hilar branching anatomy of living adult liver donors ...€¦ · of the biliary anatomy in a donor...

J Korean Radiol Soc 2004;50:185-193

─ 185 ─

Hilar Branching Anatomy of Living Adult Liver Donors: Comparison of T2-MR Cholangiography and Contrast Enhanced

T1-MR Cholangiography in Terms of Diagnostic Utility1

Joon Seok Lim, M.D.1, Myeong-Jin Kim, M.D.1,3, Kyung Sik Kim, M.D.2, Joo Hee Kim, M.D.1, Young Taik Oh, M.D.1, Jin Yong Kim, M.D.1, Hyung Sik Yoo, M.D.1,

Jong Tae Lee, M.D.1, Ki Whang Kim, M.D.1

1Department of Diagnostic Radiology, Yonsei University College of Medicine2Department of Surgery, Yonsei University College of Medicine3BK21 Project of Medical Science Yonsei University College of Medicine Received June 24, 2003 ; Accepted November 17, 2003Address reprint requests to : Myeong-Jin Kim, M.D., Department of Diagnostic Radiology, Yonsei University Medical College, 134 Shinchon-dong,Seodaemoon-gu, Seoul 120-752, Republic of Korea. Tel. 82-2-361-5843 Fax. 82-2-393-3035 E-mail: [email protected]

Purpose: To compare T2-weighted MR cholangiography (T2-MRC) and contrast-en-hanced T1-weighted MRC (enhanced T1-MRC) in the assessment of biliary anatomy indonor candidates for living related liver transplantation (LRLT). Materials and Methods: Thirty-three potential donors underwent MR examination forpreoperative evaluation. Using the single-shot half-Fourier RARE sequence, T2-weightedsingle-section and coronal images were obtained, and enhanced T1-MRC was performed,using 3D GRE sequences after the administration of mangafodifir trisodium. To assess thehilar ductal branching pattern and determine diagnostic confidence, two reviewers firstevaluated the unpaired T2-MRC and enhanced T1-MRC images, and then paired T2-MRCand enhanced T1-MRC images together. In particular, in 12 cases in which direct cholan-giographys were performed, the feasibility of single duct-to-duct anastomosis was assessedusing the unpaired and the paired sets sequentially. Results: The reviewers’confidence tended to be higher for enhanced T1-MRC than T2-MRC, but the difference was not statistically significant. For both reviewers, confidencewas significantly higher for the paired set than for T2- or enhanced T1-MRC alone (p <.001). The types of biliary anatomy determined in the paired set matched the consensusreading in 33 (100%) and 30 cases(91%) assessed by reviewer 1 and 2, respectively. Theseparate interpretation of T2- and enhanced T1-MRC findings matched the consensus in-terpretation in 30 (91%) and 28 cases (85%), respectively, assessed by reviewer 1, and 26(79%) and 28 cases (85%), respectively, assessed by reviewer 2. The possibility of singleanastomosis was accurately predicted in 91.6% of cases in T2-MRC, and 100% at en-hanced T1-MRC and the combined set.Conclusion: In the evaluation of the biliary anatomy of potential donors for LRLT, thecombined use of T2-MRC and enhanced T1-MRC may improve diagnostic confidence anddecrease the occurrence of a non diagnostic or equivocal interpretation at T2-MRC alone.

Index words : Bile duct radiography, technologyBile ducts MRBile ducts surgeryLiver, transplantation

The evaluation of the biliary anatomy of donor candi-dates for adult-to-adult right lobe transplantation is es-sential. A candidate with biliary variants such as anom-alous drainage of the right posterior segmental duct(draining segments Ⅵ and Ⅶ) or trifurcation can pre-clude single duct-to-duct biliary anastomosis in thetransplant recipient (1).

T2 weighted MR cholangiography (T2-MRC) is be-coming the modality of choice for the noninvasive eval-uation of biliary tract abnormalities, but its diagnosticlimitations include poor visualization of the intrahepaticbiliary tree compared with the extrahepatic (2), particu-larly in non-dilated systems such as that seen in healthydonor candidates. The recent development of liver-spe-cific contrast agents which excrete into the biliary tree,such as mangafodipir trisodium, has renewed interest incontrast-enhanced MR imaging of the biliary tree, a pro-cedure that may counter the limitations of heavily T2-weighted MR cholangiography. Lee et al. suggested thatT1-weighted MR imaging, particularly when it involveshigh-resolution volumetric T1-weighted imaging of theliver, may facilitate the definition of intrahepatic bileduct anatomy in healthy liver transplant donor candi-dates and have a favorable impact on surgical results (3).

In our study, contrast-enhanced T1-weighted MRcholangiography after mangafodipir trisodium adminis-tration was used as an alternative method for evaluationof the biliary anatomy in a donor candidate for LRLT.The findings were compared with those of the widelyused T2-MRC procedure in terms of their ability to diag-nose the hilar ductal branching anatomy and detect in-trahepatic biliary anomalies, which would preclude sin-gle anastomosis. The additional effect of contrast-en-hanced MR cholangiography (enhanced T1-MRC) wasalso investigated.

Materials and Methods

Donor candidates

The study involved of 33 consecutive candidates whounderwent T2-MRC and enhanced T1-MRC betweenApril 2001 and April 2002, and were referred for exami-nation as potential living adult-to-adult liver donors.Nine candidates underwent laparotomy and operativecholangiography, and eight underwent uncomplicatedhepatectomy (right hepatectomy n=7, left extended he-patectomy, n=1). For the ninth, the transplantation wasaborted because intraoperative liver biopsy revealed un-favorable fatty change; however, operative cholangiog-

raphy was performed. Three candidates underwent endoscopic retrograde

cholangiography (ERCP), and a total of 12 including thenine who underwent operative cholangiography and thethree in whom ERCP was performed) underwent directcholangiography. The outcome of this, and the operativereports were reviewed by one investigator (J.S.L.) interms of the biliary anatomy observed and the feasibilityof single duct-to-duct anastomosis.

MRI technique

All donor candidates underwent both T2-MRC andenhanced T1-MRC using a 1.5-T MRI system (Horizon;GE Medical Systems, Milwaukee, Wis., U.S.A.) and aphased-array multicoil. Breath-hold heavily T2-weight-ed single-shot fast spin-echo MR cholangiography (T2-MRC), was performed before the administration ofmangafodipir trisodium. Initially, localizer images wereobtained in the coronal and transverse planes using aspoiled gradient-recalled sequence with the followingparameters: repetition time, msec/echo time, msec130/1.7, a flip angle of 90°, a field of view of 36×24-36cm, section thickness of 10 mm with no gap, a matrixsize of 256×128, and one acquisition. Subsequently,thin-section T2-weighted images were obtained using asingle-shot half-Fourier rapid-acquisition and relaxationsequence (single-shot fast spin-echo) with a 260-320mm field of view. The imaging parameters were an ef-fective echo time of 66-100 msec, a field of view of 32×24 cm, a section thickness of 5 mm with no gap, a re-ceiver bandwidth of 31.3 kHz, a matrix size of 256×256, and half-Fourier acquisition. In order to maintainsignals from the soft-tissue structure, fat suppressionwas not used for this sequence. In addition, by using aspatial fat saturation technique, multisection imageswith a long effective echo time of 645-869 msec wereobtained. All other parameters were the same as for T2-weighted images. Single thick-section images were thenobtained, using the following parameters: an echo timeof 830-1,050 msec; a section thickness of 30 mm; and afield of view of 24×24 cm in the coronal, lateral, andleft and right 15°, 30°, and 45°oblique planes. (Eightimages were obtained.)

Mangafodipir trisodium (Teslascan; Nycomed,Princeton, N.J., U.S.A.) at a standard dose of 5 μmol/kg(0.1 mL/kg; maximum dose, 15 mL) was then adminis-tered intravenously via a slow injection lasting 1-2 minprior to a 10-mL saline flush. Between 10 and 15 min af-ter injection, axial and coronal volumetric 3D spoiled

Joon Seok Lim, et al : Hilar Branching Anatomy of Living Adult Liver Donors

─ 186 ─

gradient-echo images of the liver and biliary system (en-hanced T1-MRC) were obtained using the following pa-rameters: TR range/TE, 5-8/minimum; flip angle, 20°;matrix, 256×128; field of view, 32-24 cm (using a rec-tangular field of view); and 4 mm slice thickness with nointersection gap.

