Lee V S, Morgan G R, Teperman L W, John D, Diflo T, Pandharipande P V, Berman P M, Lavelle M T, Krinsky G A, Rofsky N M, Schlossberg P, Weinreb J C
Department of Radiology-MRI, New York University Medical Center, 530 First Ave., New York, NY 10016, USA.
AJR Am J Roentgenol. 2001 Jun;176(6):1475-82. doi: 10.2214/ajr.176.6.1761475.
Our aim was to investigate the feasibility of MR imaging as a comprehensive preoperative imaging test for examination of liver donor candidates for adult-to-adult right lobe transplantation.
Twenty-five consecutive donor candidates were examined at 1.5 T using a torso phased array coil with breath-hold T1- and T2-weighted imaging of the abdomen, MR cholangiography using T2-weighted turbo spin-echo imaging, and MR angiography and venography of the liver using two interpolated three-dimensional spoiled gradient-echo sequences (average dose of gadolinium contrast material, 0.17 mmol/kg). Images were interpreted for liver parenchymal and extrahepatic abnormalities; measurements of right and left lobe liver volumes; definition of hepatic arterial, portal venous, and hepatic venous anatomy; and definition of the biliary branching pattern. Findings were compared with those of conventional angiography in 13 patients, 11 of whom also had surgical findings for comparison.
Nine patients were excluded as candidates for donation on the basis of MR imaging findings that included parenchymal or extrahepatic abnormalities in five patients, vascular anomalies in two, and biliary anomalies in three. Two patients who did not undergo surgery underwent conventional angiography that confirmed MR angiographic findings except for a small (<2 mm) accessory left hepatic artery missed on MR imaging. Of the nine patients who underwent successful right hepatectomy, all MR imaging findings were corroborated intraoperatively. In two patients, right hepatectomy was aborted at laparotomy because of intraoperative cholangiography findings; in one of them, the biliary finding was unsuspected on MR imaging.
A comprehensive MR imaging examination has the potential to serve as the sole preoperative imaging modality for living adult-to-adult liver donor candidates provided improvements in definition of intrahepatic biliary anatomy can be achieved.
我们的目的是研究磁共振成像（MR成像）作为成人对成人右叶肝移植供体候选者全面术前成像检查的可行性。
连续25名供体候选者接受1.5T磁共振成像检查，使用体部相控阵线圈，进行腹部屏气T1加权和T2加权成像、采用T2加权快速自旋回波成像的磁共振胆胰管造影以及采用两个内插三维扰相梯度回波序列（钆对比剂平均剂量为0.17 mmol/kg）的肝脏磁共振血管造影和静脉造影。对图像进行解读，以检查肝实质和肝外异常情况；测量左右肝叶体积；明确肝动脉、门静脉和肝静脉解剖结构；以及明确胆管分支模式。将结果与13例患者的传统血管造影结果进行比较，其中11例患者也有手术结果可供对比。
9例患者因MR成像检查结果而被排除在供体候选者之外，其中5例存在实质或肝外异常，2例存在血管异常，3例存在胆管异常。2例未接受手术的患者接受了传统血管造影，除了1例在MR成像上遗漏的小（<2mm）左肝副动脉外，其余结果均证实了MR血管造影的结果。在9例成功进行右肝切除的患者中，所有MR成像检查结果均在术中得到证实。2例患者因术中胆管造影结果而在剖腹手术时中止了右肝切除；其中1例患者的胆管异常在MR成像上未被发现。
如果能够改进肝内胆道解剖结构的清晰度，全面的MR成像检查有可能成为成人对成人生存肝供体候选者唯一的术前成像方式。
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