Magnetic resonance cholangiopancreatographic (MRCP) spectrum of biliary complications after orthotopic liver transplantation (OLT).

Learning Objectives: To review MRCP findings of biliary complications in liver transplanted patients, including features after interventional procedures. Background: OLT is a widely accepted treatment for end-stage liver disease and selected cases of hepatocellular carcinoma. Despite technical progresses, biliary complications after OLT remain a serious cause of morbidity, mortality and graft dysfunction or failure in recipients. Early complications occur within few weeks after OLT and are mainly represented by bile leakage. Late complications, which become evident from 3 months to years, include strictures, stones, intraductal debris or sludge formation, kinking and ampullary dysfunction. Donor-to-recipient common bile duct disproportion has been reported as a borderline condition. Diagnosis is challenging because of the low specificity of clinical and biologic findings. Sonography does not provide projectional images of the biliary tract or direct evaluation of the anastomoses. Moreover, conventional direct cholangiography has an unacceptable complication rate in patients with low clinical suspicion. Some evidences suggest that MRCP, also as the only imaging modality, plays a key role in the diagnosis and management of biliary complications after OLT. Imaging Findings: High quality heavy T2-weighted MRCP images lead to a panoramic evaluation of the biliary tract, showing OLT complications as a variable combination of bile ducts dilatation, stenoses, filling defects, fluid collections and morphologic changes, as reviewed in this exhibit. Main features after therapeutic interventional procedures are illustrated too. Conclusion: MRCP is a safe and highly accurate tool in the assessment of biliary complications after OLT, and provides for adequate planning and follow-up of therapeutic procedures. :