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Peripheral Anatomic Evaluation Using 3D CT Hepatic Venography in Donors: Significance of Peripheral Venous Visualization in Living-Donor Liver Transplantation

Yuya Onodera1, Tokuhiko Omatsu1, Jun Nakayama1, Toshiya Kamiyama2, Hiroyuki Furukawa3, Satoru Todo2, Takeshi Nishioka1 and Kazuo Miyasaka1

1 Department of Radiology, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo 060-8638, Japan.
2 First Department of Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
3 Department of Organ Transplantation and Regenerative Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.



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  		Fig. 1A. —Nakamura and Tsuzuki's classification [24]. Volume-rendered reconstructions show hepatic venous drainage pattern at right liver lobe. Pattern is classified according to dominant development among right hepatic vein (RHV), inferior right hepatic vein (IHV), and middle hepatic vein (MHV). LHV = left hepatic vein. In type 1 (n = 27, 50.9%), right hepatic vein is large and drains lateral sector and dorsal or lateral part of paramedian sector. Middle hepatic vein drains ventral or medial part of paramedian sector.

 


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  		Fig. 1B. —Nakamura and Tsuzuki's classification [24]. Volume-rendered reconstructions show hepatic venous drainage pattern at right liver lobe. Pattern is classified according to dominant development among right hepatic vein (RHV), inferior right hepatic vein (IHV), and middle hepatic vein (MHV). LHV = left hepatic vein. In type 2 (n = 25, 47.1%), right hepatic vein is of medium size and thick, and some inferior hepatic veins are present. Inferior hepatic veins drain inferior part of lateral sector, and drainage area depends on peripheral development of inferior hepatic vein. Right hepatic vein drains residual superior part of lateral sector.

 


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  		Fig. 1C. —Nakamura and Tsuzuki's classification [24]. Volume-rendered reconstructions show hepatic venous drainage pattern at right liver lobe. Pattern is classified according to dominant development among right hepatic vein (RHV), inferior right hepatic vein (IHV), and middle hepatic vein (MHV). LHV = left hepatic vein. In type 3 (n = 1, 2%), large middle hepatic vein is present and drains paramedian sector and inferior part of lateral sector. Right hepatic vein is small and drains superior part of lateral sector. Also, thick inferior hepatic vein is present.

 


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  		Fig. 1D. —Nakamura and Tsuzuki's classification [24]. Volume-rendered reconstructions show hepatic venous drainage pattern at right liver lobe. Pattern is classified according to dominant development among right hepatic vein (RHV), inferior right hepatic vein (IHV), and middle hepatic vein (MHV). LHV = left hepatic vein. In type 3 (n = 1, 2%), large middle hepatic vein is present and drains paramedian sector and inferior part of lateral sector. Right hepatic vein is small and drains superior part of lateral sector. Also, thick inferior hepatic vein is present.

 


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  		Fig. 2A. —Classification of Marcos et al. [23]. In reconstructions showing peripheral branching pattern of middle hepatic vein, various branching patterns are displayed in inferior part of paramedian sector. Dashed lines indicate proposed line of hepatic transection based on intrahepatic venous collaterals. In type 1 (n = 36, 67.9%), thick veins draining segments IVa (green arrows) and V (yellow arrows) are branches with equal size and almost equal drainage areas.

 


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  		Fig. 2B. —Classification of Marcos et al. [23]. In reconstructions showing peripheral branching pattern of middle hepatic vein, various branching patterns are displayed in inferior part of paramedian sector. Dashed lines indicate proposed line of hepatic transection based on intrahepatic venous collaterals. In type 2 (n = 9, 17%), segment V vein (yellow arrow) is small and short. Segment IVa veins (green arrows) are thin and have relatively larger drainage area than segment V vein.

 


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  		Fig. 2C. —Classification of Marcos et al. [23]. In reconstructions showing peripheral branching pattern of middle hepatic vein, various branching patterns are displayed in inferior part of paramedian sector. Dashed lines indicate proposed line of hepatic transection based on intrahepatic venous collaterals. In type 3 (n = 8, 15.1%), early proximal branching occurs and some medium-sized branches are present in both segment IVa (vein indicated by green arrows) and segment V (vein indicated by yellow arrows). In original report, type 1 constituted 70%; type 2, 20%; and type 3, 10%. Our results are consistent with original report.

 


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  		Fig. 3A. —In reconstructions, classification of Kawasaki et al. [25] defines two drainage patterns for segment IVb vein (arrow). In type 1 (n = 20, 37.7%), segment IVb vein flows into middle hepatic vein (MHV). LHV = left hepatic vein.

 


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  		Fig. 3B. —In reconstructions, classification of Kawasaki et al. [25] defines two drainage patterns for segment IVb vein (arrow). In type 2 (n = 34, 62.3%), segment IVb vein flows into left hepatic vein (LHV). MHV = middle hepatic vein.

 


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  		Fig. 4A. —25-year-old male donor for right liver transplantation. On 3D CT hepatic venography, donor displays thick vein draining segment V (arrow) with wide drainage area.

 


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  		Fig. 4B. —25-year-old male donor for right liver transplantation. Drainage volume and virtual area of congestion in segment V vein were calculated from venous visualized area (arrows) on workstation. Calculated volume was 15%, and wide postoperative venous congestion in recipient graft was suggested. Venous reconstruction was considered additional option.

 

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