American Journal of Roentgenology, Vol 165, 349-354, Copyright © 1995 by American Roentgen Ray Society
Diagnosis of duodenal leaks from kidney-pancreas transplants in patients with duodenovesical anastomoses: value of CT cystography
TP Bischof, RF Thoeni and JS Melzer
Department of Radiology, University of California, San Francisco 94143- 0628, USA.
OBJECTIVE. This study was undertaken to assess the value of CT cystography,
using scans made with full bladder distention by a combination of iodinated
contrast material and air and scans made after active voiding, for
detecting duodenal segment leaks in patients with kidney transplants and
pancreas transplants associated with small duodenal segments and
duodenovesical anastomoses. SUBJECTS AND METHODS. 18 patients with such
kidney-pancreas transplants underwent CT cystography for clinically
suspected leaks from the duodenal segment. Six patients had two
examinations, resulting in 24 CT cystograms. The CT protocol consisted of
an initial series of pelvic scans (plain CT) without oral, IV, or bladder
contrast material; CT cystogram with the bladder fully distended by
iodinated contrast material and air; and, if the findings were negative, CT
after voiding. If no leak was demonstrated, the remainder of the abdomen to
the liver dome was examined. Diagnoses were proved by surgery or cystoscopy
(n = 11) and clinical follow-up examinations (n = 13). RESULTS. Overall,
bladder- duodenal segment leaks were demonstrated in 11 of 12 studies: one
by plain CT, seven by full CT cystography, and four by CT after voiding
following negative findings on full CT cystography. One surgically proved
leak was missed by CT cystography owing to a large amount of pelvic fluid.
In 12 studies without a leak, CT cystography results correlated well with
clinical follow-up studies. There were no false- positive results.
Sensitivity was 92%, specificity was 100%, and accuracy was 96%.
CONCLUSION. CT cystography with a dedicated protocol is an accurate way to
diagnose leaks of the duodenal segment in patients with bladder-drained
kidney-pancreas transplants if administration of air combined with contrast
material into the bladder and CT after voiding are used.