Qualitative image evaluation

T2-MRC images and enhanced T1-MRC images wereseparately analyzed by two radiologists (M.J.K andJ.H.K). Images from the 33 unpaired examinations werearranged in random order, and the two observers re-viewed the images from 66 examinations. The 33 pairedsets of T2-MRC and enhanced T1-MRC images werethen arranged randomly, and four weeks later all mem-bers of the panel reviewed all the paired sets, complet-ing a standardized data sheet.

Each reviewer recorded the anatomic type of each hi-lar bile duct branching pattern (the orthogonal relation-ships between the right anterior and posterior segmentalduct, and the left and common hepatic duct), grading di-agnostic confidence on a 5-point scale (1-5). Thebranching pattern and confidence grade for T2-MRCand enhanced T1-MRC image sets were reviewed foreach modality separately, and in combination. The con-sensus subsequently reached was based on the findingsfor the combined set; the results were used as the goldstandard in 21 cases in which direct cholangiography orsurgery was not performed. The findings of ERCP (n=3)and surgery, including intraopertive cholangiography(n=9), were used as the gold standard for the remainingcases.

In donor candidates who underwent direct cholan-giography (n=12), each reviewer used the findings of T2MRC, enhanced T1-MRC and the combined set to deter-mine the feasibility of single duct-to-duct anastomosisfor right lobe donation, respectively. The results ob-tained by the two reviewers were compared using the kstatistic, and interobserver agreement thus determined.Discrepancies were resolved by consensus, and a singleconclusion thus obtained. In all these 12 candidates, theresults of MRC were compared with the confirmed re-sults of direct cholangiogrphy.

Statistical analysis

To determine the anatomic type of each hilar branch-ing pattern, the accuracy of T2-MRC, T1-MRC, and thecombined set were determined according to the consen-sual findings of the two reviewers. Wilcoxon’s signed

rank test was used to assess differences in diagnosticconfidence, and a P value less than 0.05 was consideredstatistically significant. In predicting the possibility ofsingle anastomosis, the Kappa (κ) test was used to assessinterobserver variability. Agreement was categorized asfollows: κvalue of 0-0.2, poor; κof 0.2-0.4, fair; κof0.4 -0.6, moderate; κof 0.6-0.8, good; and κof 0.8-1.0, excellent. For each method, the sensitivity , speci-ficity and accuracy of the results were calculated.

Results

Biliary variants were identified in nine (27.3%) of 33candidates. In four of these, the anterior segmental ductdrained into the left hepatic duct, and in two, drainageof the posterior segmental duct was aberrant, involvingthe left duct (Fig. 1). In two candidates had the commonhepatic duct trifurcated into two right branches and oneleft hepatic duct (trifurcation) (Fig. 2), and in one, the lat-eral segmental duct drained into the right duct (Fig. 3).

Diagnostic confidence and accuracy in determining the

anatomic types of hilar branching pattern

For both reviewers, the mean diagnostic confidencelevel was higher for enhanced T1-MRC than for T2-MRC, through the difference was not statistically signifi-cant. For T2-MRC and enhanced T1-MRC in combina-tion, however, the mean confidence level was signifi-cantly higher than for either modality alone in both re-viewer 1 and 2 (p<0.001) (Table 1). The accuracy of T2-MRC, enhanced T1-MRC, and the combined set for de-termining the anatomic types of hilar branching patternwas calculated on the basis of consensual interpretation.The separate interpretation of T2-MRC and enhancedT1-MRC matched the consensual findings in 30 (91%)


─ 187 ─

Table 1. Diagnostic Confidence of Hilar Biliary Branching Anatomyin T2-MRC, Enhanced T1-MRC and the Combined Set for EachReviewer

Reader 1 Reader 2

Mean gradeT2-MRC 3.52 3.64Enhanced T1-MRC 3.97 4Combined set 4.76 4.52

Comparison of methodsT2-MRC vs Enhanced

T1-MRC p=0.1 p=0.056T2-MRC vs Combined set p<0.001 p<0.001Enhanced T1-MRC vs

Combined set p<0.001 p<0.001

and 28 cases (85%) (reviewer 1), 26 (79%) and 28 cases(85%) (reviewer 2). The types of biliary anatomy deter-mined from the combined set matched the consensualinterpretation in 33 (100%) and 30 (91%) cases (reviewer1 and 2, respectively).


