Correlation Among 3-Dimensional Magnetic Resonance Cholangiography, Intraoperative Cholangiography, and Intraoperative Findings in Right Liver Donors.

Abstract

A correct preoperative definition of the hepatic duct confluence anatomy of right liver living donors is pivotal in determining their candidacy for donation and planning surgery during liver transplant. Here, we evaluated the accuracy of 3-dimensional magnetic resonance cholangiography compared with intraoperative cholangiography in assessing biliary anatomy and aimed to identify imaging characteristics that may help to predict the yield of hepatic duct orifices in the right liver graft. All consecutive living hepa-tectomy donors for adult liver transplant included in this study (N = 110) were evaluated with preoperative 3-dimensional magnetic resonance cholangiography, which was performed before and after intravenous administration of gadolinium (20-40 cm³). For intraoperative cholangiography, a 4F catheter was advanced through the cystic duct, and contrast matter (5-10 mL) was injected into the biliary tree via the catheter. The number of right hepatic ducts in explanted graft was determined on the back table. Of 110 donors, 71 had type 1 (normal) biliary anatomy based on both 3-dimensional magnetic resonance and intraoperative cholangiography and 39 had abnormal biliary anatomy, with 2 having type 3 (abnormal) biliary anatomy. Normal biliary anatomy was found in back-table examination, and abnormal biliary anatomy (type 2) was found with intraoperative cholangiography. Sensitivity, specificity, and predic-tive values of 3-dimensional magnetic resonance cholangiography in revealing the biliary anatomy and anomalies were compared with intraoperative cholangiography findings. Observed final hepatic duct outcomes were also assessed. Use of 3-dimensional magnetic resonance cholangiography accurately predicted the biliary anatomy in 97 of 110 cases. Sensitivity was 80.4%, positive predictive value was 94.4%, specificity was 96.9%, and negative predictive value was 87.3%. Three-dimensional magnetic resonance cholangiography reliably represented normal biliary anatomy; the presence of anatomic variations decreased its sensitivity, making intraoperative cholangiography or duct probing necessary tools to accurately perform right hepatic duct transection.