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European Radiology

, Volume 29, Issue 12, pp 6508–6518 | Cite as

Clinical usefulness of gadoxetic acid–enhanced MRI for evaluating biliary anatomy in living donor liver transplantation

  • Sang Hyun Choi
  • Kyoung Won KimEmail author
  • Heon-Ju Kwon
  • So Yeon Kim
  • Jae Hyun Kwon
  • Gi-Won Song
  • Sung-Gyu Lee
Hepatobiliary-Pancreas
  • 121 Downloads

Abstract

Objectives

To determine the incremental value of hepatobiliary-phase-MRC (HBP-MRC) added to T2-magnetic resonance cholangiography (T2-MRC) for evaluating biliary anatomy in living donor liver transplantation (LDLT) and to correlate T2+HBP-MRC findings with surgical results.

Methods

A total of 276 donors who underwent T2 and gadoxetic acid–enhanced MRI before right hemihepatectomy for LDLT between January and December 2016 were retrospectively enrolled. Two reviewers evaluated biliary anatomy classification using T2-MRC in the first session and T2+HBP-MRC in the second session. The sensitivity, specificity, and confidence level (5-point scale) of T2-MRC and T2+HBP-MRC for variant biliary anatomy were evaluated. The agreement rates between MRC and operative cholangiography for each biliary anatomy classification and the underestimation rates for multiple bile duct openings (BDOs) for both MRC techniques were evaluated.

Results

Of the 276 donors, variant biliary anatomy was observed in 36.2% (100/276). T2+HBP-MRC showed a significantly higher sensitivity for diagnosing variant biliary anatomy than T2-MRC alone (99.0% [99/100] vs. 89.0% [89/100], p = 0.006), with better observer confidence level (4.9 ± 0.3 vs. 4.6 ± 0.7, p < 0.001) and inter-observer agreement (kappa, 0.902 vs. 0.730). Compared with T2-MRC alone, T2+HBP-MRC provided significantly higher agreement with operative cholangiography in biliary anatomy classification (98.6% [272/276] vs. 89.9% [248/276], p < 0.001), and significantly lower underestimation rate for multiple BDOs (5.8% [16/276] vs. 9.4% [26/276], p = 0.002).

Conclusion

T2+HBP-MRC might be considered than T2-MRC alone, as a better depiction of biliary anatomic variations, correlated with surgical findings.

Key Points

•T2+HBP-MRC predicted variant biliary anatomy more accurately than T2-MRC alone.

•T2+HBP-MRC might have clinical usefulness by reducing the underestimation rate of multiple bile duct openings, which requires more complicated biliary anastomoses.

Keywords

Bile ducts Anatomy Magnetic resonance imaging Cholangiography Gadoxetate disodium 

Abbreviations

BDO

Bile duct opening

CBD

Common bile duct

CHD

Common hepatic duct

HBP-MRC

T1-weighted hepatobiliary-phase magnetic resonance cholangiography

LDLT

Living donor liver transplantation

LHD

Left hepatic duct

OPC

Operative cholangiography

PV

Portal vein

RAHD

Right anterior hepatic duct

RHD

Right hepatic duct

RPHD

Right posterior hepatic duct

T2-MRC

T2-weighted magnetic resonance cholangiography

T2+HBP-MRC

Combination of T2-MRC and HBP-MRC

Notes

Funding

This research was supported by the Basic Science Research Program through the National Research Foundation (NRF) of Korea, funded by the Ministry of Science, ICT, and Future Planning (no. 2017R1E1A1A03070961).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Kyoung Won Kim.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Sang Hyun Choi) has significant statistical expertise.

Informed consent

The requirement for informed consent was waived due to the retrospective nature of this study.

Ethical approval

This study was approved by our Institutional Review Board.

Methodology

• Retrospective

• Observational

• Performed at one institution

Supplementary material

330_2019_6292_MOESM1_ESM.docx (20 kb)
ESM 1 (DOCX 20 kb)

References

  1. 1.
    Brown RS Jr, Russo MW, Lai M et al (2003) A survey of liver transplantation from living adult donors in the United States. N Engl J Med 348:818–825CrossRefGoogle Scholar
  2. 2.
    Kochhar G, Parungao JM, Hanouneh IA, Parsi MA (2013) Biliary complications following liver transplantation. World J Gastroenterol 19:2841–2846CrossRefGoogle Scholar
  3. 3.
    Umeshita K, Fujiwara K, Kiyosawa K et al (2003) Operative morbidity of living liver donors in Japan. Lancet 362:687–690CrossRefGoogle Scholar
  4. 4.
    Puente SG, Bannura GC (1983) Radiological anatomy of the biliary tract: variations and congenital abnormalities. World J Surg 7:271–276CrossRefGoogle Scholar
  5. 5.
    Russell E, Yrizzary JM, Montalvo BM, Guerra JJ Jr, al-Refai F (1990) Left hepatic duct anatomy: implications. Radiology 174:353–356Google Scholar
  6. 6.
    Song GW, Lee SG, Hwang S et al (2007) Preoperative evaluation of biliary anatomy of donor in living donor liver transplantation by conventional nonenhanced magnetic resonance cholangiography. Transpl Int 20:167–173CrossRefGoogle Scholar
  7. 7.
    Fulcher AS, Szucs RA, Bassignani MJ, Marcos A (2001) Right lobe living donor liver transplantation: preoperative evaluation of the donor with MR imaging. AJR Am J Roentgenol 176:1483–1491CrossRefGoogle Scholar
  8. 8.
    An SK, Lee JM, Suh KS et al (2006) Gadobenate dimeglumine-enhanced liver MRI as the sole preoperative imaging technique: a prospective study of living liver donors. AJR Am J Roentgenol 187:1223–1233CrossRefGoogle Scholar
  9. 9.
    Rosch T, Meining A, Frühmorgen S et al (2002) A prospective comparison of the diagnostic accuracy of ERCP, MRCP, CT, and EUS in biliary strictures. Gastrointest Endosc 55:870–876CrossRefGoogle Scholar
  10. 10.
    Lee MS, Lee JY, Kim SH et al (2011) Gadoxetic acid disodium-enhanced magnetic resonance imaging for biliary and vascular evaluations in preoperative living liver donors: comparison with gadobenate dimeglumine-enhanced MRI. J Magn Reson Imaging 33:149–159CrossRefGoogle Scholar
  11. 11.
    Lee Y, Kim SY, Kim KW et al (2015) Contrast-enhanced MR cholangiography with Gd-EOB-DTPA for preoperative biliary mapping: correlation with intraoperative cholangiography. Acta Radiol 56:773–781CrossRefGoogle Scholar
  12. 12.
    Cai L, Yeh BM, Westphalen AC, Roberts J, Wang ZJ (2017) 3D T2-weighted and Gd-EOB-DTPA-enhanced 3D T1-weighted MR cholangiography for evaluation of biliary anatomy in living liver donors. Abdom Radiol (NY) 42:842–850CrossRefGoogle Scholar
  13. 13.
    Santosh D, Goel A, Birchall IW et al (2017) Evaluation of biliary ductal anatomy in potential living liver donors: comparison between MRCP and Gd-EOB-DTPA-enhanced MRI. Abdom Radiol (NY) 42:2428–2435CrossRefGoogle Scholar
  14. 14.
    Kang HJ, Lee JM, Yoon JH et al (2018) Additional values of high-resolution gadoxetic acid-enhanced MR cholangiography for evaluating the biliary anatomy of living liver donors: comparison with T2-weighted MR cholangiography and conventional gadoxetic acid-enhanced MR cholangiography. J Magn Reson Imaging 47:152–159CrossRefGoogle Scholar
  15. 15.
    Lim JS, Kim MJ, Myoung S et al (2008) MR cholangiography for evaluation of hilar branching anatomy in transplantation of the right hepatic lobe from a living donor. AJR Am J Roentgenol 191:537–545CrossRefGoogle Scholar
  16. 16.
    Mangold S, Bretschneider C, Fenchel M et al (2012) MRI for evaluation of potential living liver donors: a new approach including contrast-enhanced magnetic resonance cholangiography. Abdom Imaging 37:244–251CrossRefGoogle Scholar
  17. 17.
    Kinner S, Steinweg V, Maderwald S et al (2014) Comparison of different magnetic resonance cholangiography techniques in living liver donors including Gd-EOB-DTPA enhanced T1-weighted sequences. PLoS One 9:e113882CrossRefGoogle Scholar
  18. 18.
    Uysal F, Obuz F, Uçar A, Seçil M, Igci E, Dicle O (2014) Anatomic variations of the intrahepatic bile ducts: analysis of magnetic resonance cholangiopancreatography in 1011 consecutive patients. Digestion 89:194–200CrossRefGoogle Scholar
  19. 19.
    Takeishi K, Shirabe K, Yoshida Y et al (2015) Correlation between portal vein anatomy and bile duct variation in 407 living liver donors. Am J Transplant 15:155–160CrossRefGoogle Scholar
  20. 20.
    Jhaveri KS, Guo L, Guimarães L (2017) Current state-of-the-art MRI for comprehensive evaluation of potential living liver donors. AJR Am J Roentgenol 209:55–66CrossRefGoogle Scholar
  21. 21.
    Papanikolaou N, Prassopoulos P, Eracleous E, Maris T, Gogas C, Gourtsoyiannis N (2001) Contrast-enhanced magnetic resonance cholangiography versus heavily T2-weighted magnetic resonance cholangiography. Invest Radiol 36:682–686CrossRefGoogle Scholar
  22. 22.
    Lee VS, Krinsky GA, Nazzaro CA et al (2004) Defining intrahepatic biliary anatomy in living liver transplant donor candidates at mangafodipir trisodium-enhanced MR cholangiography versus conventional T2-weighted MR cholangiography. Radiology 233:659–666CrossRefGoogle Scholar
  23. 23.
    Carlos RC, Hussain HK, Song JH, Francis IR (2002) Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid as an intrabiliary contrast agent: preliminary assessment. AJR Am J Roentgenol 179:87–92CrossRefGoogle Scholar
  24. 24.
    Kishi Y, Imamura H, Sugawara Y et al (2010) Evaluation of donor vasculobiliary anatomic variations in liver graft procurements. Surgery 147:30–39CrossRefGoogle Scholar
  25. 25.
    Kitami M, Takase K, Murakami G et al (2006) Types and frequencies of biliary tract variations associated with a major portal venous anomaly: analysis with multi-detector row CT cholangiography. Radiology 238:156–166CrossRefGoogle Scholar
  26. 26.
    Dulundu E, Sugawara Y, Sano K et al (2004) Duct-to-duct biliary reconstruction in adult living-donor liver transplantation. Transplantation 78:574–579CrossRefGoogle Scholar
  27. 27.
    Ikegami T, Soejima Y, Taketomi A et al (2008) Hilar anatomical variations in living-donor liver transplantation using right-lobe grafts. Dig Surg 25:117–123CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of MedicineSeoulSouth Korea
  2. 2.Department of Radiology, Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulSouth Korea
  3. 3.Division of Liver Transplantation and Hepatobiliary Surgery, and Departments of SurgeryUniversity of Ulsan College of MedicineSeoulSouth Korea

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