Inferior vena cava encirclement by caudate lobe hypertrophy: evaluation by MRI and CT and its impact on caval preservation during orthotopic liver transplantation.
BACKGROUND
Presence of a dorsal sector of liver that completely encircles the IVC may increase difficulty of IVC preservation for orthotopic liver transplantation (OLT). We sought to evaluate the incidence of IVC encirclement by hepatic parenchyma using preoperative MRI and CT and its effect on surgical technique and complications.


METHODS
CT or MRI examinations less than 12 months before OLT were reviewed independently and blindly by two radiologists in 95 patients, with patient consent waived by IRB. IVC preservation was attempted for all patients without regard to imaging findings. Surgical records were reviewed regarding choice of technique or operative difficulties, and their relationship to complete IVC encirclement was calculated using ROC analysis and Fischer exact test.


RESULTS
Complete encirclement was found by both readers in 16 of 95 patients (17%). Resection of the recipient IVC was required in three of 95 patients, two of whom had complete IVC encirclement. Association of complete IVC encirclement with surgical IVC resection had an area under the ROC curve of 0.752.


CONCLUSIONS
Routine pretransplant assessment of IVC encirclement by dorsal sector hepatic tissue using MRI and CT may help identifying patients in whom IVC preservation will be difficult.
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
Rashi I
RI
Mehta
Donald G
DG
Mitchell
Liise
L
Kayler
Cataldo
C
Doria
Diane
D
Bergin
Laurence
L
Parker
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006984:Hypertrophy; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014682:Vena Cava, Inferior / Q000473:pathology; D055815:Young Adult