MAGNETIC-RESONANCE VENOGRAPHY IN POTENTIAL PEDIATRIC LIVER-TRANSPLANTRECIPIENTS

Vascular anomalies may be hazardous to liver transplantation, and pre- operative vascular evaluation is important for a safe and successful o peration. The purpose of this study was to assess the utility and accu racy of time-of-flight (TOF) magnetic resonance venography (MRV) with three-dimensional (3D) reconstruction as an alternative for convention al catheter angiography in evaluating the portal venous system and inf erior vena cava (IVC) in potential pediatric liver transplant recipien ts. Twenty consecutive cases of small children with biliary atresia we re evaluated with TOF MRV with 3D reconstruction by Advantage Window w orkstation. All 20 cases underwent conventional angiography; two cases received transhepatic portagraphy and three cases received splenoport ographic study. The whole MRV examination and filming required less th an 30 min. Findings of portal vein and IVC completely agreed with or w ere superior to the successful catheter angiographic images. The porta l vein was occluded in five cases, and patent in fifteen cases which i ncluded: twelve hepatopetal flow, two hepatofugal flow and one small c aliber portal vein. Varices were found in 18 cases. In the case of the IVC, 18 of them were normal and 2 had congenital abnormalities which included paired vena cava and hypoplasia vena cava with compensatory e nlargement of the azygos and hemiazygos systems. Eight of the cases re ceived liver transplantation, and the MRV findings totally correlated with the final anatomy as found intraoperatively. MRV is accurate for evaluating the condition of the portal venous system and IVC, detectio n, and determining the distribution and extents of the varices. It is a reliable, noninvasive and rapid technique which can be considered as an alternative workup for the invasive angiography and or portography in small children for pre-transplantation evaluation.