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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Brookmeyer CE, Bhatt S, Fishman EK, Sheth S. Multimodality Imaging after Liver Transplant: Top 10 Important Complications. Radiographics 2022;42:702-21. Review/Other-Dx N/A This review is focused on the 10 "not to be missed" complications of liver transplant that affect the health and life of the graft and graft recipient. No results stated in abstract. 4
2. Starzl TE, Marchioro TL, Vonkaulla KN, Hermann G, Brittain RS, Waddell WR. Homotransplantation of the Liver in Humans. Surg Gynecol Obstet 1963;117:659-76. Review/Other-Dx N/A An ideal treatment for several kinds of liver disease would be removal of the diseased organ and orthotopic replacement with a hepatic homograft. No abstract available. 4
3. Kwong AJ, Kim WR, Lake JR, et al. OPTN/SRTR 2022 Annual Data Report: Liver. Am J Transplant 2024;24:S176-S265. Review/Other-Dx N/A Annual report on liver transplants. No results stated in abstract. 4
4. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=164+&releaseId=2. Review/Other-Dx N/A Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. No abstract available. 4
5. Chen S, Wang X, Zhang B, Liu B, Pan H. Meta-analysis of the diagnostic value of contrast-enhanced ultrasound for the detection of vascular complications after liver transplantation. Rev Esp Enferm Dig. 111(5):388-396, 2019 May. Meta-analysis 2,781 cases 13 studies Contrast-enhanced ultrasound (CEUS) is increasingly used to identify vascular complications in patients after liver transplantation. Materials and methods: relevant studies published before February 2018 were retrieved from PubMed, EMBASE, ScienceDirect and Web of Science. Pooled sensitivity and specificity, diagnostic odds ratio (DOR) and summary receiver operating characteristic curve (SROC) were calculated to estimate the diagnostic performance of CEUS for vascular complications. Sensitivity analysis was performed that stratified studies according to age, study design and sample size in order to determine the influence of these factors on the overall effect. Meta-regression analyses were performed to examine the possible sources of heterogeneity. Quality assessment and publication bias of the included studies were also evaluated. Results: thirteen studies which consisted of 2,781 CEUS cases were included in the analysis. The pooled weighted estimates of sensitivity and specificity were 0.90 (95% CI, 0.84 to 0.95) and 1.00 (95% CI, 1.00 to 1.00), the diagnostic odds ratio (DOR) was 431.96 (95% CI, 164.60 to 1,133.59) and the area under the curve (AUC) of SROC was 0.9741. According to the sensitivity analysis, age, study design and sample size had an insignificant influence on the diagnostic performance of CEUS. The meta-regression analyses did not reveal a strong correlation between CEUS accuracy and study design, treatment time of patients and experience of the radiologists. Conclusion: the results of our meta-analysis showed a high sensitivity, specificity and accuracy of the CEUS modality for the identification of vascular complications in patients after liver transplantation. Since this is the first meta-analysis investigating in this aspect, more evidence is required to validate the clinical utility of CEUS for the identification of vascular complications in patients with a transplanted liver. Good
6. Craig EV, Heller MT. Complications of liver transplant. [Review]. Abdom Radiol. 46(1):43-67, 2021 01. Review/Other-Dx N/A Article on compilations of liver transplants. No results stated in abstract. 4
