Impact of Magnetic Resonance Cholangiography (MRC) in Liver-transplanted Patients’ Management: Preliminary Results of a Clinical Decision-making Study.

PURPOSE To assess the impact of MRC on the clinical decision-making process of referring physicians in the setting of liver-transplanted patients. MATERIAL AND METHODS Over a six-months period, 21 liver-transplanted patients with suspected biliary complications were addressed to MRC. Referring physicians were asked to prospectively state, before and after the examination: the leading diagnosis; the degree of clinical confidence on it (on a 0-100% scale); the most proper diagnostic/therapeutic planning. Data analysis assessed: (i) the diagnostic yield and accuracy of MRC; (ii) the rate of change in leading diagnosis; (iii) the diagnostic thinking efficacy as the gain in diagnostic confidence; (iv) the therapeutic efficacy as the proportion of change in initial diagnostic/therapeutic planning. RESULTS MRC diagnostic yield and accuracy resulted of 85.7% and 92.3%, respectively. MRC results determined a rate of change in leading diagnosis of 19.0%, and a diagnostic thinking efficacy of 18.8% and 78.7% for concordant and discordant leading diagnoses, respectively (p<0.01;u-Mann-Whitney test), as long with a therapeutic efficacy of 42.8%. Among the nine patients in whom MRC altered the initial diagnostic/therapeutic planning, 7 were addressed to proper treatment. Overtreatment (unnecessary Endoscopic Retrograde Cholangiography) was induced in the 2 remaining false-positive cases. Therefore, 33.3% of patients clearly benefit from MRC. CONCLUSION In the clinical setting of liver-transplanted patients, MRC shows high diagnostic yield, due to the prevalence of disease and the well-established diagnostic accuracy. MRC significantly increases the diagnostic confidence of referring physicians, irrespectively to the concordance between the pre- and post-test diagnosis. Moreover, MRC leads to a change in patients’ management that is effective at least in about one-third of patients. CLINICAL RELEVANCE/APPLICATION MRC is not only reliable as a diagnostic tool, but it is effective on clinical decision-making process, increasing the diagnostic confidence of referring physicians and frequently leading to an effective change in patients’ management.