Biliary anatomy in potential right hepatic lobe living donor liver transplantation (LDLT): the utility of CT cholangiography in the setting of inconclusive MRCP

Objective

To determine the utility of CT cholangiography (CT-Ch) in preoperative evaluation of the biliary anatomy of living-donor liver transplantation (LDLT) donors when magnetic resonance cholangiopancreatography (MRCP) is inconclusive.

Materials and methods

Over a 2-year period, 22 potential living liver donors underwent contrast-enhanced CT-Ch for preoperative evaluating biliary anatomy due to inconclusive results on MRCP and subsequently donated their right hepatic lobe. Nineteen of them underwent intraoperative cholangiography and were included in this study. Two radiologists retrospectively reviewed both MRCP and CT-Ch with 1-month interval and documented the types of bile duct branching patterns and visualization score of intrahepatic bile ducts (4-point scale).

Results

There were no complications associated with CT-Ch examinations. CT-Ch was concordant with the reference standard in 18/19 (95%) including 7/8 typical branching type and 11/11 anomalous branching types. MRCP was concordant with the reference standard in 14/19 (74%) including 4/8 typical branching types and 10/11 anomalous branching types. The discordant case by CT-Ch was the identification of a tiny accessory right intrahepatic duct joining the common bile duct which was not visualized on intraoperative cholangiography. CT-Ch showed higher visualization score (mean, 3.9) than MRCP (mean, 2.6) (P < .001).

Conclusion

CT-Ch can be effectively used for the depiction of the branching pattern of the bile duct at the hepatic hilum when MRCP is inconclusive.     

Minimizing the postoperative biliary complications in living donor liver transplantation,by utility of preoperative non-enhanced magnetic resonance cholangiopancreatography

Aim of the work

The aim of this study was to assess the utility of non-enhanced MRCP in reduction of biliary complications in LDLT donors and compare the results with IOC.

The role of ultrasound and magnetic resonance cholangiopancreatography for the diagnosis of biliary stricture after liver transplantation

Purpose

To identify the diagnostic value of ultrasound (US) and magnetic resonance cholangiopancreatography (MRCP) in diagnosing biliary strictures after liver transplantation.

Materials and methods

Sixty patients with clinically suspected biliary strictures after liver transplantation were retrospectively evaluated. All patients underwent US and MRCP before the standard of reference (SOR) procedure: endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography. Radiological images were analyzed for biliary dilatation and strictures.

Results

By SOR, biliary dilatation was present in 55 patients, stricture in 53 (44 anastomotic, 4 intrahepatic, 5 both), and dilatation and/or stricture in 58. Dilatation was diagnosed by US and MRCP in 39 and 45, respectively (sensitivity 71% vs. 82%, p = 0.18). Stricture was diagnosed by US and MRCP in 0 and 42, respectively (sensitivity 0% vs. 79%, p < 0.0001). False positive stricture was diagnosed by MRCP in 2. Dilatation and/or stricture was diagnosed by US in 39 and MRCP in 50 (sensitivity 67% vs. 86%, p = 0.01); however, using both techniques, sensitivity increased to 95%.

Conclusions

MRCP is superior to US for diagnosing biliary strictures after liver transplantation primarily because MRCP can detect stricture. The combination of US and MRCP seems superior to either method alone. Our data suggest that in patients with normal US and MRCP, direct cholangiography could be avoided.     

Role of MRCP in assessment of biliary variants in living donor liver transplantation

Introduction

Liver transplantation can be done by three different methods: Cadaveric, heterotopic and living donor liver transplantation (LDLT). In LDLT usually the right lobe of a donor liver is transplanted into the patient after proper volumetric studies. The native patient bile ducts are connected to the biliary tree of the transplanted liver segment.

Patients and methods

From January 2010 to August 2011, 50 potential LDLT donors were evaluated with preoperative MRCP.

Results

The radiologist evaluated the visualization of the common duct, right and left intra-hepatic ducts, and insertion of the right posterior lobe duct. The data were classified according to Huang and Hakki classifications. According to the more detailed classification of Hakki 13 patients (26%) were Type K1; 15 patients (30%) were Type K2a; three patients (6%) were Type K2b; 11 patients (22%) Type K3a; four patients (8%) were Type K3b; two patients (4%) were Type K4 and no patients were Type K5. Two patients with unclassified anatomical biliary pattern were encountered. In conclusion, this study has shown an extremely high accuracy of MRCP in preoperative assessment of live hepatic donors, which aided in the style and procedure of the operation and ultimately to a high success rate of the transplantation procedures.     

Dual-energy CT-cholangiography in potential donors for living-related liver transplantation: improved biliary visualization by intravenous morphine co-medication

Purpose

To prospectively evaluate whether intravenous morphine co-medication improves bile duct visualization of dual-energy CT-cholangiography.

Materials and methods

Forty potential donors for living-related liver transplantation underwent CT-cholangiography with infusion of a hepatobiliary contrast agent over 40 min. Twenty minutes after the beginning of the contrast agent infusion, either normal saline (n = 20 patients; control group [CG]) or morphine sulfate (n = 20 patients; morphine group [MG]) was injected. Forty-five minutes after initiation of the contrast agent, a dual-energy CT acquisition of the liver was performed. Applying dual-energy post-processing, pure iodine images were generated. Primary study goals were determination of bile duct diameters and visualization scores (on a scale of 0 to 3: 0—not visualized; 3—excellent visualization).

Results

Bile duct visualization scores for second-order and third-order branch ducts were significantly higher in the MG compared to the CG (2.9 ± 0.1 versus 2.6 ± 0.2 [P < 0.001] and 2.7 ± 0.3 versus 2.1 ± 0.6 [P < 0.01], respectively). Bile duct diameters for the common duct and main ducts were significantly higher in the MG compared to the CG (5.9 ± 1.3 mm versus 4.9 ± 1.3 mm [P < 0.05] and 3.7 ± 1.3 mm versus 2.6 ± 0.5 mm [P < 0.01], respectively).

Conclusion

Intravenous morphine co-medication significantly improved biliary visualization on dual-energy CT-cholangiography in potential donors for living-related liver transplantation.     

The added value of diffusion-weighted MR imaging to MR cholangiopancreatography in differentiating malignant from benign extrahepatic biliary strictures

Purpose

To investigate the added value of diffusion-weighted imaging (DWI) to magnetic resonance cholangiopancreatography (MRCP) in differentiating benign from malignant extrahepatic biliary strictures.

Methods

Magnetic resonance examination including, T2-weighted imaging, MRCP and DWI using different b-values (0,500,800 s/mm²) were performed in 38 patients with suspicious extrahepatic biliary strictures. Apparent diffusion coefficient (ADC) value was calculated. The signal intensity of the lesions on DWI using b = 500 and 800 s/mm² was examined. Analysis of the DWI and MRCP images for the cause of the extrahepatic biliary stricutre was performed. Patients were further confirmed by histopathological diagnosis and follow up. Sensitivity, specificity, accuracy, positive predictive and negative predictive values were calculated for both the MRCP images and DWI.

Results

Of the 38 cases, 23 cases had malignant extrahepatic biliary strictures and 15 had benign strictures. DWI detected 21 out of the 23 malignant biliary strictures and 14 out of 15 benign biliary strictures. Malignant strictures more frequently appeared hyperintense than benign strictures on DWI using b-values of 500 and 800 s/mm². There was a significant difference in sensitivity (91.3% vs. 73%), specificity (93.3% vs. 64.7%), accuracy (92.1% vs. 73.6%), positive predictive value (95.4% vs. 81%), and negative predictive value (87.5% vs. 64.7%) between DWI and MRCP in differentiating biliary strictures.

Conclusion

Combined evaluation using DWI added to MRCP improves the differentiation of malignant from benign extrahepatic biliary strictures.     

Clinical usefulness of free-breathing navigator-triggered 3D MRCP in non-cooperative patients: comparison with conventional breath-hold 2D MRCP

Purpose

To assess the clinical usefulness of free-breathing 3D MRCP in non-cooperative patients compared conventional breath-hold 2D MRCP.

Materials and methods

We performed FB navigator-triggered 3D MRCP using prospective acquisition correction and BH 2D MRCP in 48 consecutive, non-cooperative patients among 772 patients. Thirteen patients had malignant obstruction. Two radiologists independently graded the likelihood of a malignant obstruction, the overall image quality, and the visibility of ten, individual anatomic segments of both the biliary and pancreatic duct in each sequence. The area under the ROC curve and the repeated measures analyses of variance with multiple comparisons were used for the comparison. The κ statistics were used for interobserver agreement.

