“All‐in‐one” imaging protocols for the evaluation of potential living liver donors: Comparison of magnetic resonance imaging and multidetector computed tomography

Abstract

In order to compare the performance of "all-in-one" magnetic resonance imaging (MRI) and "all-in-one" multidetector computed tomography (MDCT) in the preharvest evaluation 25 potential living donors underwent both MRI and MDCT. MRI was performed on a high-performance 1.5-T scanner, computed tomography (CT) on a 4-row multidetector-scanner. Both scan protocols included angiography of the arterial and venous hepatic systems. CT additionally included infusion of a biliary contrast agent. Data analysis was performed by 4 reviewers, based on source images, multiplanar reformats, and three-dimensional ( L iving donor liver transplantation has evolved into a widely accepted therapeutic option to alleviate the persistent shortage of cadaveric liver transplants. [1][2][3] This innovative procedure allows healthy adults to donate a portion of their liver to compatible recipients suffering from end-stage liver disease. [4][5][6][7] Besides of augmenting the transplant organ pool, living donor liver transplantation involves the advantage of performing an elective operation, access to a graft in best condition, and lowering the likelihood of recipient death while waiting for a suitable organ. 8 In combination with improved surgical technique and highly developed immunosuppression, 9 this results in recipient survival rates as good as those obtained after conventional liver transplantation with full-sized deceased donor organs. 10 The critical issue of this procedure is the risk to the donors, who were healthy until the transplantation; this risk is now estimated to be 0.5% mortality and 21% postoperative morbidity. 1,11,12 To reduce such risk to a minimum, and also to avoid donor-recipient mismatch, the potential donors have to undergo an extensive stepwise evaluation process before being admitted to donation. Special attention is hereby paid to the determination of the liver volumes 13-17 and the recognition of vascular anomalies. [18][19][20] In fact, a majority of the candidates is eliminated mostly due to unfavorable hepatic parenchymal, biliary, or vascular morphology.In the recent past, this preharvest assessment

Expectations from imaging for pre-transplant evaluation of living donor liver transplantation

“…Both arterial-phase CT and MRI have a diagnostic accuracy comparable to that of catheter angiography and intra-operative finding [13,25,26] . However, Schroeder et al [4] found CT to be more accurate in detecting variations in vascular anatomy. This is probably related to the inherently superior spatial resolution of CT compared to MR. Hepatic artery thrombosis (HAT) is one of the most dreaded complications of LT and can be drastically decreased by excluding grafts with unfavorable anatomy [27] .…”

“…Resection of a portion of the liver from a donor is an immense personal and surgical under-taking; hence a detailed knowledge of the vascular and biliary anatomy and the presence of variants are imperative to ensure safe and successful harvesting of the graft and transplantation [3] . The risk to the donor from LDLT is estimated to be 0.5% mortality and up to 21% post-operative morbidity [4] . In the past, semi-invasive techniques such as catheter angiography and endoscopic retrograde cholangiopancreatography were used to delineate vascular and biliary anatomy respectively.…”

Double contrast percutaneous transhepatic cholangiographic CT in patients with obstructive jaundice: an initial experience of 7 cases.

“…The normal-sized biliary tract can be adequately depicted during 3D spiral CT cholangiography, facilitating the detection of biliary variations that might increase the risk of duct injury during cholecystectomy, particularly laparoscopic cholecystectomy (12 (20), in other respects the two modalities were considered equivalent for the therapeutic planning (21).…”

Biliary anatomy on 3D MRCP: Comparison of volume‐rendering and maximum‐intensity‐projection algorithms

“…Two noninvasive imaging techniques to evaluate biliary anatomies are currently in widespread use: magnetic resonance cholangiopancreatography (MRCP) and computed tomographic (CT) cholangiography (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). With regard to CT cholangiography, high spatial resolution 3D biliary images have recently been obtained using intravenous or oral cholangiographic contrast material thanks to the development of multidetector CT (4 -9).…”

“…Volume-rendering (VR) reformation has been successfully applied to evaluate 3D biliary anatomies (4,5,7,9). However, CT cholangiography has some possible disadvantages: the necessity for radiation exposure, possibility of adverse reaction caused by ionic iodine contrast medium, and a lack of suitability for patients with hyperbilirubinemia (6).…”