title: Impact of magnetic resonance cholangiography in managing liver-transplanted patients: preliminary results of a clinical decision-making study.
abstract: OBJECTIVE
  This study was performed to assess the role of magnetic resonance cholangiography (MRC) in the clinical decision-making process of referring physicians when managing liver-transplanted patients.
  
  
  METHODS
  Over a 6-month period, 21 liver-transplanted patients with a suspected biliary complication were referred for MRC. Referring physicians were asked to prospectively state, before and after MRC, the leading diagnosis; the level of confidence (on a 0-100% scale); the most appropriate diagnostic/therapeutic plan. Data analysis assessed was the diagnostic yield of MRC; the proportion of change in the leading diagnosis; the therapeutic efficacy (i.e. proportion of change in the initial diagnostic/therapeutic plan); the diagnostic thinking efficacy (i.e., gain in diagnostic confidence). Statistical significance was assessed with the Mann-Whitney U test. MRC accuracy was also calculated.
  
  
  RESULTS
  Data analysis showed a diagnostic yield of 85.7%; a proportion of change in leading diagnosis of 19.0%; a therapeutic efficacy of 42.8%; a diagnostic thinking efficacy for concordant and discordant leading diagnoses of 18.8% and 78.7%, respectively (p<0.01). MRC accuracy was 92.3%.
  
  
  CONCLUSIONS
  MRC significantly increased the diagnostic confidence, irrespective of the concordance between pre- and posttest diagnoses. Moreover, MRC determined a change in patient management in a significant proportion of cases, leading to clinical benefits.
authors: Institute of Diagnostic Radiology, University of Udine, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy. lcereser@sirm.org
authors: L
authors: L
authors: Cereser
authors: R
authors: R
authors: Girometti
authors: G
authors: G
authors: Como
authors: C
authors: C
authors: Molinari
authors: P
authors: P
authors: Toniutto
authors: D
authors: D
authors: Bitetto
authors: C
authors: C
authors: Zuiani
authors: M
authors: M
authors: Bazzocchi
mesh_terms: D000328:Adult; D000368:Aged; D001649:Bile Duct Diseases / Q000175:diagnosis* / Q000209:etiology; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity