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Vascular Complications After Living Related Liver Transplantation: Evaluation with Gadolinium-Enhanced Three-Dimensional MR Angiography

¹ Department of Diagnostic Radiology, University of Ulsan, Asan Medical Center, 388-1 Poongnap-dong, Songpa-ku, Seoul, 138-736, Korea.
² Department of Surgery, University of Ulsan, Asan Medical Center, Songpa-ku, Seoul, 138-736, Korea.

OBJECTIVE. The purpose of this study was to evaluate the efficacy of gadolinium-enhanced three-dimensional (3D) MR angiography for detection of vascular complications in patients who have undergone living related liver transplantation.

MATERIALS AND METHODS. Seventy-six patients who underwent living related liver transplantation were evaluated with gadolinium-enhanced 3D MR angiography. All MR angiograms were assessed for patency of the hepatic artery and the portal vein using a four-point scale (grades I–IV). The results were correlated with conventional angiography (n = 23) and clinical follow-up with Doppler sonography (n = 53) for more than 6 months.

RESULTS. Seventy-three of 76 MR angiography procedures were technically adequate. When grades III (focal narrowing [> 50%] at the anastomotic site) and IV (abrupt cutoff at the anastomotic site with nonvisualization of the right [or left] hepatic artery distal to the anastomosis) were regarded as the diagnostic criteria for hepatic artery stenosis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MR angiography were 100%, 74%, 29%, 100%, and 77%, respectively. In the portal vein, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MR angiography were 100%, 84%, 35%, 100%, and 85%, respectively, when grades III (narrowing [> 50%] without poststenotic dilatation) and IV (narrowing [> 50%] with poststenotic dilatation) were defined as criteria for portal vein stenosis.

CONCLUSION. MR angiography was sensitive but not specific in the detection of significant vascular stenosis after living related liver transplantation. However, normal MR angiography findings reliably exclude the possibility of significant stenosis.

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