MRI for evaluation of potential living liver donors: a new approach including contrast-enhanced magnetic resonance cholangiography.
ABSTRACT To assess the feasibility of a comprehensive MRI protocol using intrabiliary contrast medium (gadolinium-EOB-DTPA) for evaluation of living liver donors.
In this prospective study, 30 donor candidates for living-related liver transplantation (17 men; 13 women, mean age 37 ± 10.9 years) underwent MRI including MR-angiography (MRA) as well as a conventional T2-weighted MR-cholangiography (MRC) and a contrast-enhanced sequence for depiction of the biliary structures. MRC and MRA images were evaluated for quality on a four-point-scale (score of 0 indicated poor and a score of 3, excellent image quality). Anatomic variants of the arterial, venous, portal venous, and biliary structures were identified.
Image quality was diagnostic in all examinations except for 4 of 30 MRA data sets. Intrahepatic biliary structures, especially with regard to the intrahepatic bile ducts of 2nd and 3rd order could be identified with significantly increased image quality than in conventional T2-weighted MRC sequences (P = 0.005 and P = 0.035). A high percentage rate of anatomic variants regarding the biliary, arterial, venous, and portal venous anatomy was found.
This protocol allows the evaluation of liver donors especially with regard to the biliary structures. However, the depiction of the arterial anatomy requires further technical developments.
- New England Journal of Medicine 06/1990; 322(21):1505-7. · 51.66 Impact Factor
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ABSTRACT: Three-dimensional (3D) helical computed tomographic (CT) angiography is a promising method of determining vascular anatomy. This technique is useful in delineating the arterial anatomy of the liver, demonstrating the normal anatomy and vascular variants in a highly visual fashion. The "typical" hepatic arterial anatomy occurs in only 55% of the population, and numerous variants exist; the standard classification system for hepatic arterial anatomy includes 10 variations. After helical scanning, postprocessing with reconstruction algorithms such as shaded surface display and maximum-intensity projection provides highly graphic, easily understandable views of vascular anatomy. The 3D CT angiograms, with their global view of the anatomy and inherent advantage of volumetric rotation of the vascular system, are useful to surgeons and others with limited experience in interpreting axial anatomy. Determination of hepatic arterial anatomy with 3D CT angiography has already been shown to be clinically useful in patients being evaluated for liver transplantation.Radiographics 08/1995; 15(4):771-80. · 2.79 Impact Factor
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ABSTRACT: Liver transplantation from living donors developed rapidly in the last decade of the twentieth century and is now an important option in the treatment of patients with end stage and/or irreversible liver diseases. Although the disadvantages of small-for-size grafts are being significantly mitigated by the repertoire of left lobe, while left liver, and right lobe grafts, the struggle for graft size matching has disclosed not a few problems, such as small grafts for advanced disease, anatomical variations in donor livers, and, above all, the increasing importance of donor safety. The range of donor candidates is also an important point of discussion in regard to the social significance of this treatment modality. Apart from the surgical aspects, many medical aspects, including the indications and timing of transplantation specific to this technique, the prevention of disease transmission in family members, and immunological aspects, including the risk of graft-versus-host disease, remain to be clarified. Social and economic questions, as well as surgical and medical issues, will be the theme in the second decade, and the new century, of this newborn treatment modality.Journal of Hepato-Biliary-Pancreatic Surgery 02/2002; 9(2):218-22. · 1.60 Impact Factor