7. Boraschi P, Donati F, Rossi M, Ghinolfi D, Filipponi F, Falaschi F. Role of MDCT in the detection of early abdominal complications after orthotopic liver transplantation. Clinical Imaging. 40(6):1200-1206, 2016 Nov - Dec.Clin Imaging. 40(6):1200-1206, 2016 Nov - Dec. Observational-Dx 170 patients To assess the role of multidetector computed tomography (MDCT) for detecting early abdominal complications after orthotopic liver transplantation. We retrospectively enrolled 170 subjects with clinical laboratory and/or echo-color Doppler abnormalities who underwent MDCT within the first 90 days after transplantation. All images were reviewed by two radiologists in conference and imaging results were correlated with digital subtraction angiography, conventional cholangiography, surgery, clinical laboratory, and/or imaging follow-up. No significant complication was found in 142 patients, while vascular complications (hepatic artery thrombosis, n=5 and stenosis, n=5; portal vein thrombosis, n=4; cava vein thrombosis, n=1; arterial bleeding, n=1), biliary complications (anastomotic leak with biloma, n=6), parenchymal complications (abscess, n=1; extended areas of impaired perfusion, n=3), adrenal hemorrhage (n=1), and bowel perforation (n=1) were identified in the remaining 28 cases. Four false-positive cases (three hepatic artery stenoses and one hepatic artery dissection) and one false-negative case (biloma) were diagnosed on MDCT. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of MDCT in the identification of various complications were 96%, 97%, 87%, 99%, and 97%, respectively. 3
8. Lee IS, Park SH, Choi SJ, et al. Diagnostic Performance of Multidetector Computerized Tomography in the Detection of Abdominal Complications Early and Late After Liver Transplantation: A 10-Year Experience. Transplant Proc. 50(10):3673-3680, 2018 Dec. Observational-Dx 75 patients To evaluate the diagnostic performance of MDCT for detecting abdominal complications in the early and late periods after LT. We retrospectively enrolled 75 patients who had undergone LT from March 2006 to January 2010, followed by MDCT from March 2006 to November 2017. Patients were divided into 2 groups according to the timing after LT: within the first 3 months (early period) or =3 months after LT (late period). We evaluated vascular, biliary, and other complications on MDCT. Angiography, endoscopic retrograde cholangiography, and percutaneous transhepatic cholangiography were used as reference standards. We initially found 77 complications in 45 patients (60.0%) with the use of MDCT. After comparison with the reference standards, 83 complications were diagnosed in 49 patients (65.3%). Forty-seven complications (34 vascular, 10 biliary, 3 other complications) were diagnosed in 33 patients (44.0%) during the early period, and 36 complications (6 vascular, 20 biliary, 10 other complications) were detected in 27 patients (36.0%) in the late period. The sensitivity, specificity, and diagnostic accuracy of MDCT for diagnosing overall complications were, respectively, 93.6%, 90.2%, and 92.0% in the early period (for vascular complications: 97.1%, 92.6%, and 94.3%,; for biliary complications: 80.0%, 100%, and 97.7%) and 77.8%, 98.1%, and 89.8% in the late period (for vascular complications: 83.3%, 100%, and 98.9%; for biliary complications: 65.0%, 98.6%, and 90.9%). 2
9. Kim JS, Kwon JH, Kim KW, et al. Low Graft Attenuation at Unenhanced CT: Association with 1-Month Mortality or Graft Failure after Liver Transplantation. Radiology. 287(1):167-175, 2018 04. Observational-Dx 663 recipients To investigate whether low graft attenuation at unenhanced computed tomography (CT) is associated with 1-month mortality or graft failure after liver transplant and determine its diagnostic performance. Of 663 recipients, 114 had IPF (80 primary; 34 secondary). After 1 month, 11 had graft failure or died, whereas 652 survived. Low graft attenuation was more common in patients with IPF than in normal-function patients (P < .001). In the primary group (those without identifiable cause), 15 patients had low graft attenuation, which led to mortality or graft failure within 1 month in seven of those patients. No recipient with high or isoattenuation had 1-month mortality or graft failure (P < .001). The secondary group (those with identifiable cause) showed no significant association between graft attenuation and 1-month mortality and graft failure (P = .181). Values of low graft attenuation for 1-month mortality and graft failure in primary IPF were positive predictive value, 46.7%; negative predictive value, 100%; sensitivity, 100%; specificity, 89.0%; and accuracy, 90.0%. There was excellent interobserver agreement in the assessment of graft attenuation (intraclass correlation coefficient, 0.957; ? = 1.00). 3