Result

The diagnostic performance for detecting malignancy was significantly higher on FB MRCP (A_z = 0.962) than on either BH SS-RARE (A_z = 0.820, P < 0.0185) or MS-HASTE MRCP (A_z = 0.816, P < 0.0067). Interobserver agreement was excellent for FB MRCP (κ = 0.889) and fair for both BH SS-RARE (κ = 0.578) and MS-HASTE MRCP (κ = 0.49). FB MRCP had a significantly higher technical quality than BH MRCP (P < 0.001). FB MRCP was seen to have statistically better visibility of peripheral IHD, right main IHD, CHD, cystic duct, and CBD than BH MRCP (P < 0.001). FB MRCP and BH SS-RARE MRCP had statistically better visibility of both the left main IHD and pancreatic duct than did BH MS-HASTE MRCP (P < 0.001).

Conclusion

FB 3D MRCP is useful for non-cooperative patients in whom conventional BH 2D methods cannot be used successfully.     

Comparison of three-dimensional negative-contrast CT cholangiopancreatography with three-dimensional MR cholangiopancreatography for the diagnosis of obstructive biliary diseases

Purpose

The purpose of our study was to compare three-dimensional (3D) negative-contrast CT cholangiopancreatography (3D-nCTCP) with 3D MR cholangiopancreatography (3D-MRCP) for the diagnosis of obstructive biliary diseases.

Materials and methods

3D-nCTCP and 3D-MRCP were performed on seventy clinically documented obstructive biliary diseases patients. The accuracy of each technique in determining the location and cause of biliary obstruction was evaluated compared with the final clinical diagnoses.

Results

Both methods achieved 100% of accuracy in the diagnosis of the presence and location of biliary obstruction, and had a similar sensitivity, specificity, accuracy in differentiating benign from malignant biliary obstruction or calculous from noncalculous biliary obstruction (p > 0.05). At 3D-nCTCP, six patients with stones were misinterpreted as cholangitis (N = 2), papillitis (N = 3), or bile duct adenocarcinoma (N = 1); two metastases were mistaken as acute pancreatitis or pancreatic head carcinomas, and one intrahepatic cholangiocarcinoma was misled as bile duct adenoma. At 3D-MRCP, one small stone, one ampullary adenoma, and one intrahepatic cholangiocarcinoma were mistaken as cholangitis, ampullary stone, and intrahepatic bile duct stone, respectively, and three gallbladder carcinomas and another intrahepatic cholangiocarcinoma were misdiagnosed as hilar cholangiocarcinoma (N = 3) or common hepatic duct stone (N = 1); four metastases were mistaken as pancreatic head carcinomas (N = 3) or distal cholangiocarcinoma (N = 1). The overall accuracy in making specific diagnosis of the cause of biliary obstruction was 87.1% for 3D-nCTCP and 84.3% for 3D-MRCP, respectively, (p > 0.05).

Conclusion

3D-nCTCP has the similar effects as 3D-MRCP for the diagnosis of biliary obstruction and, the location and the cause of biliary obstruction. In view of selected cases contraindications for MRI, 3D-nCTCP is a potential substitute.     

The utility of MRCP in preoperative mapping of biliary anatomy in adult-to-adult living related liver transplant donors

PURPOSE: To assess the utility of magnetic resonance cholangiopancreatography (MRCP) in preoperative mapping of biliary anatomy in adult-to-adult living related liver transplant (LRLT) donors. MATERIALS AND METHODS: From 57 potential donors with preoperative MRCP, 27 cases (16 men, 11 women, age range 22-51 years, mean 37.2 years) underwent right lobe resection and had intraoperative cholangiography (IOC) for comparison. The MRCP and IOC reports were retrospectively reviewed in all 27 cases. The MRCP was performed on 1.5 Tesla MR magnets using breath-hold heavily T2-weighted sequences in axial/coronal thin sections, and variable-thickness rotating slabs. The accuracy of preoperative MRCP for biliary mapping in potential LRLT donors was analyzed compared to the IOC findings. RESULTS: Of 27 donors, 26 (96.3%) had MRCP which showed adequate information of central intrahepatic biliary anatomy. Of these, 19 had normal bifurcation confirmed by IOC, and single biliary anastomosis was created in the recipient at transplantation. MRCP correctly predicted 17 of 19 normal cases (sensitivity for normals: 89.5%). In seven donors with variant biliary anatomy, two separate biliary anastomoses were performed in the recipient. MRCP correctly predicted five of seven variants (sensitivity for variants: 71.4%). Overall, MRCP had an accuracy 84.6% (22/26). CONCLUSIONS: MRCP has potential in the preoperative assessment of nondilated bile ducts in LRLT donors, however further improvements are desired to increase its quality and accuracy.     

