HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ward, J. Articles by Robinson, P. J. Search for Related Content PubMed PubMed Citation Articles by Ward, J. Articles by Robinson, P. J.

Bile Duct Strictures after Hepatobiliary Surgery: Assessment with MR Cholangiography¹

¹ From the MRI Department, Clinical Radiology (J.W., M.B.S., J.A.G., P.J.R.) and Hepatobiliary and Transplant Unit (M.H.D., C.E.M., J.P.A.L., S.G.P., K.R.P., G.J.T.), St James’s University Hospital, Beckett St, Leeds LS9 7TF, England. Received January 20, 2003; revision requested April 11; final revision received August 15; accepted September 29. Address correspondence to J.W. (e-mail: janice.ward@leedsth.nhs.uk).

View larger version (163K): [in a new window]   Figure 1a. Intrahepatic bile duct injury after laparoscopic cholecystectomy in a 73-year-old woman. (a) Coronal oblique single-shot fast SE (4,500/940) MR cholangiographic image shows dilatation of the right-sided ducts and nonvisualization of the ductal anatomy at the point where the right-sided ducts converge (arrow). The high-signal-intensity foci (arrowheads) are small cholangitic abscesses. (b) Corresponding ERCP image shows normal left-sided ducts; right-sided ducts are not depicted because of a tight stricture. Note the surgical clip at the point of stricture (arrow).

View larger version (141K): [in a new window]   Figure 1b. Intrahepatic bile duct injury after laparoscopic cholecystectomy in a 73-year-old woman. (a) Coronal oblique single-shot fast SE (4,500/940) MR cholangiographic image shows dilatation of the right-sided ducts and nonvisualization of the ductal anatomy at the point where the right-sided ducts converge (arrow). The high-signal-intensity foci (arrowheads) are small cholangitic abscesses. (b) Corresponding ERCP image shows normal left-sided ducts; right-sided ducts are not depicted because of a tight stricture. Note the surgical clip at the point of stricture (arrow).

View larger version (165K): [in a new window]   Figure 2a. Surgically confirmed anastomotic stricture after orthotopic liver transplantation in a 54-year-old man. (a) Coronal oblique single-shot fast SE (4,500/940) MR cholangiographic image shows a caliber change at the level of the anastomosis (arrow) and dilated intrahepatic ducts consistent with anastomotic stricture. (b) Corresponding ERCP image depicts no flow of contrast material across the anastomosis (arrow). A tight anastomotic stricture was confirmed at subsequent surgery.

View larger version (157K): [in a new window]   Figure 2b. Surgically confirmed anastomotic stricture after orthotopic liver transplantation in a 54-year-old man. (a) Coronal oblique single-shot fast SE (4,500/940) MR cholangiographic image shows a caliber change at the level of the anastomosis (arrow) and dilated intrahepatic ducts consistent with anastomotic stricture. (b) Corresponding ERCP image depicts no flow of contrast material across the anastomosis (arrow). A tight anastomotic stricture was confirmed at subsequent surgery.

View larger version (178K): [in a new window]   Figure 3. Surgically confirmed common bile duct stricture after laparoscopic cholecystectomy in a 43-year-old man. Coronal oblique single-shot fast SE (4,500/940) MR image shows intrahepatic duct dilatation and caliber change but does not depict part of the common bile duct (arrow).

View larger version (159K): [in a new window]   Figure 4a. Surgically confirmed biliary-enteric anastomotic stricture after orthotopic liver transplantation in a 56-year-old woman. (a) Coronal oblique single-shot fast SE (4,500/940) MR cholangiographic image clearly depicts the Roux-en-Y loop but not the point where it joins the ducts (arrow). Note the dilatation of the intrahepatic ducts. (b) Corresponding PTHC image shows that only a small amount of contrast material has passed beyond the stricture and entered the Roux-en-Y loop (arrow).

