Multislice computed tomography in the preoperative assessment of adult-to-adult living donor liver transplantation: personal results.
OBJECTIVE
To evaluate the possible role of multislice spiral computed tomography (MSCT) as the sole imaging examination in the preoperative assessment of potential donors undergoing adult-to-adult living donor liver transplantation (LDLT).


METHODS
Fifteen patients underwent MSCT with 0.5-second gantry rotation time. Pre- (4 X 2.5 mm collimation) and post-contrast (4 X 1 mm collimation) acquisitions during arterial and portal venous phases were performed after intravenous administration of 140 ml of non ionic contrast agent at 4-5 ml/s, with a delay time of 25 and 60 seconds, respectively. Pre-contrast scans with 80 and 140 kVp were acquired at the same level used to assess liver density. Real-time interaction with the post-contrast 3D data set was performed on a dedicated workstation to determine total and lobar liver volume, and to assess arterial and venous vascular anatomy.


RESULTS
Steatosis was found in three patients, who as a consequence were excluded as possible candidates. MSCT correctly identified five cases of arterial anatomical variations: two cases of the right hepatic artery arising from the superior mesenteric artery, two cases of the common hepatic artery arising from the superior mesenteric artery and one case of the left hepatic artery arising from left gastric artery. In two cases portal trifurcation was considered a criterion for exclusion. A 4% error in the liver volume calculation was found at surgery, in no case considered significant. Two patients underwent surgery and three have been short-listed.


CONCLUSIONS
MSCT enables complete preoperative evaluation of potential donors undergoing LDLT. Total and lobar volume determination provided accurate and reproducible information. MSCT enabled correct surgical planning without intra-operative complications. One of the limits of the technique was the poor visualization of the biliary anatomy with the need to perform an intraoperative cholangiography in all the patients.
Fraioli
Francesco
F
Dipartimento di Sciernze Radiologiche, Università degli Studi di Roma La Sapienza, Roma, Italy. carlo.catalano@uniroma1.it
Francone
Marco
M
Catalano
Carlo
C
Napoli
Alessandro
A
Danti
Massimiliano
M
Rossi
Massimo
M
Pediconi
Federico
F
Rassariello
Roberto
R
D000328:Adult; D000075202:Contraindications; D005260:Female; D006499:Hepatic Artery / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008099:Liver / Q000033:anatomy & histology / Q000098:blood supply / Q000000981:diagnostic imaging*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011168:Portal System / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D011300:Preoperative Care / Q000379:methods; D036542:Tomography, Spiral Computed / Q000379:methods*