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Although unenhanced CT quantifies the degree of macrovesicular steatosis relatively well, it may preclude a liver biopsy only in a small percentage of potential donors with low LAI (unacceptable degree of steatosis). Core liver biopsy is still necessary in the majority of donors with normal LAI to identify those with both fatty liver and coexistent hemosiderin deposition or radiologically occult diffuse liver diseases.

Histologic evidence directly validates RF ablation as an effective treatment of small (<3 cm) HCC.

Purpose:To assess the utility of magnetic resonance cholangiopancreatography (MRCP) in preoperative mapping of biliary anatomy in adult-to-adult living related liver transplant (LRLT) donors. Materials and Methods:From 57 potential donors with preoperative MRCP, 27 cases (16 men, 11 women, age range 22-51 years, mean 37.2 years) underwent right lobe resection and had intraoperative cholangiography (IOC) for comparison. The MRCP and IOC reports were retrospectively reviewed in all 27 cases. The MRCP was performed on 1.5 Tesla MR magnets using breath-hold heavily T2-weighted sequences in axial/coronal thin sections, and variable-thickness rotating slabs. The accuracy of preoperative MRCP for biliary mapping in potential LRLT donors was analyzed compared to the IOC findings.Results: Of 27 donors, 26 (96.3%) had MRCP which showed adequate information of central intrahepatic biliary anatomy. Of these, 19 had normal bifurcation confirmed by IOC, and single biliary anastomosis was created in the recipient at transplantation. MRCP correctly predicted 17 of 19 normal cases (sensitivity for normals: 89.5%). In seven donors with variant biliary anatomy, two separate biliary anastomoses were performed in the recipient. MRCP correctly predicted five of seven variants (sensitivity for variants: 71.4%). Overall, MRCP had an accuracy 84.6% (22/26).Conclusions: MRCP has potential in the preoperative assessment of nondilated bile ducts in LRLT donors, however further improvements are desired to increase its quality and accuracy. ADULT-TO-ADULT living related liver transplantation (LRLT) using right hepatic lobe donation is widely accepted as an alternative life-saving treatment for patients with end-stage liver diseases. However, careful donor selection is essential to maximize the success and minimize the risk of postoperative complications in donors and recipients. Preoperative mapping of biliary anatomy is one of the critical assessments for donor selection and surgical planning. The variants of biliary anatomy are well recognized and reported in the literature (1-5), and they may require different surgical approaches. Based on Huang et al (1) (Fig. 1), normal bifurcation of the donor liver requires only a single biliary reconstruction (choledochocholedochostomy or choledochojejunostomy) in the recipient. Other donor livers with aberrant drainage of the right ductal system, such as trifurcation and right posterior duct draining into left main duct, require two separate biliary anastomoses in order to prevent postoperative biliary leakage and long-term segmental atrophy in recipients.Although endoscopic retrograde cholangiopancreatography (ERCP) is well accepted as a gold standard for evaluation of biliary anatomy, it poses substantial risks (5.5% risk of pancreatitis, 3-5% risk of perforation) (6) in otherwise healthy donors. Recently, MRCP has emerged as a non-invasive alternative imaging examination for evaluation of the biliary system and is performed with increasing frequency (7-10). This study is designed to assess the ut...

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