MR Cholangiopancreatography Features of the Biliary Tree After Liver Transplantation
Sébastien Novellas1,
Thomas Caramella1,
Maud Fournol1,
Jean Gugenheim2 and
Patrick Chevallier1
1 Service of Medical Imagery, Centre Hospitalier Régional et
Universitaire de Nice, Hôpital Archet 2, 151 route de St. Antoine de
Ginestière, B. P. 3079, 06202 Nice Cedex 3, France.
2 Service of Hepatic Surgery, Centre Hospitalier Régional et
Universitaire de Nice, Nice, France.
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Fig. 1 —MR cholangiopancreatography 3D sequence 8 days after
orthotopic liver transplantation in 62-year-old man. Bile leak from
choledochocholedochal anastomosis (solid arrow) results in
choleperitoneum (open arrow) and associated proximal dilation of
intrahepatic bile ducts.
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Fig. 2A —MR cholangiopancreatography in 45-year-old man 1 week after
orthotopic liver transplantation with choledococholedocostomy. T2-weighted
turbo spin-echo axial image shows edema in liver (open arrow) and
perihilar effusion (solid arrow).
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Fig. 2B —MR cholangiopancreatography in 45-year-old man 1 week after
orthotopic liver transplantation with choledococholedocostomy. MR image of
liver reveals absence of hepatic artery and hilar necrosis
(arrow).
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Fig. 2C —MR cholangiopancreatography in 45-year-old man 1 week after
orthotopic liver transplantation with choledococholedocostomy. Intrahepatic
bile ducts are irregular and mildly dilated (open arrow), with
lacunar aspect of convergence of primary bile ducts in contact with biloma
(solid arrow).
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Fig. 3A —66-year-old woman 6 months after liver transplantation. MR
cholangiopancreatography image with fine slices reveals intrahepatic bile duct
dilation (open arrow), focal stenosis of choledochocholedochal
anastomosis (long arrow), and lacuna in connection with biliary
sludge in common bile duct (short arrow).
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Fig. 3B —66-year-old woman 6 months after liver transplantation.
Percutaneous cholangiography image shows complete stenosis of anastomosis
(solid arrow) and dilation of proximal bile ducts (open
arrow). Biliary sludge is not clearly identified.
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Fig. 4A —55-year-old man with jaundice 11 months after liver
transplantation. MR cholangiopancreatography 3D sequence with
maximum-intensity-projection reconstruction shows focal stenosis of
choledochocholedochal anastomosis (arrow) and significant dilation of
biliary tract near stenosis.
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Fig. 5A —53-year-old woman with jaundice 4 years after orthotopic
liver transplantation. MR cholangiopancreatography image reveals short
stenosis of choledochocholedochal anastomosis (long arrow) without
dilation of intrahepatic ducts (short arrow).
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Fig. 5B —53-year-old woman with jaundice 4 years after orthotopic
liver transplantation. Percutaneous cholangiography image confirms complete
stenosis of anastomosis (long arrow). Short arrow indicates
intrahepatic ducts.
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Fig. 6A —61-year-old man 4 months after liver transplantation. MR
cholangiopancreatography sequence shows predominantly right intrahepatic bile
duct dilation (open arrow) associated with several stenoses,
predominantly in right hepatic duct (long arrow). Common bile duct is
of normal caliber (short arrow).
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Fig. 6C —61-year-old man 4 months after liver transplantation.
Percutaneous cholangiography image confirms biliary dilation and complete
stenosis of right hepatic duct (solid arrow). Bile ducts are
irregular and dilated in association with ischemic-type biliary lesion
(open arrow).
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Fig. 7A —48-year-old man 2 months after liver transplantation. MRI
sequence with maximum-intensity-projection reconstruction shows multiple
intrahepatic stenoses (short arrows) and irregular dilation of
intrahepatic bile ducts (open arrow), which is visible up to
choledochocholedochal anastomosis (long arrow).
