Image evaluation of the vascular architecture is essential before living donor liver transplantation (LDLT). However, the use of contrast-enhanced study in recipients with impaired renal function is limited due to the risk of acute kidney injury and nephrogenic systemic fibrosis. Therefore, a contrast medium-free method is both valuable and necessary for preoperative vascular evaluation. Recent literature reported inflow-sensitive inversion recovery (IFIR) magnetic resonance angiography (MRA) without the use of a contrast medium to be a reproducible and noninvasive tool to assess hepatic vasculature with adequate-to-good image quality. The purpose of this study is to clinically apply IFIR MRA preoperatively in LDLT recipients. We retrospectively reviewed 31 LDLT recipients with renal function impairment from March 2013 to August 2018 who received IFIR MRA as a pretransplant vascular architecture evaluation and who underwent a subsequent LDLT. The image findings were assessed for subjective image quality and were compared with intraoperative findings. Our results showed that the pretransplant vascular anatomy was well correlated with intraoperative findings in all recipients. Successful ratings with image quality scores ≥2 for proper hepatic arteries (PHAs), portal veins, and inferior vena cavas (IVCs) were 100.0%, 96.8%, and 93.5%, respectively. Readable ratings with imaging quality score ≥1 for left and right hepatic arteries and gastroepiploic arteries were 83.9%, 96.7%, and 22.6%, respectively. We also found that recipients with higher Model for End-Stage Liver Disease scores (>23) had lower image quality scores for PHAs (P = 0.003) and IVCs (P = 0.046). However, images were still satisfactory for pre-liver transplantation (LT) vascular evaluation. In conclusion, in pre-LT recipients with impaired renal function, IFIR MRA is a feasible and reproducible image modality.Liver Transplantation 26 196-202 2020 AASLD.

Arteriovenous fistula between common iliac vessels is uncommon. Most of the reported cases are secondary to lumbar disc surgery. 1 Mycotic aneurysm of iliac vessels caused by bacterial infection is even rarer. We describe the case of a 63 year old man with dyspnea, abdominal pain, bipedal edema, chills and fever. He had a right common iliac AVF as a result of a ruptured salmonella mycotic aneurysm, and the diagnosis was made by vascular duplex color scan. CASE REPORTA 63 year old man came to our hospital with chief complaints of having had intermittent fever, chills, abdominal pain, exertional dyspnea, and bipedal edema for 1 month. He had history of alcohol abuse but no history of abdominal trauma or surgical operation. On admission, physical examination revealed an ill-appearing man with normal state of consciousness. His body temperature was 38.3°C. His blood pressure was 124/50 mm Hg, and his pulse was 100 beats/min, regular and bounding. Respirations were 28 per min, rapid and shallow. His skin was warm, with no cyanosis. Jugular venous pressure at a 45 degree sitting position was 15 cm with large V wave and Y descent. Cardiac examination revealed a pansystolic murmur at the left lower sternal border. A continuous bruit and thrill were noted at the lower abdominal area. Bipedal pitting edema was present, and the peripheral pulses were bounding. Laboratory data showed a white blood cell count of 14.6 × 103/liter with shift to the left and a hemoglobin content of 10.1 g/dl. The prothrombin time was 16.5 s and the International Normalized Ratio was 1.6. The blood urea nitrogen level was 40 mg/dl and creatinine concentration was 1.7 mg/dl. The results for the remaining serum chemistry tests were unremarkable. Electrocardiogram revealed sinus tachycardia; chest radiography showed mild cardiomegaly. Salmonella choleraesuis was isolated on blood culture. Two-dimensional echocardiography revealed a normal left ventricular chamber size and contractility. Severe tricuspid and moderate mitral regurgitation were present. Abdominal vascular sonography showed an aneurysm  1998 by the American Institute of Ultrasound in Medicine • J Ultrasound

Background: Since the advent of a new generation of inflow-sensitive inversion recovery (IFIR) technology, three-dimensional non-contrast-enhanced magnetic resonance angiography is being used to obtain hepatic vessel images without applying gadolinium contrast agent. The purpose of this study was to explore the diagnostic efficacy of non-contrast-enhanced magnetic resonance angiography (non-CE MRA), contrast-enhanced magnetic resonance angiography (CMRA), and computed tomography angiography (CTA) in the preoperative evaluation of living liver donors. Methods: A total of 43 liver donor candidates who were evaluated for living donor liver transplantation completed examinations. Donors’ age, gender, renal function (eGFR), and previous CTA and imaging were recorded before non-CE MRA and CMRA. CTA images were used as the standard. Results: Five different classifications of hepatic artery patterns (types I, III, V, VI, VIII) and three different classifications of portal vein patterns (types I, II, and III) were identified among 43 candidates. The pretransplant vascular anatomy was well identified using combined non-CE MRA and CMRA of hepatic arteries (100%), PVs (98%), and hepatic veins (100%) compared with CTA images. Non-CE MRA images had significantly stronger contrast signal intensity of portal veins (p < 0.01) and hepatic veins (p < 0.01) than CMRA. No differences were found in signal intensity of the hepatic artery between non-CE MRA and CMRA. Conclusion: Combined non-CE MRA and CMRA demonstrate comparable diagnostic ability to CTA and provide enhanced biliary anatomy information that assures optimum donor safety.