performed to identify the biliary leakage source. However, this can lead to retrograde cholangitis and pancreatitis, and is not sufficient to diagnose bile leakage from cuts’ surface. This study aimed to describe the use of T1-Weighted Magnetic Resonance (MR) Cholangiography with Gd-EOB-DTPA (Primovist) examination for evaluating the bile duct complication following LT.
Methods
From March 2012 to December 2018, 869 adult LT were performed at the Seoul National University Hospital.Forty-three recipients had undergone MR Cholangiography with Gd-EOB-DTPA. We reviewed these cases with their clinical outcomes and described the utility of the MR cholangiography with Gd-EOB-DTPA.
Results
In radiologic examinations performed in the patients suspected of bile duct complication, 95% had bile leakage and stricture. Cut surface leakage was diagnosed in two cases, and biliary leakage from the anastomosis site was diagnosed in the others. Most patients with leakage had undergone percutaneous drainage and ERCP, which was performed to evaluate the bile secretion function of the hepatocytes. There was no contrast-enhanced bile duct image in one case with severe rejection, and it might have been related to hepatocyte secretary dysfunction.
Conclusions
T1-Weighted MR Cholangiography with Gd-EOB-DTPA 40-minute delay examination is a feasible and safe non-invasive procedure for identifying biliary leakage sites.

Keyword

Gd-EOB DTPA MRI; Liver transplantation; Biliary complication

Figure

  • Fig. 1 (A) Gd-EOB DTPA 40 minute delay image in the case of biliary anastomosis leakage. (B) ERCP findings in the case of biliary anastomosis leakage. (C) PTBD findings in the case of biliary anastomosis leakage.

  • Fig. 2 (A) Incidentally found biloma in the postoperative 7 days CT after LT. (B) CT finding after percutaneous drainage (PCD) in the biloma. (C) Gd-EOB DTPA MRI findings of leakage site after PCD drainage. (D) Interventional fluoroscopy for ERCP/PTBD.

  • Fig. 3 Gd-EOB DTPA MRI findings of the case with cut surface leakage.

  • Fig. 4 GD-EOB DTPA MRI findings of the case with chronic rejection. No bile secretion was identified in the biliary tract.


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