应用MRCP对63例肝移植术后胆道并发症的临床分析

目的评价MRCP在诊断原位肝移植术后胆道并发症中的临床应用价值。方法分析63例肝移植术后怀疑有胆道并发症患者的MRCP图像,并与手术、胆道造影、临床随访证实结果进行对照。所有病例均在高场强1.5T磁共振上进行。MRCP采用两种不同的成像方法:厚层块T2加权成像和薄层块多层T2加权成像。结果MRCP诊断移植术后胆道并发症的敏感性为95.3%(41/43),阳性预测值97.6(41/42),假阴性率为4.54%(2/44),假阳性率为2.27%(1/44)。总诊断准确率为95.2%(60/63)。MRCP作为唯一的诊断方法能为96.8%(61/63)的患者提供特异性诊断结果,仅2例患者需要ERCP和PTHC检查3.2%(2/63)。直接胆道造影作为一项治疗手段应用于22.2%(14/63)的患者中。结论MRCP是评价肝移植术后胆道并发症的有效影像学方法。

DIAGNOSIS OF BILIARY COMPLICATIONS AFTER OLT WITH MRCP

Objective We sought to evaluate MR cholangiopancreatography(MRCP) used in the diagnosis of biliary complications after orthotopic liver transplantation(OLT).Methods 63 consecutive patients who had undergone OLT and presented with clinical or biochemical signs of biliary complications underwent MRCP in 1.5-T unit scanner.The imaging findings were analyzed and compared with the findings eventually confirmed by surgery,direct cholangiography,or clinical follow-up.Two different MRCP snapshot techniques were applied: thick-slab T2weighted sequences and multisection thin-slab T2-weighted sequences.Results MRCP had a sensitivity of 95.3%(41/43)in the diagnosis of biliary complications after OLT.The positive predictive value was 97.6(41/42),and the false-negative ratio was 4.54%(2/44).There were only one false-positive,accounting for a false-positive ratio of 2.27%(1/44),and the overall diagnostic accuracy was 95.2%(60/63).MRCP imaging alone was able to provide a specific diagnosis in 96.8%(61/63)of the patients and ERCP and PTHC were required in only two patients3.2%(2/63).Direct cholangiography was required as a therapeutic procedure in 22.2%(14/63)of the patients.Conclusion MRCP is a useful imaging procedure in the assessment of biliary complications after OLT.