Biliary tract depiction in living potential liver donors: comparison of conventional MR, mangafodipir trisodium-enhanced excretory MR, and multi-detector row CT cholangiography--initial experience.
OBJECTIVE
To compare biliary tract depiction in living potential liver donors at conventional magnetic resonance (MR), mangafodipir trisodium-enhanced excretory MR, and multi-detector row computed tomographic (CT) cholangiography.


METHODS
Eight living potential liver donors underwent iodipamide meglumine-enhanced CT cholangiography. Eight different potential liver donors then underwent conventional MR cholangiography and mangafodipir trisodium-enhanced excretory MR cholangiography. Two readers independently scored all first-, second-, and third-order biliary branches with a four-point scale from 0 (not seen) to 3 (excellent visualization). Interobserver agreement was calculated by using the weighted kappa statistic. Scores were compared between imaging modalities by using generalized estimating equations. Imaging findings of second-order biliary tract anatomy were compared with intraoperative findings for nine patients.


RESULTS
Interobserver agreement for overall biliary tract visualization was good for CT, conventional MR, and excretory MR cholangiography (with weighted kappa values of 0.76, 0.66, and 0.79, respectively). The mean second-order biliary branch visualization scores for readers 1 and 2, respectively, were significantly higher at CT cholangiography (2.81 and 2.75) than at conventional MR (1.84 and 1.75, P <.001), excretory MR (2.00 and 2.06, P <.001), and combined conventional and excretory MR cholangiography (2.31 and 2.25, P <.01). At CT, conventional MR, and excretory MR cholangiography, respectively, second-order biliary branching anatomy was discernible in eight, five, and seven patients, with second-order biliary branch variants seen in three, two, and two patients. Surgical findings confirmed the pattern of second-order biliary branching seen at CT in five patients, that seen at conventional MR imaging in one patient, and that seen at excretory MR cholangiography in three patients. At surgery, one case of variant biliary anatomy was found to have been missed at CT cholangiography.


CONCLUSIONS
In living potential liver donors, CT cholangiography enables significantly better biliary tract visualization than conventional or excretory MR cholangiography either alone or in combination.
Department of Radiology, University of California San Francisco, Box 0628, C-324C, 505 Parnassus Ave, San Francisco, CA 94143-0628, USA. benyeh@itsa.ucsf.edu
Benjamin M
BM
Yeh
Richard S
RS
Breiman
Bachir
B
Taouli
Aliya
A
Qayyum
John P
JP
Roberts
Fergus V
FV
Coakley
D000293:Adolescent; D000328:Adult; D001652:Bile Ducts / Q000473:pathology*; D002758:Cholangiography / Q000379:methods*; D003287:Contrast Media / Q000493:pharmacokinetics; D004492:Edetic Acid / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation; D019520:Living Donors; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011732:Pyridoxal Phosphate / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000379:methods*
D003287:Contrast Media; D011732:Pyridoxal Phosphate; D004492:Edetic Acid; C060076:N,N'-bis(pyridoxal-5-phosphate)ethylenediamine-N,N'-diacetic acid