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Multidetector CT of Potential Right-Lobe Liver Donors

¹ Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02115.
² Present address: Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD 21287.

View larger version (121K): [in a new window]   Fig. 1A. —Hepatic arterial anatomy in potential liver donor, 51-year-old man. Axial images in arterial phase were acquired at 18 sec with 1.25-mm collimation and table speed of 7.5. Reference axial CT image shows areas selected to be used to generate reconstructed thick slabs along coronal oblique plane, which is optimum plane to depict hepatic arterial anatomy.

View larger version (101K): [in a new window]   Fig. 1B. —Hepatic arterial anatomy in potential liver donor, 51-year-old man. Axial images in arterial phase were acquired at 18 sec with 1.25-mm collimation and table speed of 7.5. Maximum-intensity-projection CT scan in thick slab (2.5 cm) reveals contrast opacification of hepatic arteries up to tertiary branches. Right (R) and left (L) hepatic arteries are well visualized. Artery (arrow) to segment IV arises from right hepatic artery. This vessel should be spared in right hepatectomy.

View larger version (79K): [in a new window]   Fig. 1C. —Hepatic arterial anatomy in potential liver donor, 51-year-old man. Axial images in arterial phase were acquired at 18 sec with 1.25-mm collimation and table speed of 7.5. Three-dimensional volume-rendered image with shaded-surface display and posterior cut confirms origin of artery (arrow) to segment IV from right hepatic artery (R). L = left hepatic artery.

View larger version (100K): [in a new window]   Fig. 2. —Hepatic arterial anatomy in potential liver donor, 36-year-old man. Three-dimensional volume-rendered CT image with shaded-surface display and posterior cut reveals replaced right hepatic artery (arrow) arising from superior mesenteric artery. This information is important in preoperative planning.

View larger version (92K): [in a new window]   Fig. 3A. —Hepatic arterial anatomy in potential liver donor, 37-year-old man. Thick-slab (2.5-cm) maximum-intensity-projection CT scan in coronal oblique plane centered over porta hepatis reveals artery (arrow) to segment IV arising from left hepatic artery (L).

View larger version (70K): [in a new window]   Fig. 3B. —Hepatic arterial anatomy in potential liver donor, 37-year-old man. Thick-slab (2.5-cm) maximum-intensity-projection CT scan in axial plane reveals artery (arrow) to segment IV and confirms its origin from left hepatic artery.

View larger version (88K): [in a new window]   Fig. 4. —Hepatic arterial anatomy in potential liver donor, 50-year-old woman. Thick-slab (2-cm) maximum-intensity-projection CT scan of hepatic arteries in coronal oblique view. Segment IV arteries (arrows) arise from right (R) and left (L) hepatic arteries.

View larger version (135K): [in a new window]   Fig. 5A. —Hepatic venous anatomy in potential liver donor, 24-year-old man. Axial portal-venous-phase CT images were acquired at 60 sec with 2.5-mm collimation and table speed of 15. Reference coronal image used to generate thick-slab (2.5-cm) maximum-intensity-projection images along axial plane. Plane shown is optimum for revealing hepatic venous anatomy.

View larger version (113K): [in a new window]   Fig. 5B. —Hepatic venous anatomy in potential liver donor, 24-year-old man. Axial portal-venous-phase CT images were acquired at 60 sec with 2.5-mm collimation and table speed of 15. Volume-rendered axial image obtained through upper liver reveals adequate contrast opacification of right (R), middle (M), and left (L) hepatic veins. Note intimate relationship between middle and left hepatic veins. Because of this intimate relationship, surgeons prefer not to include middle hepatic vein in right hepatectomy.

View larger version (135K): [in a new window]   Fig. 5C. —Hepatic venous anatomy in potential liver donor, 24-year-old man. Axial portal-venous-phase CT images were acquired at 60 sec with 2.5-mm collimation and table speed of 15. At more inferior position, note two accessory inferior right hepatic veins (arrows) draining into inferior vena cava. These vessels should be spared to avoid graft malfunction.

View larger version (135K): [in a new window]   Fig. 6. —Hepatic venous anatomy in potential liver donor, 40-year-old woman. Thick-slab (2-cm) maximum-intensity-projection CT scan of hepatic veins in coronal plane shows large accessory inferior right hepatic vein (straight arrow) draining into inferior vena cava. Measuring distance between this vessel and right hepatic vein (curved arrow) is important for surgical planning.

