Evaluation of Living Liver Donors with an All-inclusive 3D Multi–Detector Row CT Protocol

Abstract

To prospectively assess parenchymal, vascular, and biliary anatomy of potential living liver donors with an all-inclusive multi-detector row computed tomographic (CT) approach. A total of 250 potential living liver donors (112 women, 138 men; mean age, 37 years) underwent three-phase, dual-enhancement multi-detector row CT to delineate biliary, vascular, and parenchymal morphology according to an institutional review board-approved protocol. Informed consent was obtained from all subjects. For display of the biliary system, the first CT image set was collected after the infusion of a biliary contrast agent. CT angiography was subsequently performed, after automated injection of a conventional iodinated contrast agent, to display the arterial and portal-hepatic venous systems. All data sets were reconstructed in 1-mm sections. Data analysis was based on source images, multiplanar reconstructions, and three-dimensional postprocessing images; was performed in consensus by two radiologists; and was focused on the detection of biliary and vascular variants, exclusion of focal liver lesions, and determination of hepatic volumes. Preoperative findings were correlated with intraoperative findings (available in 62 subjects). Technical failures were experienced in 10 of 250 examinations. Twenty-seven subjects had moderate adverse reactions related to the biliary contrast agent. Benign hepatic lesions were detected in 61 candidates; one candidate had a renal cell carcinoma. Underlying biliary and vascular anatomy was displayed at least to the second intrahepatic branch in all but seven patients. Detected anatomic variants involved the biliary (38.8%), arterial (40.0%), portal venous (21.4%), and hepatic venous (43.5%) systems. Correlation with intraoperative findings was excellent. Some biliary (n = 4), arterial (n = 5), portal venous (n = 1), and hepatic venous (n = 6) variants were missed or misinterpreted at initial reading of preoperative data; however, variants could be retrospectively depicted in all but one biliary case and one hepatic venous case. The outlined three-phase, dual-enhancement multi-detector row CT protocol represents an all-inclusive approach to evaluate potential living liver donors in a single diagnostic step.