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E1342. Cone-Beam Computed Tomographic Cholangiography and Interventions in Pediatric Liver Transplant Recipients
Authors
  1. Andrew Woerner; University of Washington Medical Center
  2. David Shin; University of Washington Medical Center
  3. Jeffrey Chick; Seattle Children's Hospital; University of Washington Medical Center
  4. Eric Monroe; Seattle Children's Hospital; University of Washington Medical Center
Background
Orthotopic liver transplantation (OLT) is the treatment for patients with end-stage or acute, fulminant liver failure. In children, there is greater utilization of a variety of transplantation methods, including split liver transplantation. While these methods increase the available donor organs, there are higher rates of biliary complications, including biloma, anastomotic stricture, ischemic cholangiopathy, and stone disease. Interventional Radiology plays a key role in the management of these complications. Specifically, percutaneous transhepatic cholangiography and intervention are commonly performed over endoscopy due to small patient size and the presence of biliary-enteric anastomosis prohibiting the latter. Throughout pediatric Interventional Radiology, there is increasing use of cone-beam computed tomography (CBCT) for procedural guidance. With CBCT, a two dimensional flat panel detector requires one rotation around a fixed point in order to generate a three dimensional volumetric dataset. Advantages for incorporating this modality include reduction of procedure time and radiation dose, delineation of complex three dimensional anatomy, and ability to perform navigational guidance for subsequent fluoroscopic intervention as well as seamless integration into the procedural workflow.

Educational Goals / Teaching Points
The goal of this exhibit is to review biliary complications following pediatric OLT, describe CBCT cholangiography technique, and highlight its applications via a case-based presentation.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The use of cone-beam computed tomography cholangiography for intra-procedural evaluation of complex biliary anatomy following pediatric liver transplantation.

Conclusion
The addition of cone-beam computed tomography cholangiography may increase technical success and procedural efficiency in complex pediatric OLT biliary interventions.