Department of Diagnostic Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Transplantation. 2011 Jul 15;92(1):94-9. doi: 10.1097/TP.0b013e31821c1e33.
Exact knowledge of biliary anatomy is essential in living donor liver transplantation. The purpose of this study was to evaluate the accuracy of pretransplant magnetic resonance cholangiography (MRC) in depicting the biliary anatomy in comparison with intraoperative cholangiography (IOC).
From May 2006 to July 2009, 451 potential living liver donors underwent pretransplant evaluation at the Chang Gung Memorial Hospital-Kaohsiung Medical Center. Two hundred thirty-three donors underwent donor hepatectomy. Of these, only 203 donors with both preoperative MRC and IOC were included in this study.
Of the 451 potential donors, 218 (48.3%) were considered unsuitable for liver donation, hence was immediately disqualified after the initial evaluation for various reasons. Six of the 218 unsuitable donors (2.8%) were excluded due to complicated biliary anatomy. The overall accuracy rate of MRC for defining the biliary anatomy was 91.6%, with 84.9% sensitivity, 96% specificity, 88.2% positive predictive value, and 94.7% negative predictive value. There were 14 misidentified cases. The errors in MRC reading was largely attributed to the poor contrast between the biliary ducts and the surrounding tissues and organs. The concurrence between MRC and IOC were commendable (κ=0.9). No significant biliary complications were noted in the mismatch group.
MRC is essential for all pretransplantation evaluation with 91.6% accuracy rate.
精确的胆道解剖知识对于活体肝移植至关重要。本研究旨在评估术前磁共振胆胰管成像（MRC）在描述胆道解剖方面的准确性，并与术中胆管造影（IOC）进行比较。
2006 年 5 月至 2009 年 7 月，451 名潜在活体肝供者在长庚纪念医院高雄医学中心接受术前评估。233 名供者接受了供肝切除术。其中，仅 203 名供者同时进行了术前 MRC 和 IOC，这些供者被纳入本研究。
在 451 名潜在供者中，218 名（48.3%）因各种原因在初始评估后被认为不适合进行肝捐赠，因此立即被排除在外。218 名不适合的供者中有 6 名（2.8%）因复杂的胆道解剖而被排除。MRC 对胆道解剖的总体准确率为 91.6%，敏感性为 84.9%，特异性为 96%，阳性预测值为 88.2%，阴性预测值为 94.7%。有 14 例被误判。MRC 阅读中的错误主要归因于胆管与周围组织和器官之间的对比度差。MRC 与 IOC 的一致性令人赞赏（κ=0.9）。在不匹配组中未发现明显的胆道并发症。
MRC 对于所有术前评估都是必要的，准确率为 91.6%。
