The evaluation of potential donors' hepatic vascular anatomy in liver transplantation with multislice computed tomography

Abstract

The purpose of this study is to assess the role of multislice computed tomography angiography in the evaluation and determination of variations in hepatic arterial, portal and hepatic venous anatomy in potential liver donors before transplantation. Total 48 healthy liver donor candidates (11 female and 37 male) who applied for liver transplantation donation between March 2010 and July 2013 were included in our study. Donors scanned with 0.625-mm thickness, 64 detector computed tomography (CT) scanner. Unenhanced CT and CT angiography in arterial, portal and hepatic venous phases were performed. From axial images two dimensional multiplanar reformats and with maximum intensity projection and volume rendering techniques three dimensional images were obtained. Hepatic vascular system anatomy and variants were demonstrated. In 34 cases of 48 donor candidates arterial branching were detected compatible with the classic hepatic artery anatomy (Michels type I). Hepatic arterial variations were viewed in 14 cases. In four cases Michels type II and III cases Michels type III variations were present. Michels type IV in one case and Michels type V variations in one another case were detected. Five cases had rare anomalies not classified by Michels (left hepatic artery originating before the gastroduedonal artery and the common hepatic artery arising directly from the aorta). In twenty-five patients from donor candidates, normal main portal venous bifurcation branching (type I); in twenty-three patients, portal venous variations were detected. While middle and left hepatic veins separately drained into vena cava inferior in 32 donor candidates, main hepatic vein and left hepatic vein was being draining in the form of common trunk in 16 of the donors. Segment V and/or VIII veins which were larger than 5 mm and drained to the middle hepatic vein was detected in 12 patients. Fourteen of donor candidates had accessory inferior hepatic vein, 5 patients had accessory superior hepatic veins greater than 5 mm. Multislice CT is a reliable and useful non-invasive technique; in potential liver donors to provide artery, portal and hepatic venous structures mapping and to determine fairly common vascular variations that may complicate surgery before liver transplantation.