Anatomic variations of intrahepatic bile ducts in the general adult Egyptian population: 3.0-T MR cholangiography and clinical importance

Objective

To describe the anatomical variations occurring in intrahepatic bile ducts (IHDs) and their frequencies in general adult Egyptian population using 3.0-T MR cholangiography (MRC) as well as its clinical importance to reduce the biliary complications of hepatobiliary surgery.

Materials and methods

MRC was applied to a study group of 106 subjects (26 potential liver donors and 80 volunteers). Anatomical variations in IHDs were classified based on the variable insertion of right posterior hepatic bile duct (RPHD) using Huang classification.

Results

According to this classification, the frequencies of each type were as follows: Huang A1 (typical pattern): 63.2% (n = 67), Huang A2: 10.4% (n = 11), Huang A3: 17% (n = 18), Huang A4, 7.5% (n = 8), and Huang A5: 1.9% (n = 2). Total frequency for atypical types (i.e. A2, A3, A4 and A5) was 36.8%. No significant difference was detected in the distance between RPHD insertion to the junction of right and left hepatic duct in-between these Huang types. This distance was short (<1 cm) in 21 of subjects under Huang A classification. Twenty-one donors underwent intraoperative cholangiograms, of which twenty (95.2%) had similar classification in both intraoperative and MRC findings.

Conclusion

The incidence of variant biliary anatomy in general Egyptian population (36.8%) as well as the presence of Huang type A with short distance (<1 cm) between RPHD insertion and junction of right and left hepatic duct (19.8%) enhance the importance of MRC as a pre-operative tool before hepato-biliary surgical procedures to reduce post-operative biliary complications.     

CT cholangiography: assessment of feasibility and diagnostic reliability

Objective

To assess the reliability of computed tomography (CT) cholangiography in evaluating the anatomy of the intrahepatic biliary ducts.

Materials and methods

Twenty-eight patients underwent CT cholangiography at the National Cancer Institute of Milan, Italy. Twenty-one patients were candidates for liver surgery and seven had suspected postoperative biliary complications. The patients had not dilatation of the intrahepatic biliary ducts at US examination and bilirubin levels were not higher than 2 mg/dl. To define the reability of the CT cholangiography, a scoring system (from 0 to 3) was used for each order of biliary branches.

Results

In all cases, it was technically possible to carry out the CT cholangiography according to the protocol. There were no adverse reactions to the contrast agent. Two radiologists gave the maximum score of 3 for visualisation of the first- and second-order biliary branches in all cases. For visualisation of third- and fourth-order biliary branches the maximum score of 3 was given in 18 patients, a score of 2 in 8 patients and a score of 1 in 2 patients. Three anatomical variants of biliary ducts were detected. CT cholangiography was diagnostic in all seven cases of suspected postoperative biliary complications.

Conclusion

Our work confirms the high spatial resolution and reability of CT cholangiography in evaluating the intrahepatic biliary anatomy of patients who are candidates for liver surgery, with non-dilated biliary ducts and with bilirubin levels no higher than 2 mg/dl.     

Paediatric MRCP: 10 year experience with 195 patients

Purpose

Magnetic resonance cholangiopancreatography (MRCP) has now largely substituted endoscopic retrograde cholangiopancreatography (ERCP) in evaluating the biliary tree in adults giving its high sensitivity and specificity. Whilst smaller series published to date suggests this may be extrapolated to the paediatric population, its routine use in children is still debatable. The aim of our study is therefore to review the utility of MRCP in a large series of paediatric patients.

Methods and materials

All MRCPs performed in our institution were examined for diagnostic quality, spectrum of diagnoses and correlation with direct cholangiography (DC) were available. Correlation with histopathology results and final clinical diagnosis was made in the subset of patients in whom a MRCP had been performed to evaluate the presence of primary sclerosing cholangitis (PSC).

Results

There were 245 MRCP examinations performed on 195 patients and 219 were diagnostic. There was 100% MRCP and DC concordance in the 16 cases where both had been performed. MRCP yielded a sensitivity of 89% in the subset of patients with PSC.

Conclusion

MRCP was a valuable diagnostic tool in our paediatric population. Image quality is sufficiently diagnostic and shows good correlation with clinical diagnosis in conditions encountered in our population, including primary sclerosing cholangitis, post liver transplant biliary strictures, post surgical complications, dilated common bile ducts, choledochal cysts, cholelithiasis and choledocholithaisis.     

Assessment of acute cholangitis by MR imaging

Purpose

The purpose of this study is to assess the common MRI findings of acute cholangitis compared with those of non-acute cholangitis.

Materials and methods

During a 31-month period, we performed MRCP and contrast-enhanced MRI on 173 patients with biliary abnormalities including duct dilatation or stricture. The causes of the biliary abnormalities included biliary stone disease (n = 85), cholangiocarcinoma (n = 47), periampullary cancer (n = 20), GB cancer (n = 4), and others (n = 17). Among 173 patients, 66 consecutive patients were confirmed with acute cholangitis diagnosed according to the Tokyo guideline, and 107 patients were confirmed as having non-acute cholangitis. Two radiologists retrospectively and independently accessed the MR findings, including the cause of biliary abnormality, increased periductal signal intensity on T2-weighted images, the transient periductal signal difference, and the presence of abscess, thrombosis, and ragged duct. They also measured the dilated duct and the thickened wall. The Student t-test and the Pearson chi-square were used. The κ statistics were used to determine interobserver agreement. Logistic regression was used to identify the MR findings that predicted acute cholangitis.

Results

MRI correctly accessed the cause of biliary abnormality in 163 patients (94%). The statistically common findings for acute cholangitis were as follows: increased periductal signal intensity on T2-weighted imaging (n = 26, 39%, p < 0.05); transient periductal signal difference (n = 31, 47%, p < 0.05); abscess (n = 18, 27%, p < 0.05); thrombosis (n = 12, 18%, p < 0.05); and ragged duct (n = 11, 17%, p < 0.05). Interobserver agreement was good to excellent for each finding (κ = 0.74–0.97). The wall thickness showed a statistically significant difference between the acute cholangitis and the non-acute cholangitis group (2.65 mm:2.32 mm, p < 0.05), however, there was no significant difference in duct dilatation in the two groups. The periductal transient attenuation difference was an independent predictor of acute cholangitis (Exp (B) = 6.389, p = 0.018).

Conclusion

MRI accurately assesses the cause of biliary abnormality in patients with cholangitis. Using statistically common MR findings for acute cholangitis, MR imaging is very successful in predicting acute cholangitis.     

Bile duct evaluation of potential living liver donors with Gd-EOB-DTPA enhanced MR cholangiography: Single-dose,double dose or half-dose contrast enhanced imaging

Introduction

Detailed knowledge of the biliary anatomy is essential to avoid complications in living donor liver transplantation. The aim of this study was to determine the optimal dosage of Gd-EOB-DTPA for contrast-enhanced magnetic resonance cholangiography (ce-MRC) with reference to contrast-enhanced CT cholangiography (ce-CTC).

Materials and methods

30 potential living liver donors (PLLD) underwent both ce-CTC and ce-MRC. Ten candidates each received single, double or half-dose Gd-EOB-DTPA. Ce-MRC images with and without inversion recovery pulses (T1w ± IR) were acquired 20–30 min after intravenous contrast injection. Image data was quantitatively and qualitatively reviewed by two radiologists based on a on a 5-point scale. Data sets were compared using a Mann–Whitney-U-test or Wilcoxon-rank-sum-test. Kappa values were also calculated.

Results

All image series provided sufficient diagnostic information both showing normal biliary anatomy and variant bile ducts. Ce-CTC showed statistically significant better results compared to all ce-MRC data sets. T1w MRC with single dose Gd-EOB-DTPA proved to be superior to half and double dose in subjective and objective evaluation without a statistically significant difference.

Conclusions

Ce-MRC is at any dosage inferior to ce-CTC. As far as preoperative planning of bile duct surgery is focused on the central biliary anatomy, ce-MRC can replace harmful ce-CTC strategies, anyway. Best results were seen with single dose GD-EOB-DTPA on T1w MRC+IR.     

Multi-slice computed tomography imaging of the post transplant complications in the recipients after living donor liver transplantation

Aim

To evaluate the clinical utility of MSCT in the detection and proper management of the different post-transplant complications in the recipients after LDLT.

Patients and methods

33 patients (28 males & 5 females) who underwent LDLT were referred to the Radiology department (CT unit) for evaluation of vascular, biliary, and parenchymal complications after LDLT using MSCT.

Results

Vascular complications were found in 16 cases (48.5%) [hepatic artery thrombosis (8 cases), hepatic artery stenosis (1 case), portal vein thrombosis (3 cases), portal vein stenosis (2 cases), hepatic veins stenosis (2 cases)]. Biliary complications were found in 9 cases (27.3%) [biloma (6 cases) 18.2%, biliary stricture (3 cases) 9.1%]. Hepatic abscess was found in 2 cases (6%), acute rejection was found in 2 cases (6%), recurrent HCC was found in 3 cases (9.1%). Neoplastic lympho-proliferative disorder was found in 1 case (3%).

Conclusion

MSCT is a non-invasive and accurate examination to detect complications after LDLT, it provides synchronous evaluation of the hepatic vasculature, biliary tract, liver parenchyma and the other abdominal organs in a single examination. MSCTA is the best option for confirming the US suspicion of vascular complications, with DSA reserved if therapeutic intervention is contemplated.     

Impact of butylscopolamine on image quality of magnetic resonance cholangiopancreatography

Purpose

To assess the effect of parenteral butylscopolamine on magnetic resonance cholangiopancreatography (MRCP) image quality.

Materials and methods

The 3D free-breathing respiratory-compensated MRCP images (mean acquisition time 7 min) of 94 consecutive non-paired patients (47 with and 47 without 20 mg intramuscular butylscopolamine) were analysed retrospectively. Two experienced abdominal radiologists scored the image quality of five predefined pancreaticobiliary ductal segments on the MRCP images in a blinded fashion in both cohorts using a 5 point validated scale, ranging from perfect visualization of the entire ductal structure to the ductal structure being not visible. Interobserver agreement was determined.

Results

Parenteral butylscopolamine injection significantly reduced bowel peristalsis-related artefacts of the inferior common bile duct (CBD; p = 0.031) and the pancreatic duct (PD; p = 0.034) for reader 1 and the inferior CBD (p = 0.041) for reader 2. The difference in visualization of all remaining ductal segments, and of the overall pancreaticobiliary tree, was not statistically significant between the two cohorts. Interobserver agreement between the two readers was substantial for the superior CBD, common hepatic duct (CHD) and PD, was moderate for the inferior CBD, and was fair for the peripheral intrahepatic ducts.

Conclusion

On free-breathing 3D MRCP images, parenteral butylscopolamine improves only the visualization of the inferior CBD and the PD. However, no significant improvement in visualization of other ductal segments was demonstrated.     

Primary biliary cirrhosis: evaluation with T2-weighted MR imaging and MR cholangiopancreatography

Purpose

The aim of this retrospective study is to evaluate the role of T2-weighted MR imaging (MRI) and MR cholangiopancreatography (MRCP) findings in the diagnosis of primary biliary cirrhosis (PBC).

Materials and methods

The following T2-weighted MRI and MRCP findings: segmental hepatic atrophy/hypertrophy, irregular liver surface, parenchymal lace-like fibrosis, rounded low signal intensity lesions centering portal vein branches (periportal halo sign), periportal hyperintensity (cuffing), splenomegaly, ascites, lymphadenopathy, venous collaterals, and the configuration of intrahepatic biliary ducts were reviewed for their diagnostic significance by two observers in 13 female patients (mean age: 49 years) with PBC. Discordant readings of the observers were resolved at consensus.

Results

When parenchymal lace-like fibrosis and periportal halo sign were seen together the sensitivity of T2-weighted MR images was 69%. In six cases periportal hyperintensity (cuffing) and periportal halo sign were seen together. Segmental hypertrophy was present in nine patients and hepatic surface irregularity due to regenerative nodules were present in 10 patients. Lymphadenopathy was seen in 10, splenomegaly was seen in 5, collateral vascular structures were seen in 2 and minimal perihepatic free fluid was seen in 2 patients. MRCP images revealed various mild irregularity in the intrahepatic bile ducts in 8 patients and focal narrowing at the common bile duct level in 1 patient.

