American Journal of Roentgenology, Vol 164, 871-878, Copyright © 1995 by American Roentgen Ray Society

ARTICLES

Evaluation of the portal venous system before liver transplantation: value of phase-contrast MR angiography

HV Nghiem, TC Winter 3rd, MC Mountford, LA Mack, C Yuan, DM Coldwell, SJ Althaus, RL Carithers Jr, JP McVicar and PC Freeny
University of Washington, Department of Radiology, Seattle 98195, USA.

OBJECTIVE. The purpose of this study was to assess the accuracy of phase-contrast MR angiography with gadolinium in evaluating the patency and blood flow direction of the portal venous system; the presence, extent, and type of varices; and the patency of surgical decompressive shunts in patients before liver transplantation. This information is essential in management and care of patients with chronic liver disease and portal hypertension and those who are candidates for liver transplantation. SUBJECTS AND METHODS. Twenty-four patients with portal venous hypertension were evaluated with phase-contrast MR angiography. Two patients had surgical splenorenal shunts and one had a mesocaval shunt. Phase-contrast angiograms were acquired as a series of two- dimensional sequential coronal sections during breath-holding and after IV administration of gadopentetate dimeglumine. Correlative findings from color flow Doppler sonography, contrast-enhanced CT scanning, and conventional angiography were available in 23, 20, and 10 patients, respectively, and were used as standards. The images from each technique were analyzed independently for patency of and flow direction in the portal vein, splenic vein, superior mesenteric vein, and surgically created shunts, and for detection, distribution, and extent of five variceal groups. RESULTS. Findings from phase-contrast MR angiography completely agreed with those of sonography, CT scanning, and conventional angiography. The main portal vein was patent in 18 patients, stenosed in one, partially thrombosed in one, and occluded in four. Phase-contrast MR angiography correctly showed hepatofugal flow in three patients and hepatopetal flow in 17 patients. Both the splenic and superior mesenteric veins were patent in 20, partially thrombosed in one, and occluded in three cases. Phase-contrast MR angiograms showed 85% of the variceal groups, and MR rating of variceal size was not significantly different from that of CT rating. Phase-contrast MR angiography correctly showed the patency of all three surgical decompressive shunts. CONCLUSION. Phase-contrast MR angiography is accurate for evaluating the patency and flow direction of the portal venous system, detecting and determining the distribution and extent of varices, and assessing the patency of surgically created shunts. Therefore, it is a reliable and noninvasive technique that can provide crucial information in the preoperative workup of liver transplant recipients.
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				K. Ito, S. Koike, A. Shimizu, M. Tanabe, C. Jo, M. Miyazaki, and N. Matsunaga Portal Venous System: Evaluation with Unenhanced MR Angiography with a Single-Breath-Hold ECG-Synchronized 3D Half-Fourier Fast Spin-Echo Sequence Am. J. Roentgenol., August 1, 2008; 191(2): 550 - 554. [Abstract] [Full Text] [PDF]

				M. Miyazaki and V. S. Lee Nonenhanced MR Angiography Radiology, July 1, 2008; 248(1): 20 - 43. [Abstract] [Full Text] [PDF]

				Y. J. Kim, S. S. Raman, N. C. Yu, K. J. To'o, R. Jutabha, and D. S. K. Lu Esophageal Varices in Cirrhotic Patients: Evaluation with Liver CT Am. J. Roentgenol., January 1, 2007; 188(1): 139 - 144. [Abstract] [Full Text] [PDF]

				M. Matsuo, M. Kanematsu, T. Kim, M. Hori, M. Takamura, T. Murakami, H. Kondo, N. Moriyama, H. Nakamura, and H. Hoshi Esophageal Varices: Diagnosis with Gadolinium-Enhanced MR Imaging of the Liver for Patients with Chronic Liver Damage Am. J. Roentgenol., February 1, 2003; 180(2): 461 - 466. [Abstract] [Full Text] [PDF]

				A S Shaw, S M Ryan, R C Beese, S Norris, M Bowles, M Rela, and P S Sidhu Liver transplantation Imaging, August 1, 2002; 14(4): 314 - 328. [Abstract] [Full Text] [PDF]

				M. T. Lavelle, V. S. Lee, N. M. Rofsky, G. A. Krinsky, and J. C. Weinreb Dynamic Contrast-enhanced Three-dimensional MR Imaging of Liver Parenchyma: Source Images and Angiographic Reconstructions to Define Hepatic Arterial Anatomy Radiology, February 1, 2001; 218(2): 389 - 394. [Abstract] [Full Text]

				O. Ernst, V. Asnar, G. Sergent, E. Lederman, L. Nicol, J.-C. Paris, and C. L'Hermine Comparing Contrast-Enhanced Breath-Hold MR Angiography and Conventional Angiography Am. J. Roentgenol., February 1, 2000; 174(2): 433 - 439. [Abstract] [Full Text] [PDF]

				L. Kopka, J. Rodenwaldt, R. Vosshenrich, U. Fischer, B. Renner, T. Lorf, J. Graessner, B. Ringe, and E. Grabbe Hepatic Blood Supply: Comparison of Optimized Dual Phase Contrast-enhanced Three-dimensional MR Angiography and Digital Subtraction Angiography Radiology, April 1, 1999; 211(1): 51 - 58. [Abstract] [Full Text]