10. Boraschi P, Della Pina MC, Donati F. Graft complications following orthotopic liver transplantation: Role of non-invasive cross-sectional imaging techniques. [Review]. Eur J Radiol. 85(7):1271-83, 2016 Jul. Review/Other-Dx N/A Orthotopic liver transplantation is the treatment of choice in adult patients with endstage liver disease. No results stated in abstract. 4
11. Liao M, Guo H, Tong G, et al. Can ultrasonography differentiate anastomotic and non-anastomotic biliary strictures after orthotopic liver transplantation- a single-center experience. Eur J Radiol. 134:109416, 2021 Jan. Observational-Dx 1, 259 patients To evaluate the role of ultrasonography (US) in differentiating anastomotic biliary strictures (AS) and non-anastomotic biliary strictures (NAS) after orthotopic liver transplantation (OLT). This retrospective study included 1259 OLT recipients between 2005-2018. Seventy-six with anastomotic strictures (AS) and 103 with non-anastomotic strictures (NAS) were analyzed. The reference standard was cholangiography. The sensitivity, specificity, accuracy of US was evaluated. There were significant differences between AS and NAS groups (p < 0.001) for skipped and irregular dilatation of intrahepatic bile duct and visualization of hilar biliary lumen. The better US imaging feature for NAS was poorly visualized and non- visible hilar bile duct luminal contour. The sensitivity, specificity and accuracy were 94.2 %, 84.2 % and 88.9 % respectively. Combined two predictors greatly increased the specificity to 93.4 % while diminished its sensitivity and accuracy. 3
12. Maheshwari E, Tublin ME. Sonography of liver transplantation. [Review]. Abdom Radiol. 46(1):68-83, 2021 01. Review/Other-Dx N/A Orthotopic liver transplant (OLT) is established as the definitive treatment of choice for end stage liver disease. No results stated in abstract. 4
13. Bhargava P, Vaidya S, Dick AA, Dighe M. Imaging of orthotopic liver transplantation: self-assessment module. AJR Am J Roentgenol. 196(3 Suppl):S35-8, 2011 Mar. Review/Other-Dx N/A The educational objectives for this self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of imaging of orthotopic liver transplant recipients and to improve familiarity with the complications of orthotopic liver transplantation. No results stated in abstract. 4
14. Uzochukwu LN, Bluth EI, Smetherman DH, et al. Early postoperative hepatic sonography as a predictor of vascular and biliary complications in adult orthotopic liver transplant patients. AJR Am J Roentgenol 2005;185:1558-70. Review/Other-Dx 110 To quantitatively assess the value of early posttransplantation hepatic artery resistive indexes in predicting vascular and nonvascular complications in adult orthotopic liver transplant (OLT) patients. Even patients (6.4%) had vascular complications, including two (1.8%) hepatic artery and two (1.8%) hepatic vein stenoses, one (0.9%) hepatic vein thrombosis, two (1.8%) portal vein thromboses, and one (0.9%) thrombosis and two (1.8%) stenoses of the inferior vena cava (IVC). In 19 patients (17.3%), biliary complications included anastomotic strictures and leaks 1 week to 18 months after transplantation. In 11 patients (10%), sonographically large hematomas required surgical evacuation. In grafts with vascular complications or large hematomas, the mean early posttransplant main, right, and left indexes were significantly lower (< or = 0.6) than without these complications (p < 0.01). In grafts with and without biliary complications, mean early posttransplant main, right, and left indexes did not differ significantly. 4
