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MR Imaging as the Sole Preoperative Imaging Modality for Right Hepatectomy

A Prospective Study of Living Adult-to-Adult Liver Donor Candidates

¹ Department of Radiology—MRI, New York University Medical Center, 530 First Ave., New York, NY 10016.
² Department of Surgery, New York University, New York, NY 10016.

View larger version (100K): [in a new window]   Fig. 1A. —Presumed focal nodular hyperplasia and inferior accessory hepatic vein in 36-year-old woman who was potential liver donor. Axial T2-weighted short tau inversion recovery turbo spin-echo MR image (TR/TE, 4200/76) shows mildly hyperintense mass in right lobe (arrow).

View larger version (109K): [in a new window]   Fig. 1B. —Presumed focal nodular hyperplasia and inferior accessory hepatic vein in 36-year-old woman who was potential liver donor. Axial equilibrium phase contrast-enhanced image from 3D gradient-echo MR image (4.5/1.9; flip angle, 12°) depicts same lesion with small central scar (arrow). This was one of several lesions in this asymptomatic patient, all of which were presumed to be focal nodular hyperplasia.

View larger version (140K): [in a new window]   Fig. 1C. —Presumed focal nodular hyperplasia and inferior accessory hepatic vein in 36-year-old woman who was potential liver donor. Axial reformation of same data shown in B depicts inferior accessory hepatic vein (arrow).

View larger version (165K): [in a new window]   Fig. 1D. —Presumed focal nodular hyperplasia and inferior accessory hepatic vein in 36-year-old woman who was potential liver donor. Coronal reformation of data shown in C shows inferior hepatic vein (arrow) and craniocaudal location of confluence with inferior vena cava (I). Coronal reconstruction is often helpful for surgical planning.

View larger version (154K): [in a new window]   Fig. 2. —Enlarged abdominal lymph nodes in 36-year-old woman examined as potential liver donor. Axial contrast-enhanced 3D gradient-echo MR image (TR/TE, 4.5/1.9; flip angle, 12°) confirms numerous distinct enlarged abdominal lymph nodes (arrows). Patient was subsequently proven to have sarcoidosis at mediastinal lymph node biopsy.

View larger version (109K): [in a new window]   Fig. 3A. —Normal hepatic artery anatomy and portal vein variant in 27-year-old man, a potential liver donor. Volume-rendered contrast-enhanced three-dimensional (3D) MR angiogram (TR/TE, 6.8/2.3; flip angle, 25°) shows normal hepatic artery branching pattern with right (curved arrow) and left (straight broad arrow) hepatic arteries arising just beyond gastroduodenal artery (short thin arrow) and normal left gastric artery (long thin arrow).

View larger version (131K): [in a new window]   Fig. 3B. —Normal hepatic artery anatomy and portal vein variant in 27-year-old man, a potential liver donor. Coronal view of digital subtraction angiogram from selective celiac injection shows comparable anatomy with vessels labeled as in A.

View larger version (110K): [in a new window]   Fig. 3C. —Normal hepatic artery anatomy and portal vein variant in 27-year-old man, a potential liver donor. Oblique coronal volume-rendered reconstruction of delayed contrast-enhanced 3D acquisition (4.5/1.9; flip angle, 12°) in same patient shows anomalous origin of left portal vein (L) from anterior branch of right portal vein (RA). Right posterior portal vein (RP) branch arises more proximally.

View larger version (147K): [in a new window]   Fig. 4. —Replaced right hepatic artery in 51-year-old man being examined as possible liver donor. Volume-rendered contrast-enhanced MR angiogram (TR/TE, 6.8/2.3; flip angle, 25°) depicts anomalous origin of right hepatic artery (straight broad arrow) from superior mesenteric artery (S). Proper hepatic artery (curved arrow) supplies left lobe, and middle hepatic artery (straight thin arrow) can be seen arising from proper/left hepatic artery.

View larger version (106K): [in a new window]   Fig. 5A. —Biliary anomaly in 51-year-old woman in whom MR cholangiography was initially interpreted as showing normal anatomy. Coronal heavily T2-weighted turbo spin-echo MR image (TR/TE, 2800/1100) depicts large branch (thin arrow) off left hepatic duct (broad arrow) that was originally interpreted as draining portion of left lobe.

View larger version (155K): [in a new window]   Fig. 5B. —Biliary anomaly in 51-year-old woman in whom MR cholangiography was initially interpreted as showing normal anatomy. Intraoperative cholangiogram shows biliary variant. Large branch (thin arrow), seen on MR image A, was in fact right lateral duct draining aberrantly into proximal left hepatic duct (broad arrow). This finding excluded patient as right hepatectomy candidate, and surgery was aborted.

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