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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.

View larger version (107K): [in a new window]   Fig. 1A. —54-year-old man referred for MR imaging with absent hepatic arterial tracing on Doppler sonography (not shown). Lateral image of volume-rendered arterial phase contrast-enhanced three-dimensional MR angiogram (TR/TE, 3.8/1.8; flip angle, 25°) shows celiac artery stenosis (arrow).

View larger version (100K): [in a new window]   Fig. 1B. —54-year-old man referred for MR imaging with absent hepatic arterial tracing on Doppler sonography (not shown). Correlative digital subtraction angiogram confirms findings in A of celiac artery stenosis (arrow).

View larger version (93K): [in a new window]   Fig. 2A. —33-year-old man referred for MR imaging 4 months after liver transplantation for suspected hepatic arterial compromise in context of known biliary compromise. Oblique frontal image of volume-rendered arterial phase contrast-enhanced three-dimensional MR angiogram (TR/TE, 4.2/1.8; flip angle, 12°) shows hepatic artery thrombosis (arrow).

View larger version (125K): [in a new window]   Fig. 2B. —33-year-old man referred for MR imaging 4 months after liver transplantation for suspected hepatic arterial compromise in context of known biliary compromise. Correlative digital subtraction angiogram confirms findings in A of hepatic artery thrombosis (arrow).

View larger version (70K): [in a new window]   Fig. 3A. —54-year-old man referred for MR imaging with abnormal hepatic arterial waveforms on Doppler sonography (not shown) 2 days after liver transplantation. Frontal image of volume-rendered arterial phase contrast-enhanced three-dimensional MR angiogram (TR/TE, 4.2/1.8; flip angle, 25°) shows hepatic artery attenuation originating at bifurcation (arrow) of right and left hepatic arterial branches.

View larger version (115K): [in a new window]   Fig. 3B. —54-year-old man referred for MR imaging with abnormal hepatic arterial waveforms on Doppler sonography (not shown) 2 days after liver transplantation. Correlative digital subtraction angiogram shows nearly normal hepatic arterial tree (arrow). On other projections, mild stenosis was seen at origin of left hepatic artery (not shown). Digital subtraction angiographic findings suggest overestimation of arterial disease on MR angiography. Slow hepatic arterial flow noted during digital subtraction angiography may have resulted in attenuated appearance of hepatic artery and its branches on MR angiography.

View larger version (101K): [in a new window]   Fig. 4A. —38-year-old man who was referred for MR imaging with elevated liver function tests. Coronal half-Fourier acquisition single-shot turbo spin-echo image (TR/TE, infinite, 62; refocusing pulse, 120°) shows abrupt change in caliber of distal common bile duct suggestive of anastomotic stricture (white arrow). Central signal loss in common bile duct is due to presence of biliary catheter (black arrow).

View larger version (139K): [in a new window]   Fig. 4B. —38-year-old man who was referred for MR imaging with elevated liver function tests. T-tube cholangiography confirms presence of stricture (arrow).

View larger version (102K): [in a new window]   Fig. 5. —59-year-old man with recurrent hepatocellular carcinoma 8 months after liver transplantation. Axial image from arterial phase contrastenhanced three-dimensional MR imaging (TR/TE, 4.5/1.9; flip angle, 12°) shows multiple intrahepatic masses (short arrows identify subset of visible lesions) and subcutaneous nodule (long arrow) with dynamic imaging features consistent with hepatocellular carcinoma. Subsequent biopsy of subcutaneous nodule confirmed recurrent hepatocellular carcinoma.

View larger version (94K): [in a new window]   Fig. 6. —57-year-old man with recurrent hepatocellular carcinoma 27 months after liver transplantation. Axial image from arterial phase contrast-enhanced three-dimensional MR imaging (TR/TE, 4.2/1.9; flip angle, 12°) shows large portacaval lymph node (arrow) subsequently biopsied and found to be consistent with recurrent hepatocellular carcinoma.

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