Conclusion

MRI and MRCP may support the clinical and laboratory findings of PBC even in the early stages of the disease. MRI can also be a choice of method for the recommended prolonged follow up.     

Accurate perioperative flow measurement of the portal vein and hepatic and renal artery: A role for preoperative MRI?

Background

Quantification of abdominal blood flow is essential for a variety of gastrointestinal and hepatic topics such as liver transplantation or metabolic flux measurement, but those need to be performed during surgery. It is not clear whether Duplex Doppler Ultrasound during surgery or MRI before surgery is the tool to choose.

Objective

To examine whether preoperative evaluation of abdominal blood flow using MRI could prove to be a useful and reliable alternative for the perioperative sonographic approach.

Methods

In this study portal and renal venous flow and hepatic arterial flow were sequentially quantified by preoperative MRI, preoperative and perioperative Duplex Doppler Ultrasound (DDUS). 55 Patients scheduled for major abdominal surgery were studied and methods and settings were compared. Additionally, average patient population values were compared.

Results

Mean (±SD) plasmaflow measured by perioperative DDUS, preoperative DDUS and MRI, respectively was 433 ± 200/423 ± 162/507 ± 96 ml/min (portal vein); 96 ± 70/74 ± 41/108 ± 91 ml/min (hepatic artery); 248 ± 139/201 ± 118/219 ± 69 ml/min (renal vein). No differences between the different settings of DDUS measurement were detected. Equality of mean was observed for all measurements. Bland Altman Plots showed widespread margins. Hepatic arterial flow measurements correlated with each other, but portal and renal venous flow correlations were absent.

Conclusions

Surgery and method (DDUS vs. MRI) do not affect mean flow values. Individual comparison is restricted due to wide range in measurements.Since MRI proves to be more reliable with respect to inter-observer variability, we recommend using mean MRI results in experimental setups.     

MR胆道成像评价活体肝移植供体胆道结构的应用价值

目的 探讨MR胆道成像(MRC)评价活体肝移植供体肝内胆道结构的准确性以及在活体肝移植中的应用价值.方法 回顾性分析58例活体肝移植的供体,分析术前MRC资料,进行胆道分型,并与术中胆道造影(IOC)结果对照.结果 IOC诊断58例供体,发现胆道结构正常者34例(58.6%),胆道结构变异者24例(41.4%);MRC对58例供体胆道结构分型总准确率为91.4%(53/58),对胆道变异类型的诊断敏感度为83.3%(20/24),特异度为100%(34/34),阳性预测值为100%(20/20),阴性预测值为89.5%(34/38).结论 MRC能在术前准确评价活体肝移植供体的肝内胆管结构,有助于活体肝移植术前手术方案的制定.     

Detection of biliary and vascular anatomy in living liver donors: Value of gadobenate dimeglumine enhanced MR and MDCT angiography

Objective

To evaluate the performance of magnetic resonance (MR) and multidetector computed tomography (MDCT) in the assessment of living donor's vascular and biliary anatomy, having surgical findings as reference standard.

Methods

Thirty-two living liver donors underwent MR cholangiography (1.5-T; standard cholangiography pulse sequences and delayed acquisitions after administration of biliary contrast agent) for biliary anatomy evaluation. MDCT (16-row multidetector scanner, multiphase protocol, 3 mm slice thickness) was also performed in all cases for the assessment of vascular anatomy before transplantation. Hepatic veins (<4 mm in diameter) were not considered. MR and MDCT images interpretation was performed by two reviewers by consensus, based on source axial images, multiplanar reformats, and three-dimensional (3D) postprocessing images. Surgical intraoperative findings were used as standard of reference.

Results

At surgery, 17 biliary anomalies, 3 portal anomalies, 32 venous and 8 arterial variants were found in the 32 patients. MR correctly identified 15/17 biliary anomalies, with a sensitivity of 88% and a specificity of 93%. MDCT correctly identified 8/8 arterial, 3/3 portal and 29/32 venous variants, with a sensitivity of 100% and 91%, respectively, and a specificity of 100%.

Conclusions

MR and MDCT proved to be efficient in evaluating living liver donor's biliary and vascular anatomy.