Accuracy and utility of 3-dimensional computed tomography in evaluating donors for adult living related liver transplants.
Three-dimensional (3D) computed tomography (CT) is an imaging technique that renders anatomic detail in 3D images from helical computed tomographic scans. The purpose of this study is to assess 3D CT in the preoperative evaluation of adult living related liver transplant donors. Nine patients underwent right-lobe liver resection for adult living related liver transplants between October 1999 and September 2000. All donors underwent triphasic helical CT of the liver with 3D computed tomographic reconstruction and conventional angiography. The 3D images were correlated with angiography and intraoperative findings. The origin of vessels, relative length of segments, and position of branches were considered for accuracy. The 3D computed tomographic images were compared with angiograms to determine whether angiography could be replaced by 3D CT. 3D CT identified all variations of the hepatic vein confluences and portal vein trifurcations and all hepatic arterial variants. At surgery, the 3D computed tomographic images of hepatic and portal veins were judged to be accurate and helpful in 8 of 9 cases, and images of the hepatic artery, accurate and helpful in 5 of 9 cases. The 3D computed tomographic images of hepatic and portal veins were better than or equivalent to angiograms in nearly all cases. The 3D computed tomographic images of the hepatic artery were better than or equivalent to angiography in 5 of 9 cases. By providing an accurate 3D map of the liver and its vasculature, 3D computed tomographic reconstructions of the hepatic vasculature are a useful adjunct for surgical planning in adult living related liver donors. 3D CT clearly delineates portal and hepatic veins as well as or better than the angiogram and can identify the hepatic artery and its branches well enough to consider replacing angiography, thus reducing cost, inconvenience, and risk to the donor.
Bogetti
J D
JD
Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, USA.
Herts
B R
BR
Sands
M J
MJ
Carroll
J F
JF
Vogt
D P
DP
Henderson
J M
JM
D000328:Adult; D000792:Angiography; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000592:standards*; D008099:Liver / Q000000981:diagnostic imaging; D016031:Liver Transplantation; D019520:Living Donors; D011169:Portal Vein / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000592:standards*