“一站式”MRI在活体肝移植术前评估中的价值

目的：探讨“一站式”MRI在活体肝移植供肝术前影像评估中的价值。方法：61例行活体半肝移植的供体术前行“一站式”MRI检查,后处理重建肝血管及胆道系统,并与手术所见对照。结果：61例活体供肝中,MichelⅠ型肝动脉48例,Ⅲ型7例,Ⅷ型2例,Ⅸ型1例,2例Ⅳ段肝动脉起自肝右动脉（RHA）,1例RHA起自腹腔干（CT）。58例正常门静脉解剖,3例“三分叉”型门静脉。41例正常肝静脉解剖,18例肝左静脉（LHV）和肝中静脉（MHV）形成共干后汇入IVC;2例肝右下静脉（IRHV）汇入下腔静脉（IVC）。58例正常肝管解剖,2例“三分叉＇型胆管,1例肝右后叶胆管（RPHD）起自左肝管（LHD）。术前MR对供体肝动脉、门静脉和肝静脉解剖的诊断正确率分别为96.7%,100%,95.1%。MRCP结合增强MR胆管造影联合显示胆道系统解剖的准确率为93.4%。结论：“一站式”MRI检查方案能够显示活体肝动脉、门静脉、肝静脉及胆道系统的解剖及变异,可以作为活体肝移植的术前评估方式。

The value of "one-stop" comprehensive MR evaluation in living donor liver transplantation

Objective： To explore the value of ＂one-stop＂ comprehensive MR evaluation in living donor of liver transplantation （LDLT）. Methods： Sixty-one living liver donors underwent ＂one-stop＂ MRI before LDLT. All the primary data were reconstructed by maximum intensity projection（MIP） in post-procession workstation. The anatomy and variation of hepatic arterial, portal venous branching, hepatic veins and biliary system were evaluated and compared with the result of surgery. Results： Of the 61 the living donors, 48 had type Ⅰ, 7 type Ⅲ, 2 type Ⅷ and 1 type Ⅸ hepatic arterial anatomy according to Michel＇ s hepatic artery classification. Two had dominant artery to segment Ⅳ arising from the right hepatic artery （RHA） and 1 RHA from the celiac trunk（CT）. Fifty-eight had conventional portal vein anatomy and 3 had ＂three bifurcation＂ type of portal vein. 41 had normal draining pattern of the hepatic veins. Left hepatic vein（LHV） and middle hepatic vein（MHV） formed a common trunk before draining into the inferior vcna cava （IVC） were found in 18 cases. 2 inferior right hepatic vein （IRHV） were detected. Fifty-eight cases had normal anatomy of the hepatic duct, 2 had ＂three bifurcation＂ type bile duct, and 1 posterior right hepatic bile duct（RPHD） draining into the left hepatic duet（LHD）. The diagnostic accuracy of MR in hepatic artery, portal vein, hepatic venous and biliary system was 96.7%, 100%, 95.1% and 93.4%, respectively. Conclusion： ＂One-stop＂ comprehensive MR evaluation can successfully delineate the anatomy and variations of hepatic vascular and hiliary system and can be used in the preoperation evaluation of living donor in living donor liver transplatation.