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Fig. 7B —48-year-old man 2 months after liver transplantation.
Percutaneous cholangiography image confirms irregular stenoses (short
arrow), dilation of biliary tract (open arrow), and extension to
proximal part of common bile duct. Cholangiography is artifactually distorted
by opacification of lymphatic network surrounding bile ducts (long
arrow).
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Fig. 8A —46-year-old woman 1 month after liver transplantation from a
living donor. MR cholangiopancreatography sequence shows moderate dilation of
intrahepatic bile ducts (long arrows) and perianastomotic biloma
(open arrow). Common bile duct is slender (short
arrows).
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Fig. 8B —46-year-old woman 1 month after liver transplantation from a
living donor. Percutaneous cholangiography image confirms perianastomotic
biliary leak (open arrow), moderate dilation of intrahepatic biliary
tracts (long arrows), and integrity of common bile duct (short
arrows). Biloma (open arrow) was percutaneously drained.
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Fig. 9A —41-year-old man 10 years after second orthotopic liver
transplantation. T2-weighted turbo spin-echo axial image reveals atrophy of
right lobe of liver (short arrow) and moderate dilation of
intrahepatic bile ducts in hypertrophied left lobe of liver (long
arrow).
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Fig. 9B —41-year-old man 10 years after second orthotopic liver
transplantation. On MR cholangiopancreatography image, note biliary stone in
left hepatic duct (long arrow) proximal to hepatojejunal anastomosis
(open arrow). Old cystic dilation of biliary tract of atrophied right
lobe of liver (short arrows) is well visualized.
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Fig. 9C —41-year-old man 10 years after second orthotopic liver
transplantation. Percutaneous cholangiography image shows lacunae of left
hepatic duct (long arrow), incomplete stenosis of hepatojejunal
anastomosis (open arrow), and passage of contrast material in loop
(short arrow).
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Fig. 10A —55-year-old man 3 years after liver transplantation. MR
cholangiopancreatography image shows large dilation of left intrahepatic bile
ducts (open arrow) filled with biliary stones presenting as filling
defects. Hepatojejunal anastomosis (solid arrow) appears
stenotic.
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Fig. 10B —55-year-old man 3 years after liver transplantation.
Percutaneous cholangiography image confirms ductal dilation, presence of
innumerable biliary stones (open arrow), and incomplete stenosis of
hepatojejunal anastomosis (solid arrow).
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Fig. 11A —63-year-old man 1 year after liver transplantation. MR
cholangiopancreatography 3D image with maximum-intensity-projection
reconstruction shows large dilation of intrahepatic bile ducts (long
arrow) and long stenosis involving hepatojejunal anastomosis and hepatic
hilum (open arrow). Jejunal loop is well seen (short
arrows).
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Fig. 11B —63-year-old man 1 year after liver transplantation. MR
cholangiopancreatography image with thick slices shows that stenosis of
anastomosis is in fact focal (short arrow). Note proximal biliary
stones involving common bile duct and liver hilum (open arrow). Long
arrow indicates large dilation of intrahepatic bile ducts.
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Fig. 11C —63-year-old man 1 year after liver transplantation.
Percutaneous cholangiography image shows dilation of intrahepatic bile ducts
(long arrow), focal complete stenosis of hepatojejunal anastomosis
(short arrow), and filling defects in bile ducts of hilum (open
arrow).
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Fig. 12A —45-year-old woman 18 months after liver transplantation. MR
cholangiopancreatography sequence shows several round fluid collections
(open arrow) appearing to communicate with bile ducts. Anastomosis
(solid arrow) does not appear to be stenosed.
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Fig. 12B —45-year-old woman 18 months after liver transplantation.
Percutaneous cholangiography image shows communication of bilomas (open
arrow) with bile ducts and confirms anastomotic patency (solid
arrow).
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Copyright © 2008 by the American Roentgen Ray Society.
