Trasplante hepático de donante vivo. Aportación de la resonancia magnética en el cálculo volumétrico hepático y en el estudio de la anatomía vascular y biliar.
ENGLISH ABSTRACT. TÍTLE: Living donor liver transplantation. Magnetic resonance imaging contribution to liver volume calculation, and vascular and biliary anatomy depiction. SUMMARY: Large waiting lists for cadaveric liver transplantation have lead to the development of live donor liver transplantation (LDLT). Evaluation of potential candidates for donation includes liver volume calculation and arterial, portal, hepatic venous and biliary anatomy assessment. The use of the least noninvasive diagnostic tool for this group of individuals is mandatory. This work tries to demonstrate that magnetic resonance imaging (MRI) is enough in the evaluation of live living donors (LLD) candidates because it is reliable for the vascular and biliary anatomy evaluation and for liver volume calculation. Thirty nine consecutive LLD were studied with MRI. Angiographic and cholangographic sequences, the latest both prior and after biliary enhancing contrast agent administration were performed. MRI vascular findings were correlated with angiographic and surgical data, right lobe liver calculation on MRI was compared to graft weight and MRI cholangiographic findings were correlated with those obtained at intraoperative cholangiography. Simple linear Pearson correlation and Fisher test were used for statistical analyses. A high correlation between right lobe liver calculation on MRI and graft weight (r2 = 0.78) was observed, with an overestimation of about 18%. Hepatic, celiac, splenic and mesenteric arteries, as well as main trunk and lobar and segmental portal branches and the three main hepatic veins were always excellently depicted. Right and left hepatic arteries were sufficiently depicted in 74% and 72% of individuals respectively. Arterial distribution, according to Michels pattern was correctly assessed in 92.3% and portal venous distribution, according to Chengs classification was correctly assessed in 97.4% of subjects. MRI sensitivity, specificity and accuracy in depicting accessory hepatic veins requiring additional vascular anastomosis was 80%, 100% and 94,8% respectively. Contrast enhanced MRI cholangiography was better than non-enhanced MRI cholangiography for biliary anatomy assessment. A correct depiction of the biliary distribution in 88% and 57% was respectively achieved, following the Couinauds classification pattern. In conclusion, MRI evaluation of LLD is reliable for liver volume calculation and vascular and biliary anatomy depiction, and can be used as the only imaging tool prior to surgery. Angiography can be reserved for those individuals with inadequate arterial vascular demonstration on MRI.
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Advisor:García-Valdecasas Salgado, Juan Carlos; Ayuso Colella, M. Carmen
School:Universitat de Barcelona
Source Type:Master's Thesis
Keywords:obstetrícia i ginecologia pediatria radiologia medicina física
Date of Publication:11/23/2004