Magnetic resonance cholangiography of biliary strictures after liver transplantation: A prospective double-blind study

Purpose: To compare magnetic resonance cholangiography (MRC) with endoscopic retrograde cholangiography (ERC) in quantitatively evaluating biliary strictures in liver transplant recipients. Materials and Methods: Eight liver transplant recipients with suspected biliary complications were referred for ERC and also underwent MRC within 24 hours using a combination of single-shot rapid acquisition with relaxation enhancement (SS-RARE) and three-dimensional (3D)-RARE sequences. The studies were independently interpreted by two blinded radiologists and a single blinded endoscopist who recorded the presence of a stricture and/or upstream dilatation, the ratio of recipient-to-donor duct diameters at the anastomosis, as well as the proximal duct diameter, length, and percent stenosis of any stricture detected. Results: Using ERC as the standard of reference, MRC had a sensitivity and negative predictive value of 100%, mean specificity of 83.3%. and mean positive predictive value of 92.9% in the detection of six strictures. Compared with ERC, MRC obtained accurate measurements of recipient-to-donor duct diameter ratios (r, 0.91; P < 0.01), proximal duct diameters (r, 0.83. P < 0.05), stricture lengths (r, 0.58; P = 0.06), and percent stenosis (r, 0.78; P = 0.06). Conclusion: MRC can provide equivalent imaging to ERC and can reliably identify and quantitatively evaluate biliary strictures in post-orthotopic liver transplantation (OLT) patients.