Feasibility of morphologic assessment of vascular and biliary anatomy in pediatric liver transplantation: all-in-one protocol with breath-hold magnetic resonance.

BACKGROUND/PURPOSE: Noninvasive imaging for children with liver transplantation for possible sites of vascular and biliary complication remains a challenge. The aim of this study was to investigate the feasibility of magnetic resonance (MR) imaging as a comprehensive noninvasive test for the above purpose. METHODS: Thirteen children (age, 8-16 years) with biliary atresia and who received liver transplantation underwent a comprehensive MR study including MR cholangiography and gadolinium-enhanced MR angiography. Images were interpreted by 3 radiologists for liver parenchymal abnormalities; definition of hepatic arterial and venous, portal venous, and biliary anatomy; and detection of any complications. Findings were correlated with surgical records. Conventional angiography and percutaneous cholangiography were obtained for correlation in 2 patients. Confidence level scores (1-5) for depiction of anatomy were given for source, multiplanar, and 3-dimensional images. RESULTS: Hepatic artery anastomosis was visualized in 12 patients (92%) and the intrahepatic arteries were demonstrated in 10 (77%). The portal, hepatic venous, and biliary anastomoses were clearly demonstrated in all patients. Stenosis of hepatic artery anastomosis and multiple biliary strictures were detected in 1 patient each and confirmed by conventional imaging. High confidence scores (higher than 4) were obtained for all kinds of MR images. CONCLUSIONS: Comprehensive MR imaging can be used in long-term follow-up of pediatric liver transplant recipients for depiction of hepatic structures and possible complications.

Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration.

This study aims to compare the therapeutic effectiveness of continuous catheter drainage versus intermittent needle aspiration in the percutaneous treatment of pyogenic liver abscesses. Over a 5-year period, 64 consecutive patients with pyogenic liver abscess were treated with intravenous antibiotics (ampicillin, cefuroxime, and metronidazole) and randomized into two percutaneous treatment groups: continuous catheter drainage (with an 8F multi-sidehole pigtail catheter); and intermittent needle aspiration (18G disposable trocar needle). There was no statistically significant difference between the two groups regarding patient demographics, underlying coexisting disease, abscess size, abscess number, number of loculation of abscess, the presenting clinical symptoms such as fever, abdominal pain, and pretreatment liver function test. Although not statistically significant, the duration of intravenous antibiotics treatment before percutaneous treatment was longer with the catheter group, and the change of antibiotics after the sensitivity test was more frequent with the needle group. The needle group was associated with a higher treatment success rate, a shorter duration of hospital stay, and a lower mortality rate, although this did not reach statistical significance. In conclusion, this study suggests that intermittent needle aspiration is probably as effective as continuous catheter drainage for the treatment of pyogenic liver abscess, although further proof with a large-scale study is necessary. Due to the additional advantages of procedure simplicity, patient comfort, and reduced price, needle aspiration deserves to be considered as a first-line drainage approach.

Magnetic resonance colonography in the detection of colonic neoplasm in high-risk and average-risk individuals.

OBJECTIVES: Magnetic resonance colonography (MRC) is a new noninvasive diagnostic modality for colorectal cancer. However, the use of MRC in the detection of colorectal neoplasm in average-risk individuals remains unknown. This study determined the performance and the patient's preference of MRC in the detection of colorectal neoplasm. METHODS: Both high-risk (i.e., symptoms suggestive of colorectal neoplasm, positive fecal occult blood test, history of colorectal cancer in one or more first-degree relatives) and average-risk (i.e., asymptomatic individuals >50 yr) individuals were recruited. MRC was performed immediately prior to conventional colonoscopy (CC) by using air inflation without contrast. The finding on CC together with histology was used as a gold standard. Patients' pain and discomfort score were recorded immediately and 24 h after the procedure. They were also asked about their preferences for the two procedures. RESULTS: A total of 165 patients (79 average risk and 86 high risk) were recruited. Eight patients had incomplete MRC and one patient had failed CC. Of the remaining 156 patients, 4 were found to have colonic cancer and 31 were found to have 67 polyps. MRC correctly identified 3 cancers (sensitivity 75%, specificity 99.3%) and 4 patients with colonic polyps (sensitivity 12.9% and specificity 97.6%). Sensitivity of MRC tended to be lower in polyps <10 mm in size and in average-risk individuals. The mean procedure time of CC was significantly shorter than MRC (13.6 +/- 6.7 vs 20.6 +/- 2.7 min, p < 0.001). Although there was no significant difference in the pain and discomfort scores of the 2 procedures, 75% of patients preferred CC to MRC. CONCLUSIONS: The performance of MRC when used in the detection of colonic neoplasm in average-risk individuals is unsatisfactory.