15. Horrow MM, Blumenthal BM, Reich DJ, Manzarbeitia C. Sonographic diagnosis and outcome of hepatic artery thrombosis after orthotopic liver transplantation in adults. AJR Am J Roentgenol 2007;189:346-51. Review/Other-Dx 25 patients To determine the timing and frequency of symptomatic hepatic artery thrombosis in an adult orthotopic liver transplant population, the sensitivity of Doppler sonography for this diagnosis, and the clinical and sonography outcomes in this population. Of 522 transplants, 25 (4.8%) developed hepatic artery thrombosis that was primary in 18 (3.5%), with five early (1.0%) and 13 late (2.5%), and secondary in seven (1.3%). Sensitivities of sonography compared with angiography were 100% for detection of early hepatic artery thrombosis and 72.7% for late hepatic artery thrombosis. Seventeen patients (68%) with an episode of hepatic artery thrombosis are currently alive, 11 of whom have irreversible hepatic artery thrombosis; in 10 of the 11 cases, sonography showed that collateral arterial flow had developed. The mean survival was 51.4 months in the patients with irreversible hepatic artery thrombosis, eight of whom had documented biliary or septic complications (or both). 4
16. Girometti R, Pancot M, Como G, Zuiani C. Imaging of liver transplantation. [Review]. European Journal of Radiology. 93:295-307, 2017 Aug. Review/Other-Dx N/A Imaging modalities including ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) play a pivotal role in the selection of patients and donors, as well as in early detection of those complications at risk of impairing graft function and/or survival. No results stated in abstract. 4
17. Dodd GD, 3rd, Memel DS, Zajko AB, Baron RL, Santaguida LA. Hepatic artery stenosis and thrombosis in transplant recipients: Doppler diagnosis with resistive index and systolic acceleration time. Radiology 1994;192:657-61. Review/Other-Dx 125 To assess the value of resistive index (RI) and systolic acceleration time (SAT) for diagnosis of stenoses and thromboses of the hepatic artery in liver transplant recipients. Forty-seven patients had a marked stenosis; 16 had thrombosis. There was a statistically significant difference (P < .05) in the RI and SAT of patients with stenosis or thrombosis versus those with normal arteries but not in patients with stenosis versus thrombosis. RI and SAT parameters allowed detection of abnormalities not found with peak velocity and no-flow parameters. Combined parameters produced 97% sensitivity and 64% specificity for marked arterial disease. 4
18. Sureka B, Bansal K, Rajesh S, Mukund A, Pamecha V, Arora A. Imaging panorama in postoperative complications after liver transplantation. Gastroenterol Rep (Oxf) 2016;4:96-106. Review/Other-Dx N/A With the advancements in surgical, oncological and imaging techniques, orthotopic liver transplantation has become the first-line treatment for many patients with end-stage liver disease. No results stated in abstract. 4
19. Zhong J, Smith C, Walker P, Sheridan M, Guthrie A, Albazaz R. Imaging post liver transplantation part I: vascular complications. Clin Radiol 2020;75:845-53. Review/Other-Dx N/A Complications are increasingly uncommon but when they occur, early recognition and intervention is vital to save grafts. No results stated in abstract. 4
20. Chong WK, Beland JC, Weeks SM. Sonographic evaluation of venous obstruction in liver transplants. AJR Am J Roentgenol 2007;188:W515-21. Observational-Dx 94 liver transplant cases The purpose of our study was to identify specific Doppler criteria for portal vein and outflow vein (hepatic veins and inferior vena cava) obstruction in liver transplants. A retrospective review was performed of Doppler sonographic studies and angiograms in 94 liver transplant cases (72 whole liver, 22 lobar) with suspected vascular obstruction. The angiograms were classified as normal, occluded, or stenosed on the basis of appearance and elevated pressure gradient. Sonography was correlated with angiography. The following Doppler parameters were evaluated: for the portal vein, peak anastomotic velocity and anastomotic-to-preanastomotic velocity ratio; and for the outflow veins, venous pulsatility index. Receiver operating characteristic curves were constructed and optimum thresholds for stenosis were defined. There were 16 cases of portal vein obstruction (11 stenosis, five occlusion) and 35 cases of outflow vein obstruction (34 stenoses, one occlusion). Mean peak anastomotic velocity in normal portal veins was 58 cm/s, whereas mean peak anastomotic velocity in stenosed veins was 155 cm/s (p = 0.0007). Peak anastomotic velocity threshold of > 125 cm/s was 73% sensitive and 95% specific for stenosis. Mean anastomotic-to-preanastomotic velocity ratio in normal portal veins was 1.5, and mean anastomotic-to-preanastomotic velocity ratio in stenosed veins was 4.69 (p = 0.001). A 3:1 ratio was 73% sensitive and 100% specific for stenosis. Mean venous pulsatility index for normal outflow veins was 0.75, and mean venous pulsatility index in stenosed veins was 0.39. A venous pulsatility index of < 0.45 was 95.7% specific for stenosis. The areas under the receiver operating characteristic curve were 0.83 for peak anastomotic velocity, 0.86 for 3
