title: Magnetic resonance cholangiography in living donor liver transplantation: comparison of preenhanced and post-gadolinium-enhanced methods.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the image quality and diagnostic accuracy of postgadolinium complex of diethylenetriaminepentaacetic acid (GD-DTPA)-enhanced magnetic resonance cholangiography (MRC) in donor selection.
  
  
  METHODS
  Donors (n=228) with both preoperative MRC and intraoperative cholangiography (IOC) were enrolled in this study. MRC pre- and post-GD-DTPA enhancement were performed using 1.5-T magnetic resonance imaging. The signal-to-noise ratio (SNR) of liver parenchyma and contrast-to-noise ratio of bile duct, as well as the contrast between bile duct and liver parenchyma, were calculated. The biliary anatomy correlation with the IOC during hepatectomy and patient prognosis were also evaluated.
  
  
  RESULTS
  Quantitative results of the SNR of the liver parenchyma post-GD-DTPA were statistically significantly lower than preenhanced MRC (2.69 times reduced from the preenhanced MRC). The contrast of the bile duct and liver parenchyma in post-GD-DTPA were significantly higher than the preenhancement MRC. The anatomic diagnostic accuracy rate of post-GD-DTPA MRC was 92.9%. The sensitivity and specificity of GD-PTPA MRC were 85% and 96%, respectively. GD-DTPA-enhanced MRC has higher accuracy than the preenhanced MRC (92.9% vs 75%). The concurrence between GD-DTPA-enhanced MRC and IOC were commendable (kappa=0.9). The posttransplant biliary complication rate was 5.5%, and the 3-year survival rate was 91.2% in the recipients.
  
  
  CONCLUSIONS
  GD-DTPA, a paramagnetic metal, can shorten the T1 and T2 relaxation values of surrounding protons. This decreases the signal of the liver parenchyma and brightens the biliary anatomy. It can improve the image quality of MRC and increase the diagnostic accuracy of the biliary tract classification. It is mandatory in the "donor and recipient surgery during the LDLT".
authors.affiliation: Liver Transplantation Program and Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: H-J
authors.initials: HJ
authors.lastname: Chiang
authors.forename: H-W
authors.initials: HW
authors.lastname: Hsu
authors.forename: P-C
authors.initials: PC
authors.lastname: Chen
authors.forename: H-W
authors.initials: HW
authors.lastname: Chiang
authors.forename: T-L
authors.initials: TL
authors.lastname: Huang
authors.forename: T-Y
authors.initials: TY
authors.lastname: Chen
authors.forename: C-L
authors.initials: CL
authors.lastname: Chen
authors.forename: Y-F
authors.initials: YF
authors.lastname: Cheng
mesh_terms: D000293:Adolescent; D000328:Adult; D001659:Biliary Tract / Q000033:anatomy & histology / Q000293:injuries; D002758:Cholangiography / Q000379:methods*; D003287:Contrast Media; D046148:Donor Selection; D005260:Female; D019786:Gadolinium DTPA; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008099:Liver / Q000033:anatomy & histology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D019520:Living Donors; D008279:Magnetic Resonance Imaging; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012680:Sensitivity and Specificity; D059629:Signal-To-Noise Ratio; D016019:Survival Analysis; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000209:etiology / Q000517:prevention & control; D055815:Young Adult
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA