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



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.


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.


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).


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.


Bile ducts Anatomy Magnetic resonance imaging Cholangiography Gadoxetate disodium 



Bile duct opening


Common bile duct


Common hepatic duct


T1-weighted hepatobiliary-phase magnetic resonance cholangiography


Living donor liver transplantation


Left hepatic duct


Operative cholangiography


Portal vein


Right anterior hepatic duct


Right hepatic duct


Right posterior hepatic duct


T2-weighted magnetic resonance cholangiography


Combination of T2-MRC and HBP-MRC



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


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.


• Retrospective

• Observational

• Performed at one institution

Supplementary material

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


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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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