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Clinical usefulness of gadoxetic acid–enhanced MRI for evaluating biliary anatomy in living donor liver transplantation

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To determine the incremental value of hepatobiliary-phase-MRC (HBP-MRC) added to T2-magnetic resonance cholangiography (T2-MRC) for evaluating biliary anatomy in living donor liver transplantation (LDLT) and to correlate T2+HBP-MRC findings with surgical results.

Methods

A total of 276 donors who underwent T2 and gadoxetic acid–enhanced MRI before right hemihepatectomy for LDLT between January and December 2016 were retrospectively enrolled. Two reviewers evaluated biliary anatomy classification using T2-MRC in the first session and T2+HBP-MRC in the second session. The sensitivity, specificity, and confidence level (5-point scale) of T2-MRC and T2+HBP-MRC for variant biliary anatomy were evaluated. The agreement rates between MRC and operative cholangiography for each biliary anatomy classification and the underestimation rates for multiple bile duct openings (BDOs) for both MRC techniques were evaluated.

Results

Of the 276 donors, variant biliary anatomy was observed in 36.2% (100/276). T2+HBP-MRC showed a significantly higher sensitivity for diagnosing variant biliary anatomy than T2-MRC alone (99.0% [99/100] vs. 89.0% [89/100], p = 0.006), with better observer confidence level (4.9 ± 0.3 vs. 4.6 ± 0.7, p < 0.001) and inter-observer agreement (kappa, 0.902 vs. 0.730). Compared with T2-MRC alone, T2+HBP-MRC provided significantly higher agreement with operative cholangiography in biliary anatomy classification (98.6% [272/276] vs. 89.9% [248/276], p < 0.001), and significantly lower underestimation rate for multiple BDOs (5.8% [16/276] vs. 9.4% [26/276], p = 0.002).

Conclusion

T2+HBP-MRC might be considered than T2-MRC alone, as a better depiction of biliary anatomic variations, correlated with surgical findings.

Key Points

•T2+HBP-MRC predicted variant biliary anatomy more accurately than T2-MRC alone.

•T2+HBP-MRC might have clinical usefulness by reducing the underestimation rate of multiple bile duct openings, which requires more complicated biliary anastomoses.

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Abbreviations

BDO:

Bile duct opening

CBD:

Common bile duct

CHD:

Common hepatic duct

HBP-MRC:

T1-weighted hepatobiliary-phase magnetic resonance cholangiography

LDLT:

Living donor liver transplantation

LHD:

Left hepatic duct

OPC:

Operative cholangiography

PV:

Portal vein

RAHD:

Right anterior hepatic duct

RHD:

Right hepatic duct

RPHD:

Right posterior hepatic duct

T2-MRC:

T2-weighted magnetic resonance cholangiography

T2+HBP-MRC:

Combination of T2-MRC and HBP-MRC

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Funding

This research was supported by the Basic Science Research Program through the National Research Foundation (NRF) of Korea, funded by the Ministry of Science, ICT, and Future Planning (no. 2017R1E1A1A03070961).

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center,88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Sang Hyun Choi, Kyoung Won Kim & So Yeon Kim

  2. Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Heon-Ju Kwon

  3. Division of Liver Transplantation and Hepatobiliary Surgery, and Departments of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Jae Hyun Kwon, Gi-Won Song & Sung-Gyu Lee

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  1. Sang Hyun Choi
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Correspondence to Kyoung Won Kim.

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Guarantor

The scientific guarantor of this publication is Kyoung Won Kim.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Sang Hyun Choi) has significant statistical expertise.

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The requirement for informed consent was waived due to the retrospective nature of this study.

Ethical approval

This study was approved by our Institutional Review Board.

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• Retrospective

• Observational

• Performed at one institution

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Choi, S.H., Kim, K.W., Kwon, HJ. et al. Clinical usefulness of gadoxetic acid–enhanced MRI for evaluating biliary anatomy in living donor liver transplantation. Eur Radiol 29, 6508–6518 (2019). https://doi.org/10.1007/s00330-019-06292-8

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  • DOI: https://doi.org/10.1007/s00330-019-06292-8

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