3-DIMENSIONAL HELICAL COMPUTED TOMOGRAPHIC CHOLANGIOGRAPHY - APPLICATION TO LIVING-RELATED HEPATIC TRANSPLANTATION

Variations in the anatomy of intrahepatic bile ducts complicate operat ions in living related hepatic transplantation (LRHT). Preoperative de lineation of the biliary system is important to achieve successful res ults. The purpose of this study was to assess the utility and accuracy of three-dimensional helical computed tomographic cholangiography (3D HCTC) as a replacement for endoscopic retrograde cholangiography (ERC) in evaluating the anatomy of the intersegmental biliary connection of the potential donors in LRHT. Helical CT was performed in 16 potentia l donors after a slow infusion of 100 cm(3) meglumine iodipamide. By u sing the maximum intensity projection and shaded surface displaced ima ge reconstruction technique, three-dimensional images of the bile duct s were isolated from the surrounding hepatic parenchyma. Among the 16 potential donors, 3 cases underwent an ERC study and another 7 cases d onated liver graft during LRHT. In all 16 cases the anatomy of the bil ateral essential intrahepatic ducts was well displayed with and withou t the liver parenchyma background in an axial and three-dimensional fa shion which had good correlation with images from ERC and intra-operat ive cholangiography. Two variants were found, including drainage of th e right posterior intrahepatic duct into the left hepatic duct and dir ect drainage of the segment II bile duct into the common hepatic duct, respectively. It is concluded that unusual routes of intrahepatic duc ts may necessitate a change in the cutting plane during graft retrieva l and patterns of ductoenteral anastomosis to avoid potential complica tions to both donors and recipients. With the advantages of non-invasi veness and comparable accuracy in demonstrating biliary anatomy, 3DHCT C may replace the traditional ERC in the pre-transplant survey of pote ntial donors for LRHT.