21. McNaughton DA, Abu-Yousef MM. Doppler US of the liver made simple. Radiographics 2011;31:161-88. Review/Other-Dx N/A Doppler ultrasonography (US) is usually the first-line modality for evaluating flow in native liver vessels and transjugular intrahepatic portosystemic shunts (TIPS). No results stated in abstract. 4
22. Beswick DM, Miraglia R, Caruso S, et al. The role of ultrasound and magnetic resonance cholangiopancreatography for the diagnosis of biliary stricture after liver transplantation. Eur J Radiol 2012;81:2089-92. Observational-Dx 60 Patients To identify the diagnostic value of ultrasound (US) and magnetic resonance cholangiopancreatography (MRCP) in diagnosing biliary strictures after liver transplantation. By SOR, biliary dilatation was present in 55 patients, stricture in 53 (44 anastomotic, 4 intrahepatic, 5 both), and dilatation and/or stricture in 58. Dilatation was diagnosed by US and MRCP in 39 and 45, respectively (sensitivity 71% vs. 82%, p=0.18). Stricture was diagnosed by US and MRCP in 0 and 42, respectively (sensitivity 0% vs. 79%, p<0.0001). False positive stricture was diagnosed by MRCP in 2. Dilatation and/or stricture was diagnosed by US in 39 and MRCP in 50 (sensitivity 67% vs. 86%, p=0.01); however, using both techniques, sensitivity increased to 95%. 3
23. Memeo R, Ciacio O, Pittau G, et al. Systematic computer tomographic scans 7 days after liver transplantation surgery can lower rates of repeat-transplantation due to arterial complications. Transplant Proc. 46(10):3536-42, 2014 Dec. Review/Other-Dx 231 patients-first series 250 patients-second series To assess the clinical impact of systematic early postoperative injected computed tomographic (CT) scans after LT rather than its performance on demand in the event of abnormalities. During the first period, an injected CT scan was only performed in the event of clinical, biological, or ultrasound abnormalities revealed by tests performed daily during the first week after surgery. During the second period, in addition to standard follow-up examination, an injected CT scan was performed systematically at approximately postoperative day 7. During the first (versus the more recent) period, both recipients (whose ages were 46 ± 13 years versus 50 ± 12 years; P = .004) and donors (whose ages were 42 ± 17 versus 52 ± 17 years; P = .0001) were younger and end-stage liver disease was more common (34% versus 12%; P = .0001), but hepatocellular carcinoma (7% vs 26%; P = .0001) and retransplantation (2% versus 7%; P = .01) were less frequent. Postoperative mortality was higher during the first period (14% versus 4%; P = .0003). The incidence of early arterial thrombosis (<1 month) was similar (1.3% versus 1.6%; P = .78), but that of arterial stenosis was higher with a systematic CT scan (1.7 versus 4.4; P = .07). As a consequence of the early detection and treatment of arterial abnormalities, the repeat LT rate due to late arterial thrombosis was nil in the second period and 2.1% (5/231) in the first period. 4
