Gadolinium-enhanced magnetic resonance venography of the portal venous system prior to transjugular intrahepatic portosystemic shunts and liver transplantation. Original investigation.
OBJECTIVE
The accuracy of gadolinium-enhanced magnetic resonance venography (GdMRV) in identifying visceral venous abnormalities was assessed in patients before they underwent transjugular intrahepatic portosystemic shunt (TIPS) or orthotopic liver transplantation (OLT).


METHODS
Twenty-seven patients with portal hypertension underwent GdMRV and transcatheter venography prior to OLT or TIPS. The gadolinium dose was 0.5 mL/kg (0.25 mmol/kg), administered by rapid hand injection. Coronal 3D spoiled gradient-echo GdMRV was performed in a single breath-hold. Four blinded reviewers retrospectively evaluated coronal maximum intensity projection (MIP) images, while two reviewers evaluated the MIPs and multiplanar reconstructions. Abnormalities that could affect transjugular intrahepatic portosystemic shunt or transplantation were noted and compared with the results of corresponding catheter venograms read by a separate blinded reviewer.


RESULTS
Abnormalities were identified by GdMRV with a sensitivity and specificity of 83% and 97% for the right hepatic vein, 86% and 100% for the main portal vein (MPV), 42% and 99% for the right portal vein, 54% and 94% for the left portal vein, 61% and 96% for the superior mesenteric vein, and 74% and 91% for the splenic vein. Varices and shunts were correctly identified with a sensitivity of 96%. Multiplanar reconstruction increased MPV sensitivity to 100%.


CONCLUSIONS
Vascular abnormalities that affect TIPS and OLT can be identified by GdMRV. Multiplanar reconstruction increased the accuracy to 100% for the MPV.
Department of Radiology, University of California, San Francisco 94115-0628, USA.
M W
MW
Wilson
B H
BH
Hamilton
Q
Q
Dong
D B
DB
Stafford-Johnson
S N
SN
Kazanjian
D M
DM
Williams
M V
MV
Marx
K J
KJ
Cho
M R
MR
Prince
D002405:Catheterization, Central Venous; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium / Q000008:administration & dosage; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D007089:Image Enhancement / Q000379:methods*; D007262:Infusions, Intravenous; D017093:Liver Failure / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D016031:Liver Transplantation; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011168:Portal System / Q000473:pathology*; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011300:Preoperative Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D003287:Contrast Media; D005682:Gadolinium