─ 188 ─

A C

BFig. 1. Right posterior segmental duct to left hepatic duct pattern.A. Heavily T2-weighted coronal single shot fast spin-echo thick-section MRC (∞/1004 [effective], 30-mm thickness) depicts abranch (white arrow) off left hepatic duct.B. T1-weighted coronal enhanced T1-MRC shows right posterior segmental duct (white arrow) draining aberrantly into proximalleft hepatic duct through serial image review from posterior to anterior. Diagnostic confidence of enhanced T1-MRC was higherthan that of T2-MRC in both reviewers.C. Intraoperative cholangiography confirmed this anomaly. The single anastomosis was identified to be impossible. Dual ductalanastomosis was performed in the associated recipient.


─ 189 ─

A B

C DFig. 2. Unfavorable trifurcation pattern that single anastomosis cannot be performed. A. The junction of right posterior segmental duct and right hepatic duct cannot be accurately visualized on heavily T2-weightedsingle shot fast spin-echo MRC (∞/1,088 [effective], 30-mm thickness) T2-MRC was interpreted as normal biliary anatomy. B, C. But enhanced T1-MRC depicts the unfavorable trifurcation pattern or very short right hepatic duct to disable a single duct toduct anastomosis in recipient (B is posterior to C). D. Intraoperative cholangiography confirmed this biliary anomaly. Extended left hepatectomy was performed in this donor.


─ 190 ─

A B

C DFig. 3. Left lateral segmental duct to right hepatic duct pattern.A. Heavily T2-weighted single shot fast spin-echo MRC (∞/995 [effective], 30-mm thickness) depicts a branch (white arrow) offright hepatic duct.B, C. T1-weighted coronal enhanced T1-MRC shows the left lateral segmental duct (white arrow) to right hepatic duct pattern (B isposterior to C).D. This left lateral segmental duct (white arrow) to right hepatic duct pattern well visualized on intraoperative cholangiography

Assessement of the possibility of single duct to duct

anastomosis

In four of twelve cases in which direct cholangiogra-phy was performed, biliary anomalies were visualized(one case each of anterior duct to left duct, posteriorduct to left duct, unfavorable trifurcation, and lateralduct to right duct). Singe duct-to-duct anastomosis forright lobe donation was found to be impossible in allfour cases. In three recipients who received donationsfrom three of four candidates with biliary anomalies,double anastomosis was performed in two cases, andleft lobe transplantion in the other. Liver donation didnot proceed in the candidate with lateral duct to rightduct anomaly.

Overall interobserver agreement in determining thepossibility of single anastomosis showed good or excel-lent agreement (κ=1.0 for T2-MRC, κ=0.657 for en-hanced T1-MRC, and κ=0.824 for the combined set).Table 2 shows the sensitivity, specificity and accuracyof the findings, with each imaging technique assessedfor possible single duct-to-duct anastomosis for rightlobe donation.T2-MRC showed 100% sensitivity, 80%specificity, and 91.6% accuracy, with no false negativecases, one false positive and seven true positives.Enhanced T1-MRC and the combined set showed 100%sensitivity and 100% specificity and 100% accuracy.

Discussion

Most current MRC techniques are based on variantsof heavily T2-weighted fat-suppressed rapid acquisitionusing relaxation enhancement (RARE) pulse sequences.The spatial resolution of current MRC techniques is,however, limited owing to the use of thick sections andblurring from the use of multiecho techniques with longecho trains. Because of relatively low spatial resolution,the depiction of intrahepatic biliary anatomy is often in-adequate in individuals without a dilated biliary system,and for this reason, a new approach to MR cholangiog-raphy which permits its accurate delineation is clearly

