MRI in donor candidates for living donor liver transplant: Technical and practical considerations

Kim, Bohyun; Kim, So Yeon; Kim, Kyung Won; Jang, Hye Young; Jang, Jong Keon; Song, Gi Won; Lee, Sung Gyu

doi:10.1002/jmri.26257

Cited by 19 publications

(13 citation statements)

References 91 publications

(230 reference statements)

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“…(14) A 3-dimensional vascular reconstruction was routinely performed for all donors before the operation to obtain more information regarding any vascular variations. (15,16) In our institute, the hepatic vein was defined, based on the Nakamura classification, as the direct import type, upper branch type, or indirect import type, according to whether it could be anatomically separated extrahepatically. For the direct import type or the upper branch type, the LHV or the upper branch of the LHV was isolated extrahepatically.…”

Section: Discussionmentioning

confidence: 99%

Left Hepatic Vein Preferential Approach Based on Anatomy Is Safe and Feasible for Laparoscopic Living Donor Left Lateral Sectionectomy

Lu¹,

Wang²,

Zhu³

et al. 2020

Liver Transpl.

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We assess the safety and feasibility of the left hepatic vein preferential approach (LHVPA) based on left hepatic vein (LHV) anatomy for living donor laparoscopic left lateral sectionectomy (LLLS). Data from 50 donors who underwent LLLS in Huashan Hospital from October 2016 to November 2019 were analyzed retrospectively. On the basis of the classification of the LHV anatomy, the vein was defined as the direct import type, upper branch type, or indirect import type. A subgroup analysis was performed to compare the outcomes between the LHVPA and non-LHVPA groups. All 50 patients underwent pure LLLS. The mean operative duration was 157.5 ± 29.7 minutes. The intraoperative blood loss was 160.4 ± 97.5 mL. No complications more severe than grade 3 occurred. LHVPA was applied in 13 patients, whereas non-LHVPA was applied in 10 patients with the direct import type and upper branch type anatomy. The operative duration was shorter in the LHVPA group than the non-LHVPA group (142.7 ± 22.0 versus 173.0 ± 22.8 minutes; P = 0.01). Intraoperative blood loss was reduced in the LHVPA group compared with the non-LHVPA group (116.2 ± 45.6 versus 170.0 ± 63.3 mL; P = 0.02). The length of the LHV reserved extrahepatically in the LHVPA group was longer than in the non-LHVPA group (4.3 ± 0.2 versus 3.3 ± 0.3 mm; P = 0.01). Fewer reconstructions of the LHV in the direct import type anatomy were required for the LHVPA group than for the non-LHVPA group (0/8 versus 4/6). LHVPA based on the LHV anatomy is recommended in LLLS because it can further increase the safety and the efficiency of surgery for suitable donors.

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Section: Discussionmentioning

confidence: 99%

Left Hepatic Vein Preferential Approach Based on Anatomy Is Safe and Feasible for Laparoscopic Living Donor Left Lateral Sectionectomy

Lu¹,

Wang²,

Zhu³

et al. 2020

Liver Transpl.

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“…Complex-based CSE MRI was first approved by the U.S. Food and Drug Administration in 2011 and is now available from all major MRI vendors for the purpose of tissue fat quantification (81), leading to widespread availability. Importantly, MRI PDFF is increasingly accepted as the most optimal method, among the invasive or noninvasive methods, for quantifying liver fat content-even overperforming biopsy (22,57,78,82). Indeed, the ability to interrogate the entire liver avoids sampling limitations of biopsy and also MRS.…”

Section: Mri Examinationsmentioning

confidence: 99%

“…Given the subjective nature of semiquantitative evaluation of biopsy samples, which has high intra-and interobserver variability, the heterogeneous character of steatosis (Fig 9), and sampling limitations of biopsy and MRS, CSE MRI has the best combination of accuracy, precision, and reproducibility for quantification of PDFF as a biomarker of steatosis (20,22,38,78,82).…”

Section: Cse Mrimentioning

confidence: 99%

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Quantification of Liver Fat Content with CT and MRI: State of the Art

