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Non-Contrast-Enhanced MR Arteriography of Potential Living-Related Liver Donor: Using Contrast Enhanced CT
Wei-Ching Lin1,2,3, Chun-Ming Chen1, Antonio Carlos Westphalen4
1Department of Medical Imaging, China Medical University Hospital, Taichung, Taiwan.
Insights
Non-contrast-enhanced magnetic resonance angiography (NC-MRA) shows promise for evaluating liver donor arteries. Inhance IFIR NC-MRA effectively visualizes arterial variants, potentially serving as an alternative to CT angiography (CTA).
Area of Science:
- Radiology
- Medical Imaging
- Transplant Surgery
Background:
- Contrast-enhanced computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are standard for assessing donor vessels before transplantation.
- Both CTA and MRA carry risks, including radiation exposure and potential harm from contrast media for living donors.
Purpose of the Study:
- To compare image quality and visualization scores of hepatic arteries using CTA and non-contrast-enhanced MRA (NC-MRA) with balanced steady-state free-precession (bSSFP) sequences.
- To evaluate the potential of bSSFP NC-MRA as a substitute for CTA in liver donor assessment.
Main Methods:
- A prospective study involving 56 potential living-related liver donors.
- Evaluated four bSSFP NC-MRA sequences (including respiratory-triggered Inhance inflow inversion recovery [IFIR]) and CTA on a 1.5T scanner.
- Quantified artery-to-liver contrast (Ca-l), assessed visualization scores for hepatic artery anatomy, identified variants using Hiatt's classification, and evaluated image quality.
Main Results:
- Inhance IFIR NC-MRA demonstrated significantly higher Ca-l compared to breath-hold bSSFP sequences.
- Breath-hold bSSFP with TI1200 achieved higher overall image quality scores than other NC-MRA sequences.
- While CTA generally yielded higher visualization scores, Inhance IFIR NC-MRA showed excellent visualization (>92.3% scores ≥3) for most arteries and high identification rates (92.9%-97%) for arterial variants.
Conclusions:
- All evaluated NC-MRA techniques adequately depicted donor arterial anatomy.
- Inhance IFIR NC-MRA shows potential as an alternative imaging modality to CTA for assessing arterial variants in living liver donors, minimizing risks associated with contrast agents and radiation.
Background:
Contrast-enhanced computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are the primary modalities to assess donors' vessels before transplant surgery. Radiation and contrast medium are potentially harmful to donors.
Purpose:
To compare the image quality and visualization scores of hepatic arteries on CTA and balanced steady-state free-precession (bSSFP) non-contrast-enhanced MRA (NC-MRA), and to evaluate if bSSFP NC-MRA can potentially be a substitute for CTA.
Study Type:
Prospective.
Population:
Fifty-six consecutive potential living-related liver donors (30.9 ± 8.4 years; 31 men).
Field Strength/Sequence:
1.5T; four bSSFP NC-MRA sequences: respiratory-triggered (Inhance inflow inversion recovery [IFIR]) and three breath-hold (BH); and CTA.
Assessment:
The artery-to-liver contrast (Ca-l) was quantified. Three radiologists independently assigned visualization scores using a four-point scale to potential origins, segments, and branches of the hepatic arteries, determined the anatomical variants based on Hiatt's classification, and assessed the image quality of NC-MRA sequences.
Statistical Tests:
Fleiss' kappa to evaluate the readers' agreement. Repeat measured ANOVA or Friedman test to compare Ca-l of each NC-MRA. Friedman test to compare overall image quality and visualization scores; post hoc analysis using Wilcoxon signed-rank test. P-value <0.05 was considered statistically significant.
Results:
Inhance IFIR Ca-l was significantly higher than all BH bSSFP Ca-l (0.56 [0.45-0.64] vs. 0.37 [0.29-0.47] to 0.41 [0.23-0.51]). Overall image quality score of BH bSSFP TI1200 was significantly higher than other NC-MRA (4 [4-4] vs. 4 [3 to 4-4]). The median visualization scores of almost all arteries on CTA were significantly higher than on NC-MRA (4 [3 to 4-4] vs. 1 [1-2] to 4 [4-4]). The median visualization scores were all 4 [4-4 ] on Inhance IFIR with >92.3% observed scores ≥3, except the segment 4 branch (3 [1-4], 53.6%). The identification rates of arterial variants were 92.9%-97% on Inhance IFIR.
Data Conclusions:
Although CTA is superior to the NC-MRA, all NC-MRA depict the donor arterial anatomy well. Inhance IFIR can potentially be an alternative image modality for CTA to evaluate the arterial variants of living donors.
Level Of Evidence:
3 TECHNICAL EFFICACY: Stage 2.
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