Quantitative analysis of hepatic functional biomarker and biliary morphology using MRI techniques — clinical application in patients with biliary atresia and living-related liver donors
Date Issued
2011
Date
2011
Author(s)
Mo, Yuan-Heng
Abstract
Biliary atresia (BA) is a congenital and progressively obliterative cholangiopathy of unknown etiology. The prevalence rate was about 3.7 in 10000 live births in Taiwan, much higher than western country (about 0.4 to 0.8 in 10000 live births). It is a major and severe cause of obstructive jaundice, also the leading indication for liver transplantation in pediatric population. After a Japanese surgeon, Kasai, reported a portoenterostomy operation for treatment, the long term survival rate has improved greatly. Earlier diagnosis and earlier operation improve the long term survival of biliary atresia. Progressive liver cirrhosis may persist in some patients even after successful operation. Long term complications include retrograde cholangitis, and portal hypertension including esophageal variceal bleeding, ascites and hypersplenism.
Up to date, liver biopsy is still the golden standard of assessing the stages of cirrhosis. However, it has potential risk and is prone to regional sampling variability and error. Magnetic resonance imaging (MRI), a noninvasive imaging modality, was suggested to monitor progression of hepatitis-related cirrhosis periodically to assess the severity of liver cirrhosis. Several previous studies have shown a decrease in hepatic apparent diffusion coefficient (ADC) obtained from diffusion weighted image in patients with hepatitis-related liver cirrhosis compared with healthy control subjects. Incorporation of albumin and alanine transaminase into the ADC-related noninvasive indices may correlate with liver function further. MRI also plays an important role in the preoperative evaluation of the living related liver donors to reduce postoperative morbidity and complications. Though invasive, intraoperative cholangiography is still the golden standard in demonstrating anatomical variation of bile ducts.
Firstly, we evaluated the validity of less-invasive quantitative imaging parameters for predicting the presence of clinically significant esophageal varices in BA patients. In addition, the values of hepatic ADC and ADC-related indices were applied to BA patients and correlated with cirrhotic severity scores of Child-Turcotte (CT) or Child-Pugh (CP) systems, and pediatric end-stage liver disease (PELD) or model of end-stage liver disease (MELD). We also design a serial studies to compare the difference between magnetic resonance cholangiopancreatography (MRCP) and intraoperative cholangiography, and to investigate the effectiveness of the combined use of intravenous morphine and intramuscular glucagon in improving MRCP image quality in donors for living-related liver transplantation.
Our results may draw conclusions including: (1) less-invasive quantitative imaging parameters can predict the presence of clinically significant esophageal varices in BA patients; (2) the values of hepatic ADC and ADC-related indices can predict the cirrhotic severity of BA patients and negatively correlated with clinical cirrhotic severity score systems; (3) MRCP is comparable to intraoperative cholangiography in clinical usage; (4) combined usage of morphine and glucagon can improve MRCP image quality in donors for living-related liver transplantation.
Subjects
biliary atresia
magnetic resonance imaging
liver fibrosis/cirrhosis
diffusion weighted image
apparent diffusion coefficient
magnetic resonance cholangiopancreatography
cholangiography
SDGs
Type
thesis
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