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Diagnosing Biliary Complications of Orthotopic Liver Transplantation with Mangafodipir Trisodium–Enhanced MR Cholangiography: Comparison with Conventional MR Cholangiography

¹ Department of Radiology, Mayo Clinic Jacksonville, 4500 San Pablo Rd., Jacksonville, FL 32224.
² Department of Transplantation, Division of Transplant Medicine, Mayo Clinic Jacksonville, Joe Adams 1100 Transplant Center, Jacksonville, FL 32216.

OBJECTIVE. This study was designed to determine whether the addition of mangafodipir trisodium–enhanced MRI could improve the image quality, visualization of ductal structures, and diagnostic confidence provided by conventional T2-based MR cholangiography (MRC) in patients with suspected biliary complications after orthotopic liver transplantation.

SUBJECTS AND METHODS. Our study group consisted of 25 consecutive patients who were referred for MR evaluation of clinically suspected biliary complications after orthotopic liver transplantation. Conventional MRC in the axial and coronal planes was performed in each patient, followed by fat-suppressed volumetric gradient-echo imaging in the same planes both before and after the IV administration of mangafodipir trisodium. Imaging was performed in all patients until the contrast agent was seen in the bowel. Images were then graded for quality, visualization of bile ducts and anastomoses, presence of significant stricture or leak, and level of diagnostic confidence.

RESULTS. Mangafodipir trisodium–enhanced MRC tended to outperform conventional MRC in overall image quality and extrahepatic duct visualization; it was also more effective in delineating biliary anastomoses, and the difference was statistically significant (p < 0.001). All 25 enhanced examinations were considered diagnostic. Diagnostic confidence was scored as poor or lacking in 14 of the conventional MRC examinations for biliary stenosis and in 12 examinations for biliary leak.

CONCLUSION. Enhancement with mangafodipir trisodium improves the performance of MRC for the detection and exclusion of biliary abnormalities after orthotopic liver transplantation. Future investigations should compare the performance of mangafodipir trisodium–enhanced MRC with the performance of more invasive techniques.

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