et al. 2021

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A bnormal accumulation of liver fat, or hepatic steatosis, is a pathologic condition that is increasing in prevalence, progressive in nature, and associated with hepatic and extrahepatic complications. Development of quantitative imaging methods over the past 2 decades has produced accurate, precise, and reproducible methods to assess the severity of hepatic steatosis. Herein, we review state-of-theart liver fat quantification using CT and MRI, including advantages and limitations, followed by a guide for their use in clinical practice. Burden of Hepatic Steatosis and Nonalcoholic Fatty Liver DiseaseIn hepatic steatosis, several lipid metabolites can accumulate in the liver, including triglycerides (the majority), free fatty acids, and cholesterol (1,2). In the absence of specific causes (eg, alcohol abuse, steatogenic medications, or viral infection), the term nonalcoholic fatty liver disease (NAFLD) is used (3). NAFLD is the most common chronic liver disease (4), with an estimated pooled overall global prevalence of 25%, as diagnosed with imaging (US and/or CT) (4). Areas most affected include the Middle East (32%), South and North America (30% and 24%, respectively), and Asia (27%) (4).NAFLD can occur at an early age (5) and may result in fibrosis or cirrhosis in childhood or early adulthood (5,6). The pooled mean prevalence of pediatric NAFLD is estimated to be 8% in the general population and 34% in children seen at obesity clinics (6). As for the early onset of NAFLD, additional considerations including race, ethnicity (7), and genetically inherited metabolic disorders should be considered (3,7,8). Pediatric NAFLD, however, remains generally underdiagnosed because of lack of awareness.NAFLD represents a spectrum of disease, with the majority at one end with only "isolated" hepatic steatosis or nonalcoholic fatty liver (3). A fraction of patients with NAFLD, estimated at 20% (projected to be 27% in 2030), will develop hepatocyte injury and inflammation, representing a more aggressive subset known as nonalcoholic steatohepatitis (NASH). We note that an Hepatic steatosis is defined as pathologically elevated liver fat content and has many underlying causes. Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, with an increasing prevalence among adults and children. Abnormal liver fat accumulation has serious consequences, including cirrhosis, liver failure, and hepatocellular carcinoma. In addition, hepatic steatosis is increasingly recognized as an independent risk factor for the metabolic syndrome, type 2 diabetes, and, most important, cardiovascular mortality. During the past 2 decades, noninvasive imaging-based methods for the evaluation of hepatic steatosis have been developed and disseminated. Chemical shift-encoded MRI is now established as the most accurate and precise method for liver fat quantification. CT is important for the detection and quantification of incidental steatosis and may play an increasingly prominent role in risk stratification, particularly wi...

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“…Further, using quantitative biomarkers clinical diagnosis and decisions can be made using cutoff values to classify the presence, absence or severity of disease (eg hepatic steatosis) [54]. Due to the high accuracy and precision, easy postprocessing, time effectivness and wide availability, MRI-PDFF is increasingly recognized as the best method for the detection and accurate quantification of liver fat [55,[93][94][95] (Fig. 8, Table 1).…”

Section: Mri-pdff In Clinical Usementioning

confidence: 99%

Liver fat quantification: where do we stand?

Starekova

Reeder

2020

Abdom Radiol

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Excessive intracellular accumulation of triglycerides in the liver, or hepatic steatosis, is a highly prevalent condition affecting approximately one billion people worldwide. In the absence of secondary cause, the term nonalcoholic fatty liver disease (NAFLD) is used. Hepatic steatosis may progress into nonalcoholic steatohepatitis, the more aggressive form of NAFLD, associated with hepatic complications such as fibrosis, liver failure and hepatocellular carcinoma. Hepatic steatosis is associated with metabolic syndrome, cardiovascular disease and represents an independent risk factor for type 2 diabetes, cardiovascular disease and malignancy.Percutaneous liver biopsy is the current reference standard for NAFLD assessment; however, it is an invasive procedure associated with complications and suffers from high sampling variability, impractical for clinical routine and drug efficiency studies. Therefore, noninvasive imaging methods are increasingly used for the diagnosis and monitoring of NAFLD. Among the methods quantifying liver fat, chemical shift encoded MRI (CSE-MRI) based proton density fat-fraction (PDFF) has shown to the most promise. MRI-PDFF is increasingly accepted as quantitative imaging biomarker of liver fat that is transforming daily clinical practice and influencing the development of new treatments for NAFLD. Furthermore, CT is an important imaging method for detection of incidental steatosis, and the practical advantages of quantitative ultrasound hold great promise for the future. Understanding the disease burden of NAFLD and the role of imaging may initiate important interventions aimed at avoiding the hepatic and extrahepatic complications of

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MRI in donor candidates for living donor liver transplant: Technical and practical considerations

Cited by 19 publications

References 91 publications

Left Hepatic Vein Preferential Approach Based on Anatomy Is Safe and Feasible for Laparoscopic Living Donor Left Lateral Sectionectomy

Left Hepatic Vein Preferential Approach Based on Anatomy Is Safe and Feasible for Laparoscopic Living Donor Left Lateral Sectionectomy

Quantification of Liver Fat Content with CT and MRI: State of the Art

Liver fat quantification: where do we stand?

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