Magnetic resonance of the hepatic veins with angular reconstruction - Application in living-related liver transplantation

Background. Preoperative mapping of the hepatic venous system of the partia l liver graft is indispensable to the success of living-related liver trans plantation. We assessed the accuracy of magnetic resonance (MR) venography with angular reconstruction in depicting the tributaries of the middle hepa tic vein and left hepatic vein in the donors, which was essential in graft retrieval and venoplasty, Methods. Nineteen living-related liver transplantation donors underwent a p retransplantation survey, including sonography and MRI for hepatic venous e valuation, T1-weighted images were reconstructed manually, using the inferi or vena cava as a fixed point for tilting to produce an oblique plane image where both the middle hepatic vein and left hepatic vein could be demonstr ated draining into the inferior vena cava, The reconstructed images of the hepatic veins were compared with preoperative sonography, intraoperative so nography, and operative findings. Results. Preoperative sonography and MR findings correlated well with the o perative findings in the major hepatic veins. The MR venography of the rami fication of the hepatic veins has an accuracy of 93%, the sonography, 84%. Sonography is slightly inferior in the evaluation of the hepatic vein in se gment 4 and the left superior hepatic vein, with an accuracy of 73% and 67% , respectively. Conclusion. MR venography with angular reconstruction is accurate in depict ing the complex distribution of the hepatic veins of the left liver, provid ing important information for decision making as to the cutting plane durin g graft retrieval and the method off venoplasty and anastomosis, Thus, unne cessary blood loss could be avoided and vascular complications could be pre vented, as these conditions would be unacceptable for a healthy living dono r. We propose that MR venography, a rapid and reliable technique, is an app ropriate alternative examination or complementary modality to sonography in the pretransplantation evaluation of the living donor.