From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800, Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath); Department of Radiology, University of Chicago School of Medicine, Chicago, Ill (C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H.); and Department of Radiology, University of Toronto, Toronto, Ontario, Canada (A.Z.K.).
Radiographics. 2021 Oct;41(6):1572-1591. doi: 10.1148/rg.2021210012.
The need for liver transplants is increasing because the prevalence of liver diseases and the indications for transplants are growing. In response to the shortage of grafts from deceased donors, more transplants are being performed worldwide with grafts from living donors. Radiologic evaluation is an integral component in the assessment of donor candidates to ensure their eligibility and to choose the most appropriate surgical approach. MRI is the preferred modality for evaluation of the liver parenchyma and biliary tree. In most centers, a combination of MRI and CT is used to take advantage of the higher spatial resolution of CT for evaluation of arteries. However, MRI-only assessment is feasible. In addition to assessment of the liver parenchyma for abnormalities such as steatosis, a detailed evaluation of the hepatic vascular and biliary system for pertinent anatomic variants is crucial, because these variants can affect surgical techniques and outcomes in both recipients and donors. In this pictorial article, after a brief review of the most common surgical techniques and postsurgical liver anatomy, the biliary and vascular anatomy are discussed, with specific attention paid to the variants that are pertinent to this surgical procedure. The roles of liver segmentation and volumetric assessment and current imaging techniques and protocols are also discussed. RSNA, 2021.
由于肝脏疾病的发病率和移植适应证不断增加，对肝移植的需求也在不断增加。为了应对已故供体器官短缺的问题，全球范围内越来越多的移植手术采用活体供体器官。放射学评估是评估供体候选人的一个重要组成部分，以确保其符合条件，并选择最合适的手术方法。磁共振成像（MRI）是评估肝实质和胆道系统的首选方式。在大多数中心，将 MRI 和 CT 相结合，以利用 CT 对动脉评估的更高空间分辨率。但是，仅行 MRI 检查也是可行的。除了评估肝脏实质是否存在脂肪变性等异常外，详细评估肝血管和胆道系统的相关解剖变异也至关重要，因为这些变异会影响受者和供者的手术技术和结果。在这篇影像学文章中，简要回顾了最常见的手术技术和术后肝脏解剖结构后，我们将讨论胆道和血管解剖结构，并特别关注与该手术相关的变异。还讨论了肝分段和体积评估的作用，以及当前的成像技术和方案。放射学学会，2021 年。
