Preoperative evaluation of patients awaiting liver transplantation: Comparison of multiphasic contrast‐enhanced 3D magnetic resonance to helical computed tomography examinations

Abstract

Purpose:To determine the feasibility of using a multiphasic magnetic resonance (MR) examination to evaluate the hepatic arterial anatomy and parenchyma in patients awaiting orthotopic liver transplantation (OLT). Materials and Methods:Twenty consecutive patients awaiting OLT underwent multiphasic MR (using a T1-weighted 3D gadolinium-enhanced gradient-echo (GRE) sequence and two separate injections of contrast material) and computed tomography (CT) imaging; both imaging studies were performed within a 1-week period for each patient. Quantitative and qualitative assessment of the hepatic arterial system on MR data was performed. Two independent observers classified the hepatic arterial anatomy and evaluated the hepatic parenchyma from the MR data. The prospective CT interpretation was used as the gold standard.Results: Overall qualitative rating of hepatic arterial system-to-background contrast on MR data was good to excellent (average pooled score of 2.00 Ϯ 0.27), with no significant difference between the two observers after the first or second injections of contrast material. Classification of hepatic arterial anatomy by MR angiography (MRA) and CT angiography (CTA) was concordant in 85% (17/20) of patients and discordant in 15% (3/20) of patients. Focal parenchymal lesions were detected in 25% (5/20) of patients by MR and CT; however, two lesions in one patient with multiple lesions were detected only with MR. Conclusion:Multiphasic T1-weighted 3D gadolinium-enhanced MR examination can provide comprehensive evaluation of the hepatic arterial anatomy and parenchyma in patients awaiting OLT. MR may offer an advantage over CT in the detection of focal parenchymal lesions.

Accuracy of magnetic resonance imaging for preoperative detection of portal vein thrombosis in liver transplant candidates

“…A strength of the current study is that compared with other studies, it includes a larger number of patients who underwent liver transplantation, and findings on MRI were correlated with findings on explant 9, 18. Limitations of our study include a variable, and in some cases lengthy, time interval between the last MRI and surgery, and relatively few patients with PVT.…”

“…The experience gained with living related donor procedures has demonstrated that MRI is extremely accurate at evaluating the parenchyma for liver masses as well as the venous, arterial, and biliary trees 8. Moreover, MRI can be performed in patients with renal impairment, a frequent complication in cirrhotic patients 9. Data regarding the sensitivity and specificity of MRI at detecting and characterizing portal vein thrombi are scarce 10.…”

Gadobenate Dimeglumine-Enhanced Liver MRI as the Sole Preoperative Imaging Technique: A Prospective Study of Living Liver Donors

“…Although the spatial resolution of MRI for the evaluation of hepatic arterial anatomy remains inferior to that of DSA, MRA has, in our experience, proven to be an accurate preoperative test for the definition of the portal and hepatic venous anatomy. Several studies have found that CT or MRI can show the anatomy of the hepatic vasculature of a liver donor before transplantation [23][24][25]. Winter et al [23] and Chan et al [24] showed that in liver transplantation candidates, successful 3D CT arteriography was as accurate as catheter angiography for assessing hepatic arterial anatomy.…”

Preoperative evaluation of the hepatic vascular anatomy in living liver donors: Comparison of CT angiography and MR angiography

“…By replacing CT with MRI, we can eliminate the need to expose the potential donor to ionizing radiation and less safe contrast agents than gadolinium chelates (9, 13). Eubank et al (10) reported that classification of the hepatic arterial anatomy by CTA and MRA was concordant in 85% (17/20) of patients, and discordant in 15% (3/20) of patients awaiting orthotopic liver transplantation. Schroeder et al (14) undertook a study comparing CT and MR for the preoperative evaluation of potential living liver donors ( N = 25).…”

“…With rapid technological developments in magnetic resonance imaging (MRI), such as increased gradient strength, surface coils with better sensitivity, and parallel imaging, MR angiography (MRA) has recently become a new imaging modality for the preoperative evaluation of potential living liver donors. It has been proven to be a useful alternative to CTA in patients with impaired renal function (9–13). Furthermore, an MR examination has additional benefits compared to CTA in the preoperative workup of liver donors, including no radiation hazard and the ability to reveal the biliary anatomy without using a biliary contrast agent.…”