AJR:190, June 2008 1527 anatomy is seen in up to 45% of the popula- tion. Imaging of the biliary anatomy also helps minimize postoperative biliary com- plications [4, 5]. The biliary anatomy is mainly evaluated by ERCP, MR cholang- iopancreatography (MRCP), or intraopera- tive cholangiography. MRCP, a noninvasive imaging technique that is useful in evaluating the biliary sys- tem, is being performed with increasing fre- quency [6]. MRCP using thick- and thin-slab heavily T2-weighted sequences has been used widely to depict the biliary tree. Although good results in evaluating relevant biliary anatomy before laparoscopic surgery and in evaluating living liver donors have been re- ported with this technique, detecting and defining intrahepatic anatomic anomalies, MR Cholangiopancreatography with T2-Weighted Prospective Acquisition Correction Turbo Spin-Echo Sequence of the Biliary Anatomy of Potential Living Liver Transplant Donors Ceyla Basaran 1 A. Muhtesem Agildere 1 Fuldem Yildirim Donmez 1 Sinasi Sevmis 2 Irem Budakoglu 3 Hamdi Karakayali 2 Mehmet Haberal 2 Basaran C, Agildere AM, Donmez FY, et al. 1 Department of Radiodiagnostic, Baskent University Faculty of Medicine, Fevzi Çakmak caddesi 10.sokak, No: 45, 06490 Bahçelievler, Ankara, Turkey. Address correspondence to C. Başaran (ceylab@baskent-ank. edu.tr). 2 Department of General Surgery, Baskent University Faculty of Medicine, Ankara, Turkey. 3 Department of Public Health, Baskent University Faculty of Medicine, Ankara, Turkey. Hepatobiliary฀Imaging฀•฀Original฀Research AJR 2008; 190:1527–1533 0361–803X/08/1906–1527 © American Roentgen Ray Society L iver transplantation is the defini- tive treatment for patients with end-stage liver disease. Owing to the shortage of deceased-donor livers for transplantation, physicians are in- creasingly using living liver donors. An im- portant component of preoperative donor as- sessment is delineating the liver anatomy to determine suitability for transplantation and to define the risk of hepatectomy. Preopera- tive evaluation of living donor liver trans- plantation (LDLT) candidates routinely in- volves imaging the hepatic vasculature with CT or MRI. The role of preoperative biliary imaging, however, is controversial [1–3]. At several liver transplantation centers, physicians also preoperatively evaluate the biliary tract anatomy because variant biliary Keywords: anatomy, biliary system, liver disease, liver transplantation, living donor liver transplantation, MR cholangiopancreatography DOI:10.2214/AJR.07.3006 Received August 9, 2007; accepted after revision December 12, 2007. OBJECTIVE. The objective of our study was to evaluate the ability of a respiratory nav- igator-triggered T2-weighted turbo spin-echo (TSE) sequence with a prospective acquisition correction (PACE) technique for MR cholangiopancreatography (MRCP) to depict the biliary anatomy of living donor liver transplantation (LDLT) donors. suBJECTs฀AND฀METHODs. Forty potential LDLT donors who ranged in age from 19 to 54 years were prospectively evaluated with preoperative MRCP. MRCP was performed with a 1.5-T magnetic field using T2-weighted PACE TSE sequence. MRCP source data sets were processed with maximum-intensity-projection (MIP) and shaded surface display (SSD) algorithms. Findings were compared with intraoperative cholangiography. Biliary anatomy was classified according to the classification proposed by Huang and colleagues. The sensitiv- ity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRCP for the detection of aberrant biliary anatomy were calculated. REsuLTs. Intraoperative cholangiography and biliary exploration revealed that 27 donor candidates (67.5%) had conventional and 13 (32.5%) had aberrant biliary anatomy. Two do- nors (5%) had type B biliary anatomy; eight donors (20%), type C; two donors (5%), type D; and one donor (2.5%), unclassified. The sensitivity of MRCP source data sets in differentiat- ing aberrant biliary anatomies from nonaberrant ones was 100%, the specificity was 88.9%, and the accuracy was 92.5%. PPV and NPV were 81.3% and 100%, respectively. The sensi- tivity of MIP images in differentiating aberrant biliary anatomies was 100%, the specificity was 88.9%, and the accuracy was 92.5%. PPV and NPV were 81.3% and 100%, respectively. The sensitivity, specificity, accuracy, PPV, and NPV of the SSD images in detecting aberrant biliary anatomies were 100%, 77.8%, 85%, 68.4%, and 100%, respectively. CONCLusION. Preoperative MRCP using a respiratory navigator-triggered T2-weight- ed TSE sequence with a PACE technique accurately depicts the biliary anatomy in LDLT donors and may guide intraoperative management of the biliary tract. Basaran et al. MRCP of the Biliary Anatomy in Liver Transplant Donors Hepatobiliary Imaging Original Research Downloaded from www.ajronline.org by 52.73.204.196 on 05/17/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved