Right Lobe Living Donor Liver Transplantation
Preoperative Evaluation of the Donor with MR Imaging
Ann S. Fulcher1,
Richard A. Szucs1,2,
Matthew J. Bassignani1,3 and
Amadeo Marcos1,4
1
Department of Radiology, Medical College of Virginia of Virginia Commonwealth
University, 401 N. 12th St., Rm. 3-407B, P. O. Box 980615, Richmond, VA
23298-0615.
2
Present address: Department of Radiology, St. Mary's Hospital, 5875 Bremo Rd.,
South Bldg., G-6, Richmond, VA 23229.
3
Present address: Department of Radiology, University of Virginia Health
Sciences Center, Lee St., Rm. 1075, Charlottesville, VA 22908.
4
Present address: Department of Surgery, University of Rochester Medical
Center, 601 Elmwood Ave., Rm. 2-6114A, Rochester, NY 14642.
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Fig. 1A — Volumetric analysis of liver in 25-year-old man (potential
donor). Axial T1-weighted fat-suppressed enhanced MR image of superior aspect
of liver shows right (R), middle (M), and left (L) hepatic veins, which are
anatomic landmarks that define boundaries of hepatic lobes and segments at
this level. Note that two right hepatic veins join to form common trunk before
entering inferior vena cava (arrow).
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Fig. 1B. — Volumetric analysis of liver in 25-year-old man (potential
donor). Axial T1-weighted fat-suppressed enhanced MR image of superior aspect
of liver with electronic tracings that demarcate right hepatic lobe (R) and
medial (M) and lateral (L) segments of left hepatic lobe. Calculated areas
(cm2) are noted in right upper corner of image. Area 1 = R, area 2
= M, area 3 = L.
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Fig. 1C. — Volumetric analysis of liver in 25-year-old man (potential
donor). Axial T1-weighted fat-suppressed enhanced MR image of middle third of
liver shows middle hepatic vein (M) and left portal vein (arrow),
which are anatomic landmarks that define boundaries of hepatic lobes and
segments at this level.
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Fig. 1D. — Volumetric analysis of liver in 25-year-old man (potential
donor). Axial T1-weighted fat-suppressed enhanced MR image of middle third of
liver with electronic tracings that demarcate right hepatic lobe (R), medial
(M) and lateral (L) segments of left hepatic lobe, and caudate lobe (C).
Calculated areas (cm2) are noted in right upper corner of image.
Area 1 = R, area 2 = M, area 3 = L, area 4 = C.
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Fig. 2. — 38-year-old man with ductal trifurcation anomaly.
Coronal—oblique thin-slab (5 mm) MR cholangiogram shows three ducts
(straight arrows) joining at hepatic confluence, indicative of ductal
trifurcation anomaly. More peripheral aspects of intrahepatic bile ducts were
depicted on additional thin-slab images. Proximal extrahepatic bile duct
(curved arrow) and gallbladder (GB) are shown. This anomaly was
confirmed at surgery.
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Fig. 3. — 55-year-old man with dorsocaudal branch of right hepatic
lobe draining into central left hepatic duct. Coronal thick-slab (40-mm) MR
cholangiogram shows dorsocaudal branch (straight arrows) of right
hepatic lobe draining into central left hepatic duct (arrowhead).
Extrahepatic bile duct (curved arrow) is shown. This anomaly was
confirmed at surgery.
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Fig. 4A. — 38-year-old woman with normal findings at MR angiography.
Coronal two-dimensional time-of-flight MR angiogram shows normal main portal
vein (short solid arrow). Common hepatic artery (long straight
arrow) arises from branch of celiac axis (curved arrow).
Superior mesenteric artery origin (open arrow) can be seen.
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Fig. 4B. — 38-year-old woman with normal findings at MR angiography.
Coronal two-dimensional time-of-flight MR angiogram obtained 12 mm anterior to
A shows right (long arrow) and left (short arrow)
hepatic arteries.
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Fig. 5. — 30-year-old woman with inferior accessory right hepatic
vein. Coronal two-dimensional time-of-flight MR angiogram shows inferior
accessory right hepatic vein (short straight arrows) that measures 8
mm in diameter and courses toward inferior vena cava (curved arrow).
Main right hepatic vein (long arrows) is noted to enter inferior vena
cava at more cephalad location.
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Fig. 6. — 35-year-old woman with small inferior accessory right
hepatic vein. Axial T1-weighted fat-suppressed MR enhanced image of middle
third of liver shows 3-mm inferior accessory right hepatic vein (straight
arrow) entering inferior vena cava (curved arrow).
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Fig. 7A. — 54-year-old man with replaced common hepatic artery. Coronal
two-dimensional time-of-flight MR angiogram shows common hepatic artery
(short straight arrow) arising from superior mesenteric artery
(open arrow) and branching into proper hepatic artery (long
arrow) and gastroduodenal artery (curved arrow). Celiac axis
(arrowhead) and main portal vein (PV) are noted.
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Fig. 7B. — 54-year-old man with replaced common hepatic artery. Digital
subtraction angiogram conducted with superior mesenteric artery injection
shows that common hepatic artery (short straight arrow) arises from
superior mesenteric artery (open arrow) and branches into proper
hepatic artery (long arrow) and gastroduodenal artery (curved
arrow).
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Copyright © 2001 by the American Roentgen Ray Society.
