Preoperative evaluation of the entire hepatic vasculature in living liver donors with use of contrast-enhanced MR angiography and true fast imaging with steady-state precession.
OBJECTIVE
To preoperatively assess the entire hepatic vasculature in living related liver donors with use of a combination of contrast material-enhanced magnetic resonance (MR) angiography and true fast imaging with steady-state precession (FISP).


METHODS
Twenty-five living potential liver donors were examined preoperatively on a 1.5T Siemens Sonata system. Twenty-four underwent surgery and two had catheter angiography performed to delineate complex anatomy. Contiguous 5-mm-thick, sub-second true FISP images of the liver were initially obtained during breath-holding in axial and coronal planes (repetition time [TR]/echo time [TE], 3.2/1.6; flip angle, 70 degrees ). MR angiography was performed with use of a three-dimensional (3D) gradient-echo fast low-angle shot (FLASH) pulse sequence (TR/TE, 3.0/1.2; flip angle, 25 degrees ), with 40 mL of Gadolinium DTPA injected at a rate of 2 mL/sec. One precontrast and two postcontrast coronal 3D volumes were acquired, each in a 20-second breath-hold, and two subtracted 3D sets were calculated. Arterial anatomy was assessed with use of maximum-intensity projection, volume rendering, and multiplanar reformatting algorithms. Hepatic and portal venous anatomy was evaluated with use of the true FISP images and the venous phase of the MR angiogram. Visualization of hepatic arterial branches was noted. Visualization of portal vein branches was scored on a scale of 0-5. The presence of anatomic variants was noted. Vascular anatomy was confirmed at the time of surgery and at catheter angiography.


RESULTS
Segmental branch vessels were visualized on MR angiography in the majority of cases. The segment four branch was identified in 96% patients. Variant arterial anatomy was seen in 50% of patients. MR angiography detected 10 of 11 arterial variants found at surgery and angiography. Visualization of portal vein branches was generally higher with true FISP compared to MR angiography. Twenty-four percent of patients had variant portal venous anatomy. Caudal hepatic veins were identified in 60% of patients, of which eight were significant (>5 mm). Hepatic and portal venous anatomy was accurately predicted by true FISP and MR angiography in all patients who went on to undergo surgery.


CONCLUSIONS
Preoperative imaging with use of a combination of contrast-enhanced MR angiography and true FISP provides a comprehensive assessment of the entire hepatic vasculature in living liver donors.
Carr
James C
JC
Department of Radiology, Northwestern University Medical School, 251 East Huron Street, Feinberg 4-710, Chicago, Illinois 60611, USA. jcarr@radiology.nwu.edu
Nemcek
Albert A
AA
Abecassis
Michael
M
Blei
Andrew
A
Clarke
Lori
L
Pereles
F Scott
FS
McCarthy
Richard
R
Finn
J Paul
JP
D000328:Adult; D003287:Contrast Media; D005260:Female; D006499:Hepatic Artery / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D006503:Hepatic Veins / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging*; D016031:Liver Transplantation; D019520:Living Donors; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011856:Radiographic Image Enhancement; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D003287:Contrast Media