Superior diagnostic strength of combined contrast enhanced MR-angiography and MR-imaging compared to intra-arterial DSA in liver transplantation candidates

To evaluate the diagnostic value of combined contrast enhanced MRA (ce-MRA) and MRI compared to that of intra-arterial DSA (i.a.DSA) in liver transpla ntation, transjugular porto-systemic (TIPSS) and spleno-renal shunt candida tes. 50 patients in the workup for liver transplantation underwent ce-MRA/MRI an d i.a.DSA within a three days interval. Both examinations were assessed wit h respect to vessel anatomy and patency of the arterial, portal venous, por to-systemic collateral and systemic venous system. The results were compare d with the intra-operative findings when available. Malignancy detection in ce-MRA/MRI and i.a.DSA were compared. There are no significant differences for the arterial part of the vascular supply to the liver that is important for transplantation. Although the dif ferences for the portal system are not significant, the difference between the two techniques is of clinical importance because i.a.DSA failed to dete ct portal vein occlusion in 4 patients. Ce-MRA is significantly better for the detection of collaterals (p < 0.001) and the assessment of the inferior vena cava, the hepatic and the renal veins (p < 0.001). Although the detec tion of liver malignancy is poor in both techniques, ce-MRA/MRI is superior to i.a.DSA. This study shows that a one step diagnostic approach with a combination of ce-MRA and MRI is a valuable radiological tool with a superior diagnostic s trength compared to i.a.DSA in the liver transplantation and shunt candidat e. Therefore, ce-MRA/MRI should replace i.a.DSA in these patients groups. ( C) 2001 Elsevier Science Inc. All rights reserved.