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Biliary Complications After Liver Transplantation: Diagnosis with MR Cholangiopancreatography

¹ Institut de Diagnòstic per la Imatge, Hospital Duran i Reynals, Autovia de Castelldefels, Km. 2,7, Hospitalet de Llobregat 08907, Spain.
² Liver Transplantation Unit, Hospital Universitari de Bellvitge, Barcelona, Spain.
³ Department of Pathology, Hospital Universitari de Bellvitge, Barcelona, Spain.

View larger version (139K): [in a new window]   Fig. 1. —56-year-old male liver transplant recipient. Coronal thick-slab MRCP T2-weighted image (echo spacing, 8.3 msec; effective TE, 1,000 msec; image matrix, 512 x 512; field of view, 350 mm) shows short high-grade stricture at level of anastomosis. Note marked intrahepatic bile duct dilatation.

View larger version (113K): [in a new window]   Fig. 2A. —54-year-old male liver transplant recipient. Coronal thick-slab (echo spacing, 8.3 msec; effective TE, 1,000 msec; image matrix, 512 x 512; field of view, 350 mm) (A) and axial thin-slab (echo spacing, 4.2 msec; effective TE, 183 msec; image matrix, 272 x 512; field of view, 385 mm) (B) MRCP T2-weighted images show hypointense filling defect consistent with stone immediately above strictured hepaticohepaticostomy site. Patient also required hepaticojejunostomy.

View larger version (152K): [in a new window]   Fig. 2B. —54-year-old male liver transplant recipient. Coronal thick-slab (echo spacing, 8.3 msec; effective TE, 1,000 msec; image matrix, 512 x 512; field of view, 350 mm) (A) and axial thin-slab (echo spacing, 4.2 msec; effective TE, 183 msec; image matrix, 272 x 512; field of view, 385 mm) (B) MRCP T2-weighted images show hypointense filling defect consistent with stone immediately above strictured hepaticohepaticostomy site. Patient also required hepaticojejunostomy.

View larger version (141K): [in a new window]   Fig. 3A. —57-year-old man who underwent liver transplantation in 1997 for hepatitis C liver cirrhosis. Coronal thick-slab (echo spacing, 8.3 msec; effective TE, 1,000 msec; image matrix, 512 x 512; field of view, 350 mm) (A) and multisection thin-slab (echo spacing, 4.2 msec; effective TE, 183 msec; image matrix, 272 x 512; field of view, 385 mm) (B) MRCP T2-weighted images depict donor's common bile duct that is larger than common bile duct of recipient. Diagnosis of anastomotic stricture was suggested.

View larger version (161K): [in a new window]   Fig. 3B. —57-year-old man who underwent liver transplantation in 1997 for hepatitis C liver cirrhosis. Coronal thick-slab (echo spacing, 8.3 msec; effective TE, 1,000 msec; image matrix, 512 x 512; field of view, 350 mm) (A) and multisection thin-slab (echo spacing, 4.2 msec; effective TE, 183 msec; image matrix, 272 x 512; field of view, 385 mm) (B) MRCP T2-weighted images depict donor's common bile duct that is larger than common bile duct of recipient. Diagnosis of anastomotic stricture was suggested.

View larger version (153K): [in a new window]   Fig. 3C. —57-year-old man who underwent liver transplantation in 1997 for hepatitis C liver cirrhosis. Percutaneous transhepatic cholangiogram shows no evidence of stenosis with rapid filling of duodenum. This was actually a case of donor-to-recipient-common bile duct disproportion misdiagnosed as anastomotic stricture. Patient was finally found to have recurrent hepatitis virus C infection.

View larger version (102K): [in a new window]   Fig. 4A. —62-year-old man who underwent imaging 2 weeks after liver transplantation. Coronal thick-slab MRCP T2-weighted image (echo spacing, 8.3 msec; effective TE, 1,000 msec; image matrix, 512 x 512; field of view, 350 mm). Signal loss in proximal common hepatic duct extends to distal main left and right hepatic ducts. Long hilar stricture is consistent with nonanastomotic stricture due to ischemic cholangitis.

View larger version (99K): [in a new window]   Fig. 4B. —62-year-old man who underwent imaging 2 weeks after liver transplantation. Photograph of gross histologic specimen after retransplantation shows thickening of biliary bifurcation with mural nonanastomotic stenosis.

View larger version (138K): [in a new window]   Fig. 5A. —60-year-old male liver transplant recipient. Coronal thick-slab MRCP T2-weighted image (echo spacing, 8.3 msec; effective TE, 1,000 msec; image matrix, 512 x 512; field of view, 350 mm) reveals dilatation of intrahepatic ducts (predominantly left) and round area of high intensity in left hepatic lobe consistent with biloma. Note that biloma includes left biliary duct. Central signal loss in intrahepatic bile duct and biloma is due to the presence of necrotic debris and biliary sludge.

View larger version (129K): [in a new window]   Fig. 5B. —60-year-old male liver transplant recipient. Photograph of corresponding gross specimen of explanted liver shows necrosis of biliary tree with biloma filled with necrotic debris.

View larger version (118K): [in a new window]   Fig. 6. —60-year-old male liver transplant recipient. Coronal thick-slab MRCP T2-weighted image (echo spacing, 8.3 msec; effective TE, 1,000 msec; image matrix, 512 x 512; field of view, 350 mm) reveals stricture of hepatic confluence and right and left hepatic ducts that resulted in intrahepatic biliary ductal dilatation. Extrahepatic bile duct with anastomosis showed no evidence of narrowing.

View larger version (125K): [in a new window]   Fig. 7A. —21-year-old male liver transplant recipient. Coronal thick-slab MRCP T2-weighted image (echo spacing, 8.3 msec; effective TE, 1,000 msec; image matrix, 512 x 512; field of view, 350 mm) obtained 67 weeks after liver transplantation shows dilatation of intrahepatic ducts. Cause of bile duct dilatation seems to be biliary sludge impacted in common bile duct, proximal to anastomosis, without any anastomotic stricture. Hepaticojejunostomy was performed.

View larger version (134K): [in a new window]   Fig. 7B. —21-year-old male liver transplant recipient. Because of patient's poor clinical outcome, repeat MRCP was performed 3 weeks after surgery. Coronal thick-slab MRCP T2-weighted image (same parameters as in A) shows multiple intrahepatic duct strictures with focal areas of mild duct dilatation with no significant stenosis at site of hepaticojejunostomy, suggesting ischemic-cholangitis. Hepatic artery thrombosis was documented with helical CT.

View larger version (121K): [in a new window]   Fig. 8A. —67-year-old male liver transplant recipient. Coronal thick-slab MRCP T2-weighted image (echo spacing, 8.3 msec; effective TE, 1,000 msec; image matrix, 512 x 512; field of view, 350 mm) shows that donor's common bile duct is larger than recipient's common bile duct and reveals questionable anastomotic stricture.

View larger version (167K): [in a new window]   Fig. 8B. —67-year-old male liver transplant recipient. Intraoperative cholangiogram shows no evidence of stenosis, with rapid contrast filling of duodenum. Absence of intrahepatic bile duct dilatation and comparison with intraoperative cholangiography allows diagnostic confirmation of donor-to-recipient-common bile duct disproportion.

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