needed. Several studies have suggested that a new ap-proach should rely on contrast agents that are excretedinto the bile ducts for delineation of intrahepatic biliaryanatomy using 3D T1-weighted imaging (3, 4), and inthis regard, the spatial resolution of MRC can be poten-tially improved by using rapid 3D T1-weighted gradient-echo techniques with contiguous or overlapping thinsections in which bile has been enhanced by the admin-istration of a suitable biliary contrast medium such asmangafodipir trisodium. In particular, in the preopera-tive assessment of living liver donor candidates, en-hanced T1-MRC can play an important role in the accu-rate depiction of hilar branching bile duct anatomy.Carlos et al. (5) reported that combining T2-MRC andenhanced T1-MRC (using gadolinium-ethoxybenzyl-di-ethylenetriamine penta-acetic acid as an intrabiliarycontrast agent) significantly improved biliary visualiza-tion compared with each test alone. The improvementwas small, however, and the perceived added value ofan intrabiliary contrast agent was modest. Their study,though, assessed the utility of the agent only in terms ofductal depiction; we tried to evaluate the added effect interms of the confidence with which the hilar branchingductal anatomy was diagnosed during the preoperativeassessment of donor candidates. Our degree of confi-dence was not significantly different between T2-MRCand enhanced T1-MRC. For reviewer 1, accuracy tend-ed to be lower for enhanced T1-MRC (91% in T2-MRCand 85% in enhanced T1-MRC) than T2-MRC, thoughfor both reviewers, diagnostic confidence for the com-bined set was significantly higher than for T2-MRC orenhanced T1-MRC alone. With regard to accuracy, forboth reviewers 1 and 2 this was also higher for the com-bined set than for T2-MRC or enhanced T1-MRC alone.These findings suggest that the combination of imagesobtained at standard T2-MRC and enhanced T1-MRCimproved both diagnostic confidence and accuracy indetermining the anatomic type of a hilar branching pat-tern.

In donor candidates, the preoperative assessment of


─ 191 ─

Table 2. Assessment of Possibility for Single Duct to Duct Anastomosis

Examination TP* TN* FP* FN* Sensitivity Specificity Accuracy

T2-MRC 7 4 1 0 100 80 91.6T1-MRC 7 5 0 0 100 100 100Combined set 7 5 0 0 100 100 100

* Data are numbers of patients, out of a total of 12, with false negative (FN), false positive (FP), true negative (TN), and true positive (TP)of determination on performance possibility of single anastomosis.Sensitivity, specificity and accuracy values are cited as percentages.

hilar branching patterns is essential. Ductal anomaliessuch as aberrant drainage of the right posterior segmen-tal duct into the left hepatic duct or at the level of the bi-furcation (trifurcation) preclude performance of singleduct-to-duct biliary anastomosis and require additionalbiliary anastomoses that may incur an increased risk ofbiliary complication (6, 7). In order to determinewhether single anastomosis was possible, we thereforedetermined the sensitivity and specificity of each imag-ing method (T2-MRC, enhanced T1-MRC and the com-bined set), finding that the sensitivity, specificity, andaccuracy of enhanced T1-MRC and the combined setwere excellent. In the case of T2-MRC, the trifurcationpattern was not identified in one candidate, and singleanastomosis was thus at first considered possible. Onthe basis of the findings of enhanced T1-MRC and thecombined set, however, the reviewers considered thatsingle anastomosis might be impossible. Intraoperativecholangiography demonstrated insufficient right hepaticduct length for single biliary anastomosis without jeop-ardizing the donor’s biliary system (Fig. 2).

Our study suffered several limitations. First, with re-gard to diagnostic confidence analysis, we found that aswith many small studies examining technological ad-vances, the expected bias was toward the new tech-nique (in this case, enhanced T1-MRC). Despite this, thediagnostic confidence rate was not significantly differentbetween T2-MRC and enhanced T1-MRC. Only thecombined set showed significantly higher diagnosticconfidence than either of the two modalities alone.Second, in evaluating the possibility of single anastomo-sis, we selected from among the 33 candidates thetwelve who underwent direct cholangiography. Thiswas not perfored in those in whom on T2-MRC or en-hanced T1-MRC depicted a definitely unfavorable bil-iary anomaly, a fact which indicated selection vias.Thirld, the combined set was in a few cases helpful in

hilar branching pattern typing and determining the fea-sibility of single anastomosis. Because of the small sam-ple size, statistical analysis was, however, limited. In thefuture, further data collection from a larger number ofsubjects may help determine whether findings for thecombined set are likely to have a favorable impact onsurgical results. However, we believe our study is thefirst to focus on the clinical application of enhanced T1-MRC to a situation in which donor candidates for livingrelated liver transplantation are assessed.

In conclusion, enhanced T1-MRC has the potential toenhance the reliability of the preoperative evaluation ofhilar biliary anatomy in donor candidates or to lessenthe occurrence of a non-diagnostic or equivocal interpre-tation at T2-MRC alone.