24. Kim BS, Kim TK, Jung DJ, et al. Vascular complications after living related liver transplantation: evaluation with gadolinium-enhanced three-dimensional MR angiography. AJR Am J Roentgenol 2003;181:467-74. Observational-Dx 76 patients The purpose of this study was to evaluate the efficacy of gadolinium-enhanced three-dimensional (3D) MR angiography for detection of vascular complications in patients who have undergone living related liver transplantation. Seventy-six patients who underwent living related liver transplantation were evaluated with gadolinium-enhanced 3D MR angiography. All MR angiograms were assessed for patency of the hepatic artery and the portal vein using a four-point scale (grades I-IV). The results were correlated with conventional angiography (n = 23) and clinical follow-up with Doppler sonography (n = 53) for more than 6 months. Seventy-three of 76 MR angiography procedures were technically adequate. When grades III (focal narrowing [> 50%] at the anastomotic site) and IV (abrupt cutoff at the anastomotic site with nonvisualization of the right [or left] hepatic artery distal to the anastomosis) were regarded as the diagnostic criteria for hepatic artery stenosis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MR angiography were 100%, 74%, 29%, 100%, and 77%, respectively. In the portal vein, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MR angiography were 100%, 84%, 35%, 100%, and 85%, respectively, when grades III (narrowing [> 50%] without poststenotic dilatation) and IV (narrowing [> 50%] with poststenotic dilatation) were defined as criteria for portal vein stenosis. 3
25. Camacho JC, Coursey-Moreno C, Telleria JC, Aguirre DA, Torres WE, Mittal PK. Nonvascular post-liver transplantation complications: from US screening to cross-sectional and interventional imaging. [Review]. Radiographics. 35(1):87-104, 2015 Jan-Feb. Review/Other-Dx N/A Orthotopic liver transplantation is becoming an increasingly routine procedure for a variety of benign and malignant diseases of the liver and biliary system. No results stated in abstract. 4
26. Cannella R, Dasyam A, Miller FH, Borhani AA. Magnetic Resonance Imaging of Liver Transplant. [Review]. Magn Reson Imaging Clin N Am. 29(3):437-450, 2021 Aug. Review/Other-Dx N/A MR imaging increasingly has been adopted for follow-up imaging post-liver transplantation and for diagnosis of its complications. No results stated in abstract. 4
27. Cieszanowski A, Stadnik A, Lezak A, et al. Detection of active bile leak with Gd-EOB-DTPA enhanced MR cholangiography: comparison of 20-25 min delayed and 60-180 min delayed images. Eur J Radiol 2013;82:2176-82. Review/Other-Dx 34 patients The purpose of this study was to assess the value of contrast-enhanced magnetic resonance cholangiography (MRC) performed in different time delays after injection of gadoxetic acid disodium (Gd-EOB-DTPA) for the diagnosis of active bile leak. Gd-EOB-DTPA enhanced MRC yielded an overall sensitivity of 96.4%, specificity of 100% and accuracy of 97.1% for the diagnosis of an active bile leak. The sensitivity of 20-25 min delayed MR images was 42.9%, of combined 20-25 min and 60-90 min delayed images was 92.9% and of combined 20-25 min, 60-90 min and 150-180 min delayed images was 96.4%. 4
28. Kul M, Erden A, Dusunceli Atman E. Diagnostic value of Gd-EOB-DTPA-enhanced MR cholangiography in non-invasive detection of postoperative bile leakage. Br J Radiol 2017;90:20160847. Observational-Dx 28 patients To assess the diagnostic value of dynamic T1 weighted (T1w) gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA)-enhanced MR cholangiography (MRC) for the detection of active bile leaks. A total of 28 patients with suspected biliary leakage who underwent routine T2 weighted (T2w) MRC and T1w GD-EOB-DTPA-enhanced MRC at our institution from February 2013 to June 2016 were included in this study. The image sets were retrospectively analyzed in consensus by three radiologists. T1w Gd-EOB-DTPA-enhanced MRC findings were correlated with clinical data, follow-up examinations and findings of invasive/surgical procedures. Patients with positive bile leak findings in Gd-EOB-DTPA-enhanced MRC were divided into hepatobiliary phase (HBP) (20-30 min) and delayed phase (DP) (60-390 min) group according to elapsed time between Gd-EOB-DTPA injection and initial bile leak findings in MRC images. These groups were compared in terms of laboratory test results (total bilirubin, liver enzymes) and the presence of bile duct dilatation in T2w MRC images. In each patient, visualization of bile ducts was sufficient in the HBP. The accuracy, sensitivity and specificity of dynamic Gd-EOB-DTPA-enhanced T1w MRC in the detection of biliary leaks were 92.9%, 90.5% and 100%, respectively (p < 0.001). 19 of 28 patients had bile leak findings in T1w Gd-EOB-DTPA-enhanced MRC [HBP group: N = 7 (36.8%), DP group: N = 12 (63.2%)]. There was no statistically significant difference in terms of laboratory test results and the presence of bile duct dilatation between HBP and DP group (p > 0.05). Three patients, each of them in DP group, showed normal laboratory test results and bile duct diameters. 2
