Magnetic resonance angiography of portal collateral pathways after hepaticportoenterostomy in biliary atresia: Comparisons with endoscopic findings

Background/Purpose: This study was undertaken to assess the usefulness of m agnetic resonance angiography (MRA) in detecting varices and to investigate the possibility of avoiding routine endoscopy after surgery for biliary at resia (BA). Methods: The subjects are 21 patients who have undergone periodical MRA sin ce 1996. The esophageal and gastric vessels were investigated as the sites of potential development of collateral vessels. The collateral vessels on M RA were compared with endoscopic findings. Results: (1) Detection of collateral vessels: of 21 patients examined, 9 pa tients had 12 varices. MRA depicted collateral vessels in all of the 12 var ices (sensitivity, 100%). However, all MRA findings, but one was compatible with endoscopic findings (specificity, 92.9%). Outside of a series of thes e 21 patients, there were 3 additional patients who had undergone endoscopi c treatments previously with success, and in whom esophageal vessels were n ot depicted on MRA, but endoscopy showed remnant varices. (2) Time-dependen t relationship between the appearance of collateral vessels and varices: of 4 varices that appeared after the start of MRA, 3 esophageal varices were found endoscopically simultaneously with or after delineation of collateral vessels on MRA, In the remaining patient, varices were found enodscopicall y 6 months before the MRA delineation, because a simultaneous MRA was not p erformed in this case, All these varices were in the early stage. Conclusions: MRA was highly sensitive and specific in detecting esophagogas tric collateral vessels of the portal venous system. An endoscopic examinat ion is unnecessary until collateral vessels are seen on MRA after surgery f or BA. Copyright (C) 2001 by W.B. Saunders Company.