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Vascular and Extravascular Complications of Liver Transplantation

Comprehensive Evaluation with Three-Dimensional Contrast-Enhanced Volumetric MR Imaging and MR Cholangiopancreatography

¹ Department of Radiology, Division of Magnetic Resonance Imaging, Basement, Schwartz Bldg., NYU Medical Center, 530 First Ave., New York, NY 10016.
² Department of Surgery, Division of Transplant Surgery, NYU Medical Center, 403 E. 34th St., New York, NY 10016.
³ Present address: Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215.
⁴ Present address: Departement de Radiologie, Hopital Maisonneuve-Rosemont, 5415 Blvd. de l'Assomption, Montreal, Quebec H1T 2M4, Canada.

OBJECTIVE. Our purpose was to evaluate a comprehensive MR imaging strategy for recipients of liver transplants that relies on dynamic interpolated three-dimensional (3D) MR imaging for simultaneous vascular, parenchymal, and extrahepatic imaging.

MATERIALS AND METHODS. Twenty-three consecutive adult patients underwent 30 MR imaging examinations between 2 days and 99 months (mean, 15 months) after transplantation using a breath-hold 3D gradient-echo sequence (TR range/TE range, 3.7-4.7/1.8-1.9; flip angle, 12-30°) with an intermittent fat-saturation pulse and interpolation in the section-select direction to enable pixel size 3 mm or less in all dimensions. Unenhanced and triphasic contrast-enhanced 3D imaging (average dose, 0.13 mmol/kg of gadopentetate dimeglumine) was performed. A subset of patients (n = 13) also underwent MR cholangiopancreatography using half-Fourier single-shot turbo spin-echo imaging. MR imaging examinations were correlated with digital subtraction angiography (n = 8), contrast-enhanced cholangiography (n = 9), sonography (n = 13), and histopathology (n = 14).

RESULTS. MR imaging revealed abnormal findings in 27 (90%) of 30 examinations, including vascular disease in nine, biliary complications in four, and evidence of intra- or extra-hepatic hepatocellular carcinoma recurrence in six. Digital subtraction angiography confirmed seven MR angiography examinations but suggested disease overestimation in one. Contrast-enhanced cholangiography confirmed findings of MR cholangiopancreatography in seven cases but suggested disease underestimation in two.

CONCLUSION. Dynamic interpolated 3D MR imaging combined with dedicated MR cholangiopancreatography can provide a comprehensive assessment of vascular, biliary, parenchymal, and extrahepatic complications in most recipients of liver transplants.

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