[Biliary-enteric anastomosis: role of cholangiography with magnetic resonance]

Our study was aimed at investigating the role of MR-cholangiography (MRC) in the examination of patients treated with biliary-enteric anastomosis. MRC was performed in 15 patients (8 men and 7 women, mean age: 64.7 years) operated on for biliary-enteric anastomoses (13 hepaticojejunostomies and 2 choledochoduodenostomies) whose symptoms were as follows: persistent jaundice in 4 patients; cholangitis and abnormal liver function tests in 2 patients; associated transient jaundice, epigastric pain, abnormal liver function tests in 2 patients. The remaining 7 patients were asymptomatic and examined during their follow-up. MRC was performed with a non-breath-hold, fat-suppressed 3D turbo spin echo sequence (TR = 3000 msec, TE = 700 msec, ETL = 128) with an acquisition time ranging 4 min 24 sec to 5 min 48 sec. Six patients were subsequently submitted to Percutaneous Transhepatic Cholangiography (PTC) to confirm the diagnosis and to perform a therapeutical procedure. Two patients, submitted to choledochoduodenostomy were examined with ERCP. The remaining seven patients, examined during their surgical follow-up and who presented no major symptoms or dilation of the bile ducts, were not submitted to any invasive procedure. Image quality was graded as good to fair in 12/15 cases (80%) and poor in 3/15 cases (20%). The degree of bile ducts dilation was correctly assessed with complete inter observer agreement in 8/8 patients. MRCP correctly showed: bile ducts irregularities in 2 of 4 patients with cholangitis (k = 0.59), anastomosis stenosis in 8 of 8 patients (k = 0.86), and 5-15 mm stones in 5 of 5 patients (k = 0.95). In conclusion, MRCP is a safe, noninvasive technique in the study of biliary-enteric anastomoses with high accuracy in assessing the cause of jaundice. MRCP images can be used as a guide for subsequent interventional procedures. Its main disadvantages are the lack of functional information and the high cost which limits its its use to the screening of symptomatic patients.