View larger version (103K): [in a new window]   Fig. 7. —Three-dimensional computer model of hepatic veins in potential liver donor, 42-year-old man. Model is viewed from right superior oblique position. Right (R), middle (M), and left (L) hepatic veins are well visualized. This image is essential to identify major branching points to right of middle hepatic vein, where parenchymal dissection will be undertaken. Note large branch (arrow) from middle hepatic vein toward right. Surgeons need to be aware of this finding before surgery because it may determine site of parenchymal dissection.

View larger version (144K): [in a new window]   Fig. 8A. —Portal venous anatomy in potential liver donor, 31-year-old man. Axial images were obtained during portal venous phase. Reference axial CT image is used to generate thick-slab (2.5-cm) maximum intensity projections along coronal plane centered over portal vein, which is optimum plane to depict portal venous anatomy.

View larger version (122K): [in a new window]   Fig. 8B. —Portal venous anatomy in potential liver donor, 31-year-old man. Axial images were obtained during portal venous phase. Coronal maximum-intensity-projection CT image reveals contrast medium opacification of main portal vein (M) and its branches. Note posterior right portal vein (arrow) arising directly from main portal vein, an anatomic portal vein variant that some surgeons may deem a contraindication to performing donor right hepatectomy because of increased risk of postoperative portal vein thrombosis.

View larger version (65K): [in a new window]   Fig. 9. —Portal venous anatomy in potential liver donor, 28-year-old woman. Three-dimensional computer model of portal veins as seen anteriorly reveals normal portal venous anatomy. Main (M), right (R), and left (L) portal veins are well visualized. Note vein (arrow) supplying segment IV arising from right portal vein.

View larger version (94K): [in a new window]   Fig. 10. —Portal venous anatomy in potential liver donor, 37-year-old man. Three-dimensional computer model of portal veins as seen anteriorly reveals trifurcation of main (M) portal vein into anterior right (A), posterior right (P), and left (L) portal veins. This information is important for surgical planning.

View larger version (74K): [in a new window]   Fig. 11. —Portal venous anatomy in potential liver donor, 52-year-old man. Three-dimensional computer model of portal veins as seen anteriorly reveals quadrifurcation of main (M) portal vein into anterior right (A), posterior right (P), vein (arrow) to segment IV, and left (L) portal veins.

View larger version (153K): [in a new window]   Fig. 12A. —Hepatic volume determination in potential liver donor, 42-year-old man. Hand tracing is used to visually isolate liver from surrounding tissues with similar attenuation, using selected axial images obtained during portal venous phase. Care is exercised to avoid major vessels, including inferior vena cava (straight arrow), portal vein (arrowhead), and fissures, including fissure for ligamentum teres (curved arrow).

View larger version (126K): [in a new window]   Fig. 12B. —Hepatic volume determination in potential liver donor, 42-year-old man. Coronal plane after computer interpolation of hand-traced images shows adequate coverage of liver outline.

View larger version (122K): [in a new window]   Fig. 13A. —Hepatic volume determination in potential liver donor, 36-year-old woman. Three-dimensional computer model depicting volume of liver is seen anteriorly. Shape of liver is important because it determines whether graft can be accommodated in recipient's right upper quadrant.

View larger version (100K): [in a new window]   Fig. 13B. —Hepatic volume determination in potential liver donor, 36-year-old woman. Three-dimensional computer model of hepatic veins superimposed on liver model enhances relationship between liver parenchyma and vascular anatomy. Notice presence of an accessory inferior right hepatic vein (arrow).

View larger version (60K): [in a new window]   Fig. 14. —Hepatic volume determination in potential liver donor, 27-year-old man. Three-dimensional computer model depicting volume of liver with superior cut is seen from anterior oblique view. Three-dimensional models of hepatic veins (blue) and portal veins (red) are also superimposed. This view emphasizes relationship between liver parenchyma and vascular anatomy.

View larger version (49K): [in a new window]   Fig. 15A. —Right-lobe volume determination in potential liver donor, 38-year-old man. Three-dimensional computer model of hepatic veins (blue) and portal vein (red) volume is seen from anterior superior oblique view. Obtaining such image allows surgeons to predict site of parenchymal dissection at donor hepatectomy.

View larger version (80K): [in a new window]   Fig. 15B. —Right-lobe volume determination in potential liver donor, 38-year-old man. Three-dimensional computer model of hepatic veins and portal vein is superimposed on right lobe of liver after virtual donor hepatectomy. This model is used to calculate graft volume and to depict major vascular branches traversing hepatectomy plane. This plane can be interactively adjusted to satisfy volumetric requirements for donor and matching recipient.

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