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Intrahepatic Biliary Anatomy of Living Adult Liver Donors: Correlation of Mangafodipir Trisodium—Enhanced MR Cholangiography and Intraoperative Cholangiography

¹ Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213.
² Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213.

View larger version (111K): [in a new window]   Fig. 1A. —49-year-old living male liver donor who underwent right hepatectomy. Three-dimensional volumetric maximum-intensity-projection mangafodipir trisodium—enhanced MR cholangiogram (A) shows right posterior (dorsocaudal) hepatic duct (single straight arrow) joining right anterior (cranioventral) hepatic duct (short double arrowheads) to form right hepatic duct (long arrowhead). Left hepatic duct (double arrows) joins right hepatic duct to form common hepatic duct (curved arrow). Intraoperative cholangiogram (B) confirms findings on mangafodipir trisodium—enhanced MR cholangiography (A).

View larger version (103K): [in a new window]   Fig. 1B. —49-year-old living male liver donor who underwent right hepatectomy. Three-dimensional volumetric maximum-intensity-projection mangafodipir trisodium—enhanced MR cholangiogram (A) shows right posterior (dorsocaudal) hepatic duct (single straight arrow) joining right anterior (cranioventral) hepatic duct (short double arrowheads) to form right hepatic duct (long arrowhead). Left hepatic duct (double arrows) joins right hepatic duct to form common hepatic duct (curved arrow). Intraoperative cholangiogram (B) confirms findings on mangafodipir trisodium—enhanced MR cholangiography (A).

View larger version (106K): [in a new window]   Fig. 2A. —36-year-old living female liver donor who underwent left hepatectomy. Three-dimensional volumetric maximum-intensity-projection mangafodipir trisodium—enhanced MR cholangiogram (A) shows right posterior hepatic duct (single straight arrow) joining left hepatic duct (double arrows), the most common variant of biliary duct anatomy. Right anterior hepatic duct (arrowhead) drains into common duct (curved arrow). Intraoperative cholangiogram (B) confirms finding on mangafodipir trisodium—enhanced MR cholangiography (A). Intraoperative cholangiogram (C) after left hepatectomy shows resected margin of left hepatic duct.

View larger version (108K): [in a new window]   Fig. 2B. —36-year-old living female liver donor who underwent left hepatectomy. Three-dimensional volumetric maximum-intensity-projection mangafodipir trisodium—enhanced MR cholangiogram (A) shows right posterior hepatic duct (single straight arrow) joining left hepatic duct (double arrows), the most common variant of biliary duct anatomy. Right anterior hepatic duct (arrowhead) drains into common duct (curved arrow). Intraoperative cholangiogram (B) confirms finding on mangafodipir trisodium—enhanced MR cholangiography (A). Intraoperative cholangiogram (C) after left hepatectomy shows resected margin of left hepatic duct.

View larger version (131K): [in a new window]   Fig. 2C. —36-year-old living female liver donor who underwent left hepatectomy. Three-dimensional volumetric maximum-intensity-projection mangafodipir trisodium—enhanced MR cholangiogram (A) shows right posterior hepatic duct (single straight arrow) joining left hepatic duct (double arrows), the most common variant of biliary duct anatomy. Right anterior hepatic duct (arrowhead) drains into common duct (curved arrow). Intraoperative cholangiogram (B) confirms finding on mangafodipir trisodium—enhanced MR cholangiography (A). Intraoperative cholangiogram (C) after left hepatectomy shows resected margin of left hepatic duct.

View larger version (118K): [in a new window]   Fig. 3A. —51-year-old living female liver donor who underwent left hepatectomy. Three-dimensional volumetric maximum-intensity-projection mangafodipir trisodium—enhanced MR cholangiogram (A) shows aberrant right posterior duct draining segment VI (straight arrow) joining common hepatic duct (curved arrow). This variant is unfavorable for right lobe harvesting because additional biliary anastomosis is required in recipient, with increased risk of recipient biliary complications. Donor also had accessory right hepatic artery arising from superior mesenteric artery; this variant made harvesting of right lobe unfavorable. Intraoperative cholangiogram (B) confirms finding on mangafodipir trisodium—enhanced MR cholangiogram (A).

