Living related liver transplantation:: Preoperative magnetic resonance imaging for assessment of hepatic vasculature of donor candidates

Purpose: To evaluate the accuracy of magnetic resonance angiography (MRA) for preoperative assessment of hepatic vascular anatomy in liver donors before living related liver transplantation. Material and Methods: A total of 55 consecutive living liver donors (mean age 42 years, range 18-68 years) underwent multiphase contrast-enhanced MRA of the hepatic vessels. Two readers categorized vessel visualization on a five-point scale and recorded vascular anatomy or variations thereof for the arterial, portal venous and venous systems. All 55 living liver donors subsequently underwent right hemihepatectomy for hemiliver donation, and preoperative MRA results were correlated with surgical findings. Results: Overall vessel visualization assessment demonstrated good or very good ratings for the majority of patients. For hepatic arteries, the mean score was 4.4+/-0.8 (mean+/-standard deviation), and for the portal venous and venous systems it was 4.6+/-0.7 and 4.3+/-0.8, respectively. Among all 55 donors, 16 (29%) demonstrated accessory or replaced hepatic arteries, and seven (13%) and 20 (36%) donors had surgically relevant portal vein (trifurcation or early right posterolateral branching types) and hepatic vein variations, respectively. Correlation coefficients between MRA and surgery were 0.94, 1.00 and 0.91 for hepatic arteries, portal veins and hepatic veins, respectively. Conclusion: In the preoperative evaluation before living related liver donation, contrast-enhanced MR angiography was a highly accurate, noninvasive tool for visualizing the hepatic vasculature and variations thereof in liver donor candidates.