The role of abdominal CT and MRI in detection of complications after transplantations of liver, kidney and pancreas.

The role of abdominal CT and MRI in detection of complications after transplantations of liver, kidney and pancreas. Poster No.: C-1319 Congress: ECR 2015 Type: Educational Exhibit Authors: R. Muslimov, M. Khubutiya, I. Popova, M. Novruzbecov, A. 1 2 2 2 2 2 1 2 2 Pinchuk, V. Sinitsyn, E. A. Mershina ; RU, Moscow/RU Keywords: Transplantation, Grafts, Diagnostic procedure, Computer Applications-3D, Complications, MR, CT-Angiography, CT, Liver, Kidney, Abdomen DOI: 10.1594/ecr2015/C-1319 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 13

Learning objectives The number of organ transplants in the world is steadily increasing and there is a need for evaluation of the grafted organs in the post-transplant period. Dysfunction or loss of grafts are associated with high morbidity and mortality. Medical imaging (first of all, CT and MRI) plays a pivotal role in timely diagnosis of these complications [1,2,3]. This education poster is based on analysis of CT and MRI performed in patients after transplantation of the kidneys, cadaveric liver and combined grafting of the kidneys and pancreas. Background The results of CT and MRI examinations in 92 patients after transplantation of the liver, kidney and the pancreaticoduodenal complex (simultaneous kidney and pancreas transplantation) have been analyzed. Imaging was done in period of 1 day - 6 month after the operation. Terminal stages of various acute and chronic conditions affecting the liver, kidneys, including diabetes mellitus and tumors were indications for transplantation. All imaging procedures were performed using a Toshiba Aquilion PRIME CT (80x0.5) and a Toshiba Atlas-X 1.5T MRI scanner. Findings and procedure details Standard CT and MRI scanning protocols were implemented in combination with MRIand CT-angiography. The most typical purpose of performimg CT in these patients was to determine the size, location and structure of the transplanted organs, to evaluate the characteristics of contrast enhancement of their parenchyma and to analyse the surrounding tissues. Special attention was paid to the patency of host-graft anastomosises such as: vascular, biliary, intestinal and ureteral. To assess vascular anastomosis, two kinds of angiography - the contrast (CTA, CE-MRA) and non-contrast (MRA) were employed (Fig.1, Fig.2, Fig.3). The spectrum of complications found with help of CT and mri included focal graft pathology (abscesses, pancreatitis, ischemia, tumor lesions), abdominal and retroperitoneal fluid collections (Fig.4, Fig.5, Fig.6). Most important for clinical Page 2 of 13

management of patients was the detection of vascular complications. The most serious vascular complications of grafted organs are: stenosis and occlusion of the transplant arteries (Fig.7, Fig.10), stenosis and thrombosis of the transplanted organ veins (Fig.8), narrowing or trombosis of the portal vein (Fig.9), and the formation the pseudoaneurysms in the region of the anastomosis (Fig.11). MRCP enabled the diagnosis of specific complications developed in the biliary anastomosises following the liver transplantation (strictures, insufficiencies) and vizualisation of main pancreatic duct dilatation secondary to the pancreatic transplantation (Fig.12). Both, CT and MRI, allowed for the evaluation of the condition of the anastomosis between the transplant urethra and the recipient's bladder. Images for this section: Page 3 of 13

Fig. 1: In the patient with a transplanted pancreas and kidney, the contrast enhanced CT revealed no deviations: retroperitoneal on the right hand side - the transplanted pancreas, on the left - a kidney transplant. Fig. 2: In the patient with a transplanted liver, the contrast enhanced CT and MRI revealed a well functioning arterial and portal anastomosises and a wide caval junction. Page 4 of 13

Fig. 3: Retroperitoneally on the right hand side the pancreatic transplant, arterial and venal anastomosises were visualized with no deviations. Fig. 4: CT with CE. Hematoma behind the pancreatic transplant and on the left hand side lymphocele in the transplant bed (asterisks). Page 5 of 13

Fig. 5: CT with CE. Recurrent HCC in the liver transplant Fig. 6: MDCT. Peripancreatic fluid collections, pseudocyst. Page 6 of 13

Fig. 7: CTA.Acute hepatic artery stenosis after liver transplantation. Page 7 of 13

Fig. 8: Thrombosis of the middle and the left hepatic veins in the transplanted liver resulted in the decreased intrahepatic portal perfusion in the left lobe which, in turn, led to the dysfunction of the latter, which required retransplantation. Page 8 of 13

Fig. 9: MDCT.VRT.Severe portal vein stenosis in the area of anastomosis exacerbated with portal hypertension. Page 9 of 13

Fig. 10: CTA. #hrombosis one branch artery of the transplanted pancreas (arrows). Severe arterial stenosis in the level of anastomosis (circle). Page 10 of 13

Fig. 11: CTA. Mild pseudoaneurysm of the hepatic artery was found in the region of the anastomosis. Page 11 of 13

Fig. 12: MRCP.Anastomotic stricture was exacerbated with biliary hypertension located in the area of connection between the donor's liver choledochus and the recipient's choledochus Page 12 of 13

Conclusion As the number of patients with different types of abdominal organs transplantation grows, radiologists will increasingly be called upon to assess these patients for presence of possible complications. Knowledge of the normal posttransplantation anatomy and the common complications in this special population is crucial for making timely and appropriate diagnoses. MDCT and MRI are the firstline noninvasive imaging modalities for evaluation of patients after abdominal organ transplantations and detection of possible complications. Personal information References 1. Duffy et al.vascular Complications of Liver Transplantation: experience in more than 4,200 patients. J Am Coll Surg. Vol. 208, No. 5, May 2009. 2. Vandermeer F.Q. et al.imaging of whole-organ pancreas transplants. Radiographics 2012, Mar-Apr;32(2):411-35. 3. Jian-Ling Che et al.imaging spectrum after pancreas transplantation with enteric drainage. Korean J Radiol 2014;15(1):45-53 Page 13 of 13