References

1. Morgan GR, Lee V, Krinsky G, et al. Duct to duct biliary anasto-mosis with t-tube drainage in adult right lobe living donor livertransplantation without bile leaks. (abstr) Hepatology 2000;32:214A

2. Hintze RE, Adler A, Veltzke W, et al. Clinical significance of mag-netic resonance cholangiopancreatography (MRCP) compared toendoscopic retrograde cholangiopancreatography (ERCP).Endoscopy 1997;29:182-187

3. Lee VS, Rofsky NM, Morgan GR, et al. Volumetric mangafodipirtrisodium-enhanced cholangiography to define intrahepatic biliaryanatomy. AJR Am J Roentgenol 2001;176:906-908

4. Mitchell DG, Alam F. Mangafodipir trisodium: effects on T2- andT1-weighted MR cholangiography. J Magn Reson Imaging 1999;9:366-368

5. Carlos RC, Hussain HK, Song JH, Francis IR. Gadolinium-Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid as an intrabil-iary contrast agent: preliminary assessment. AJR Am J Roentgenol2002;179:87-92

6. Marcos A, Fisher RA, Ham JM, et al. Selection and outcome of liv-ing donors for adult to adult right lobe transplantation.Transplantation 2000;69:2410-2415

7. Marcos A, Ham JM, Fisher RA, Olzinski AT, Posner MP. Single-center analysis of the first 40 adult-to-adult living donor liver trans-plants using the right lobe. Liver Transpl 2000;6:296-301


─ 192 ─


─ 193 ─

대한방사선의학회지 2004;50:185-193

생체 부분 간이식 공여자의 술전 담문계 해부학적 변이에 관한 T2강조 및조영증강 T1강조 담도조영술간의 진단적 유용성 비교1

1연세대학교의과대학진단방사선과학교실2연세대학교의과대학외과학교실3연세대학교의과대학BK21 의학

임준석1·김명진1,3·김경식2·김주희1·오영택1·김진용1·유형식1·이종태1·김기황1

목적: 생체 부분 간이식 공여자의 담문계 해부학적 변이 진단에 관한 T2 강조 자기공명담관조영술(T2-MRC)과 조영

증강 T1강조 조영술(CE-MRC)의 유용성을 비교 분석하였다.

대상과 방법: 33명의 간이식 공여 후보자를 대상으로 하였으며, T2-MRC는 단발포급속스핀에코 방법을 이용하여 획

득되었으며, 5 mm두께의 관상면 영상과, 총담관을 중심으로 여러 각도의 단일 절편영상을 얻었다. CE-MRC는

mangafodifir trifodium을 주사후, 삼차원 GRE sequence를 사용하여, 축상면과 관상면 영상을 얻었다. 두 명의 방사선

과 의사가, T2-MRC와 CE-MRC를 각각 분리하여 본 경우와 모두 본 경우를 구분하여, 담문계 해부학적 변이와 진단

신뢰도를 기록하였으며, consensus reading을 기준으로 각 방법의 해부학적 변이 진단의 정확도를 비교하였다. 특히

직접 담관 조영술을 시행한 12예에서는 단일 담관계 문합의 수행가능성 여부를 판단하였으며, 이를 직접 담관 조영술

의 결과와 비교하였다.

결과과: 담문계 해부학적 변이 진단에 있어 두 평가자의 진단 신뢰도는 T2-MRC보다 CE-MRC에서 높은 양상을 보였으

나, 통계학적 차이는 없었다. T2와 T1강조 MRC를 모두 본 경우에는 두 평가자 모두 각각의 영상을 따로 본 경우 보다,

통계학적으로 더 높은 진단 신뢰도를 보였다(p<0.001). 두 영상을 같이 본 경우 두 평가자는 consensus reading과 각

각 33(100%), 30(91%) 예에서 일치된 결과를 보였으며, T2-MRC와 CE-MRC를 따로 본 경우 두 평가자에서 T2-

MRC: 30(91%), CE-MRC: 28(85%) 그리고 T2-MRC: 26(79%), CE-MRC: 28(85%)의 일치된 결과를 보였다.

직접 담관 조영술을 시행한 12예에서의 단일 담관 문합술의 수행가능성 예측 정확도는 T2-MRC: 91.6% CE-MRC:

100% 그리고 paired set: 100% 였다.

결론: 생체 부분 간이식 공여자의 술전 담관계 해부학적 변이 진단에 T2-MRC와 T1-MRC를 모두 시행함으로써 진단

신뢰도와 정확도를 향상시킬 수 있다.

hilar branching anatomy of living adult liver donors ...€¦ · of the biliary anatomy in a donor...

Documents