View larger version (186K): [in a new window]   Figure 4b. Surgically confirmed biliary-enteric anastomotic stricture after orthotopic liver transplantation in a 56-year-old woman. (a) Coronal oblique single-shot fast SE (4,500/940) MR cholangiographic image clearly depicts the Roux-en-Y loop but not the point where it joins the ducts (arrow). Note the dilatation of the intrahepatic ducts. (b) Corresponding PTHC image shows that only a small amount of contrast material has passed beyond the stricture and entered the Roux-en-Y loop (arrow).

View larger version (178K): [in a new window]   Figure 5a. Surgically confirmed anastomotic stricture after orthotopic liver transplantation in a 54-year-old man. (a) Coronal oblique single-shot fast SE (4,500/940) MR cholangiographic image depicts minimal intrahepatic duct dilatation and a stone (long arrow) immediately proximal to the anastomosis (short arrow). (b) Corresponding ERCP image also shows the stone (arrow). (c) Transverse and (d) coronal oblique views from thin-section half-Fourier rapid acquisition with relaxation enhancement (1,900/100) MR cholangiography show the stone (arrow) more clearly than does a.

View larger version (138K): [in a new window]   Figure 5b. Surgically confirmed anastomotic stricture after orthotopic liver transplantation in a 54-year-old man. (a) Coronal oblique single-shot fast SE (4,500/940) MR cholangiographic image depicts minimal intrahepatic duct dilatation and a stone (long arrow) immediately proximal to the anastomosis (short arrow). (b) Corresponding ERCP image also shows the stone (arrow). (c) Transverse and (d) coronal oblique views from thin-section half-Fourier rapid acquisition with relaxation enhancement (1,900/100) MR cholangiography show the stone (arrow) more clearly than does a.

View larger version (164K): [in a new window]   Figure 5c. Surgically confirmed anastomotic stricture after orthotopic liver transplantation in a 54-year-old man. (a) Coronal oblique single-shot fast SE (4,500/940) MR cholangiographic image depicts minimal intrahepatic duct dilatation and a stone (long arrow) immediately proximal to the anastomosis (short arrow). (b) Corresponding ERCP image also shows the stone (arrow). (c) Transverse and (d) coronal oblique views from thin-section half-Fourier rapid acquisition with relaxation enhancement (1,900/100) MR cholangiography show the stone (arrow) more clearly than does a.

View larger version (200K): [in a new window]   Figure 5d. Surgically confirmed anastomotic stricture after orthotopic liver transplantation in a 54-year-old man. (a) Coronal oblique single-shot fast SE (4,500/940) MR cholangiographic image depicts minimal intrahepatic duct dilatation and a stone (long arrow) immediately proximal to the anastomosis (short arrow). (b) Corresponding ERCP image also shows the stone (arrow). (c) Transverse and (d) coronal oblique views from thin-section half-Fourier rapid acquisition with relaxation enhancement (1,900/100) MR cholangiography show the stone (arrow) more clearly than does a.

View larger version (183K): [in a new window]   Figure 6a. Anastomotic stricture overestimated at MR cholangiography after orthotopic liver transplantation in a 47-year-old man. (a) Coronal oblique single-shot fast SE (4,500/940) image clearly shows minimal duct dilatation and caliber change at the level of the anastomosis (arrow). (b) Corresponding ERCP image, in which the discrepancy in the size of the native and donor ducts is less pronounced because the biliary system is distended with contrast material, which is seen to flow freely across the anastomosis (arrow). A stent was inserted because of minor caliber change, but the patient continued to improve after the stent was removed.

View larger version (142K): [in a new window]   Figure 6b. Anastomotic stricture overestimated at MR cholangiography after orthotopic liver transplantation in a 47-year-old man. (a) Coronal oblique single-shot fast SE (4,500/940) image clearly shows minimal duct dilatation and caliber change at the level of the anastomosis (arrow). (b) Corresponding ERCP image, in which the discrepancy in the size of the native and donor ducts is less pronounced because the biliary system is distended with contrast material, which is seen to flow freely across the anastomosis (arrow). A stent was inserted because of minor caliber change, but the patient continued to improve after the stent was removed.