MR imaging as the sole preoperative imaging modality for right hepatectomy: A prospective study of living adult-to-adult liver donor candidates

OBJECTIVE. Our aim was to investigate the feasibility of MR imaging as a co mprehensive preoperative imaging test for examination of liver donor candid ates for adult-to-adult right lobe transplantation. SUBJECTS AND METHODS. Twenty-five consecutive donor candidates were examine d at 1.5 T using a torso phased array coil with breath-hold T1- and T2-weig hted imaging of the abdomen, MR cholangiography using T2-weighted turbo spi n-echo imaging, and MR angiography and venography of the liver using two in terpolated three-dimensional spoiled gradient-echo sequences (average dose of gadolinium contrast material, 0.17 mmol/kg). Images were interpreted for liver parenchymal and extrahepatic abnormalities; measurements of right an d left lobe liver volumes; definition of hepatic arterial, portal venous, a nd hepatic venous anatomy; and definition of the biliary branching pattern. Findings were compared with those of conventional angiography in 13 patien ts, 11 of whom also had surgical findings for comparison. RESULTS. Nine patients were excluded as candidates for donation on the basi s of MR imaging findings that included parenchymal or extrahepatic abnormal ities in five patients, vascular anomalies in two, and biliary anomalies in three. Two patients who did not undergo surgery underwent conventional ang iography that confirmed MR angiographic findings except for a small (<2 mm) accessory left hepatic artery missed on MR imaging. Of the nine patients w ho underwent successful right hepatectomy, all MR imaging findings were cor roborated intraoperatively. In two patients, right hepatectomy was aborted at laparotomy because of intraoperative cholangiography findings; in one of them, the biliary finding was unsuspected on MR imaging. CONCLUSION. A comprehensive MR imaging examination has the potential to ser ve as the sole preoperative imaging modality for living adult-to-adult live r donor candidates provided improvements in definition of intrahepatic bili ary anatomy can be achieved.