29. Boraschi P, Donati F, Pacciardi F, Ghinolfi D, Falaschi F. Biliary complications after liver transplantation: Assessment with MR cholangiopancreatography and MR imaging at 3T device. Eur J Radiol. 106:46-55, 2018 Sep. Observational-Dx 232 liver transplant subjects To assess the diagnostic value of MR cholangiopancreatography (MRCP) and MR imaging at 3?T device when evaluating biliary adverse events after liver transplantation. A series of 384 MR examinations in 232 liver transplant subjects with suspected biliary complications (impaired liver function tests and/or biliary abnormalities on ultrasound) were performed at 3?T device (GE-DISCOVERY MR750; GE Healthcare). After the acquisition of axial 3D dual-echo T1-weighted images and T2-weighted sequences (propeller and SS-FSE), MRCP was performed through coronal thin-slab 3D-FRFSE and coronal oblique thick-slab SSFSE T2w sequences. DW-MRI of the liver was performed using an axial spin-echo echo-planar sequence with multiple b values (150, 500, 1000, 1500?s/mm2) in all diffusion directions. Contrast-enhanced MRCP was performed in 25/232 patients. All MR images were blindly evaluated by two experienced abdominal radiologists in consensus to determine the presence of biliary complications, whose final diagnosis was based on direct cholangiography, surgery and integrating clinical follow-up with ultrasound and/or MRI findings. In 113 patients no biliary abnormality was observed. The remaining 119 subjects were affected by one or more of the following complications: non-anastomotic strictures including typical ischemic-type biliary lesions (n?=?67), anastomotic strictures (n?=?34), ampullary dysfunction (n?=?4), anastomotic leakage (n?=?4), stones, sludge and casts (n?=?65), vanishing bile duct (n?=?1). The sensitivity, specificity, PPV, NPV and diagnostic accuracy of the reviewers for the detection of all types of biliary complications were 99%, 96%, 95%, 99% and 97%, respectively. 4
30. Garg B, Rastogi R, Gupta S, Rastogi H, Garg H, Chowdhury V. Evaluation of biliary complications on magnetic resonance cholangiopancreatography and comparison with direct cholangiography after living-donor liver transplantation. Clin Radiol. 72(6):518.e9-518.e15, 2017 Jun. Observational-Dx 34 patients To evaluate the imaging characteristics of biliary complications following liver transplantation on magnetic resonance cholangiopancreatography (MRCP) and its diagnostic accuracy in comparison with direct cholangiography. In this prospective study, 34 patients being evaluated for possible biliary complications after living-donor liver transplantation (LDLT) with abnormal MRCP findings were followed up for information regarding direct cholangiography either endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) within 7 days of MRCP. Twenty-nine patients underwent ERCP and five patients underwent PTC. Compared to findings at direct cholangiography, MRCP presented 96.9% sensitivity, 96.9% positive predictive value, and 94.1% accuracy for the detection of biliary complications. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detection of anastomotic strictures, biliary leak, and biliary stone or sludge on MRCP was found to be 100%, 84.6%, 91.3%, 100% and 94.1%; 72.7%, 95.7%, 88.9%, 88% and 88.2%; 80%, 100%, 100%, 96.7% and 97.1%, respectively. 3
31. Katz LH, Benjaminov O, Belinki A, et al. Magnetic resonance cholangiopancreatography for the accurate diagnosis of biliary complications after liver transplantation: comparison with endoscopic retrograde cholangiography and percutaneous transhepatic cholangiography - long-term follow-up. Clin Transplant. 24(5):E163-9, 2010 Sep-Oct. Observational-Dx 27 patients The aim of this study was to evaluate MRCP in detecting biliary complications following liver transplantation and comparing findings with ERCP and PTC. wenty-seven consecutive liver transplant recipients who presented with clinical and biochemical, ultrasonographic, or histological evidence of biliary complications were evaluated with MRCP. Patients were followed up for a median period of 36 months. The presence of a biliary complication was confirmed in 18 patients (66.6%): anastomotic biliary stricture in 12 (66.6%); diffuse intrahepatic biliary stricture in 5 (27.7%): ischemic (n = 3), recurrence of primary sclerosing cholangitis (n = 2), and choledocholithiasis in one. In nine patients (33.3%), MRCP was normal. Six patients underwent ERCP, and eight PTC. There was a statistically significant correlation between the MRCP and both ERCP and PTC (p = 0.01) findings. The sensitivity and specificity of the MRCP were 94.4% and 88.9%, respectively, and the positive and negative predictive values, 94.4% and 89.9%, respectively. MRCP is an accurate imaging tool for the assessment of biliary complications after liver transplantation. 4
32. Singal AG, Llovet JM, Yarchoan M, et al. AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology 2023;78:1922-65. Review/Other-Dx N/A Practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. No results stated in abstract. 4
33. Clavien PA, Lesurtel M, Bossuyt PM, et al. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol 2012;13:e11-22. Review/Other-Dx N/A To review current practice regarding liver transplantation in patients with HCC and to develop internationally accepted statements and guidelines. No results stated in abstract. 4
34. Samanci C, Sobhani F, Ucbilek E, et al. Magnetic Resonance Imaging in Diagnosis and Monitoring of Hepatocellular Carcinoma in Liver Transplantation: A Comprehensive Review. [Review]. Annals of Transplantation. 21:68-76, 2016 Feb 02. Review/Other-Dx N/A If a suspicious lesion is detected on US exam, computerized tomography (CT) or magnetic resonance imaging (MRI) can be used to further evaluate this lesion. No results stated in abstract. 4
35. Bowlus CL, Lim JK, Lindor KD. AGA Clinical Practice Update on Surveillance for Hepatobiliary Cancers in Patients With Primary Sclerosing Cholangitis: Expert Review. [Review]. Clinical Gastroenterology & Hepatology. 17(12):2416-2422, 2019 11.Clin Gastroenterol Hepatol. 17(12):2416-2422, 2019 11. Review/Other-Dx N/A To define key principles in the surveillance of hepatobiliary cancers including cholangiocarcinoma, gallbladder adenocarcinoma, and hepatocellular carcinoma in patients with primary sclerosing cholangitis (PSC). No results stated in abstract. 4
36. Liu D, Chan AC, Fong DY, Lo CM, Khong PL. Evidence-Based Surveillance Imaging Schedule After Liver Transplantation for Hepatocellular Carcinoma Recurrence. Transplantation. 101(1):107-111, 2017 Jan. Review/Other-Dx 125 patients To evaluate and develop evidence-based alternate surveillance imaging schedules for post-LT hepatocellular carcinoma patients. One hundred twenty-five patients (108 men; 59.4 ± 16.6 years) underwent 1953 computed tomography and 255 magnetic resonance imaging scans. Recurrence-free survival time was not significantly different in the first 5 years after LT when the imaging interval was extended from current every 3 months to every 6 months (P = 0.786, EpD = 55 days). This alternative schedule incurred 10 (50.0%) fewer surveillance scans than the 20 in the original schedule, and a corresponding reduction in radiation dose (if involved) and cost during the 5-year follow-up period. 4
37. American College of Radiology. Liver Imaging Reporting and Data System (LI-RADS).  Available at: http://www.acr.org/quality-safety/resources/LIRADS. Review/Other-Dx N/A LI-RADS® was created to standardize the reporting and data collection of CT and MR imaging for hepatocellular carcinoma (HCC) No abstract available. 4
38. Measuring Sex, Gender Identity, and Sexual Orientation. Review/Other-Dx N/A Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. No abstract available. 4
39. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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