View larger version (120K): [in a new window]   Fig. 3B. —51-year-old living female liver donor who underwent left hepatectomy. Three-dimensional volumetric maximum-intensity-projection mangafodipir trisodium—enhanced MR cholangiogram (A) shows aberrant right posterior duct draining segment VI (straight arrow) joining common hepatic duct (curved arrow). This variant is unfavorable for right lobe harvesting because additional biliary anastomosis is required in recipient, with increased risk of recipient biliary complications. Donor also had accessory right hepatic artery arising from superior mesenteric artery; this variant made harvesting of right lobe unfavorable. Intraoperative cholangiogram (B) confirms finding on mangafodipir trisodium—enhanced MR cholangiogram (A).

View larger version (104K): [in a new window]   Fig. 4A. —57-year-old living female liver donor who underwent right hepatectomy. Three-dimensional volumetric maximum-intensity-projection mangafodipir trisodium—enhanced MR cholangiogram (A) shows accessory left hepatic duct (short straight arrow) draining directly into common hepatic duct (curved arrow). Right posterior (double arrows) and anterior (long arrow) ducts join to form right hepatic duct (arrowhead). Intraoperative cholangiogram (B) confirms finding on mangafodipir trisodium—enhanced MR cholangiogram (A).

View larger version (143K): [in a new window]   Fig. 4B. —57-year-old living female liver donor who underwent right hepatectomy. Three-dimensional volumetric maximum-intensity-projection mangafodipir trisodium—enhanced MR cholangiogram (A) shows accessory left hepatic duct (short straight arrow) draining directly into common hepatic duct (curved arrow). Right posterior (double arrows) and anterior (long arrow) ducts join to form right hepatic duct (arrowhead). Intraoperative cholangiogram (B) confirms finding on mangafodipir trisodium—enhanced MR cholangiogram (A).

View larger version (119K): [in a new window]   Fig. 5A. —19-year-old living male liver donor who underwent right hepatectomy. Three-dimensional volumetric maximum-intensity-projection mangafodipir trisodium—enhanced MR cholangiogram (A) shows biliary anatomy closely resembling trifurcation pattern that is typically difficult to diagnose on conventional T2-weighted MR cholangiography. Short right hepatic duct (long arrow) joins left hepatic duct (short arrow) to form common hepatic duct (arrowhead). Intraoperative cholangiogram (B) confirms finding on mangafodipir trisodium—enhanced MR cholangiography (A). Intraoperative cholangiogram (C) after right hepatectomy shows left (short arrow) and common (arrowhead) hepatic ducts.

View larger version (116K): [in a new window]   Fig. 5B. —19-year-old living male liver donor who underwent right hepatectomy. Three-dimensional volumetric maximum-intensity-projection mangafodipir trisodium—enhanced MR cholangiogram (A) shows biliary anatomy closely resembling trifurcation pattern that is typically difficult to diagnose on conventional T2-weighted MR cholangiography. Short right hepatic duct (long arrow) joins left hepatic duct (short arrow) to form common hepatic duct (arrowhead). Intraoperative cholangiogram (B) confirms finding on mangafodipir trisodium—enhanced MR cholangiography (A). Intraoperative cholangiogram (C) after right hepatectomy shows left (short arrow) and common (arrowhead) hepatic ducts.

View larger version (101K): [in a new window]   Fig. 5C. —19-year-old living male liver donor who underwent right hepatectomy. Three-dimensional volumetric maximum-intensity-projection mangafodipir trisodium—enhanced MR cholangiogram (A) shows biliary anatomy closely resembling trifurcation pattern that is typically difficult to diagnose on conventional T2-weighted MR cholangiography. Short right hepatic duct (long arrow) joins left hepatic duct (short arrow) to form common hepatic duct (arrowhead). Intraoperative cholangiogram (B) confirms finding on mangafodipir trisodium—enhanced MR cholangiography (A). Intraoperative cholangiogram (C) after right hepatectomy shows left (short arrow) and common (arrowhead) hepatic ducts.

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