What is the role of imaging in the diagnosis of malignancy following whole-liver orthotopic liver transplantation (OLTX)?

Updated: Nov 11, 2019
  • Author: Fazal Hussain, MD, MPH; Chief Editor: John Karani, MBBS, FRCR  more...
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US, CT scanning, and MRI can be used to detect posttransplantation neoplasms. In patients with suspected hepatic involvement, US is a reasonable screening tool, depicting approximately 85% of focal lesions larger than approximately 2 cm. However, US is less effective in demonstrating extrahepatic malignancy, because other abdominal organs are partially or completely obscured by bowel gas, fat, and bone.

CT scanning is excellent in the detection and diagnosis of most posttransplantation malignancies. Dynamic, contrast-enhanced scans of the entire chest, abdomen, and pelvis can be obtained quickly and can provide a complete overview of the disease's extent. Approximately 90% of focal lesions larger than 2 cm can be demonstrated. CT scan–guided fine-needle aspirations and core-needle biopsies can usually provide adequate material to establish a tissue diagnosis.

State-of-the-art MRI is competitive with CT scanning in the evaluation of the abdomen and pelvis for posttransplantation malignancy. Similar to CT scanning, MRI shows 90% of focal liver lesions. As a result of inherently better contrast resolution and the availability of unique contrast agents, some lesions (especially those in the liver) can be imaged and characterized only by using MRI and not by using CT. Unfortunately, MRI adds little to the evaluation of the thorax. Although MRI scans can depict mediastinal pathology, only the largest of parenchymal lung nodules can be demonstrated.

No noninvasive cross-sectional imaging modality is effective in detecting posttransplantation cholangiocarcinoma in patients with PSC. Most tumors are not conspicuous during US, CT scanning, or MRI. Occasionally, an isolated dilated bile duct, hilar or intrahepatic mass, or enlarged regional node suggests the diagnosis. However, in most patients, percutaneous transhepatic cholangiopancreatography (PTC), endoscopic retrograde cholangiopancreatography (ERCP), or cholangioscopy with brushings and biopsy of suggested malignant bile duct strictures are repeated until the diagnosis is established.

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