Bile duct strictures after hepatobiliary surgery: assessment with MR cholangiography.
OBJECTIVE
To establish the accuracy of magnetic resonance (MR) cholangiography for diagnosis of postsurgical bile duct strictures.


METHODS
Sixty-seven patients suspected of having bile duct strictures after liver transplantation (n = 54), cholecystectomy (n = 8), hepatic resection (n = 4), or pancreaticoduodenectomy (n = 1) underwent MR cholangiography. Thick-slab single-shot fast spin-echo (repetition time msec/echo time msec, 4,500/940) imaging was performed in the coronal through sagittal planes with rotation in 10 degrees increments, and contiguous thin-section images were obtained in the transverse and the optimal coronal oblique planes by using half-Fourier rapid acquisition with relaxation enhancement (1,900/96). Three blinded observers independently reviewed the MR images and recorded diagnostic features including presence of biliary stricture by using a five-point confidence scale. Receiver operating characteristic analysis was used to measure the accuracy of MR cholangiography. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Final diagnosis was established at surgery (n = 29) and direct cholangiography (23 of 29) or at direct cholangiography, liver biopsy, and/or serial liver function tests (n = 38).


RESULTS
Thirty-three of 67 patients had strictures confirmed with the reference standard. MR cholangiography enabled correct diagnosis and depicted the site of strictures in all cases. Findings of stricture at MR cholangiography were false-positive in five patients with moderate duct dilatation and caliber change at the level of the anastomosis. Mean accuracy, sensitivity, specificity, PPV, and NPV were 94%, 97%, 74%, 86%, and 96%, respectively.


CONCLUSIONS
MR cholangiography is as sensitive as direct cholangiography for the assessment of bile duct strictures after hepatobiliary surgery but may lead to overestimation of the importance of duct dilatation and caliber change.
MRI Department, Clinical Radiology and Hepatobiliary and Transplant Unit, St James's University Hospital, Beckett St, Leeds LS9 7TF, England. janice.ward@leedsth.nhs.uk
Janice
J
Ward
Maria B
MB
Sheridan
J Ashley
JA
Guthrie
Mervyn H
MH
Davies
Charles E
CE
Millson
J Peter A
JP
Lodge
Stephen G
SG
Pollard
Kondragunta R
KR
Prasad
Giles J
GJ
Toogood
Philip J
PJ
Robinson
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery; D002758:Cholangiography; D003135:Common Bile Duct / Q000473:pathology* / Q000601:surgery*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000453:epidemiology; D013505:Digestive System Surgical Procedures; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000453:epidemiology; D005189:False Positive Reactions; D005260:Female; D005704:Gallbladder / Q000473:pathology / Q000601:surgery; D006500:Hepatic Duct, Common / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome