Three-dimensional helical computed tomographic cholangiography: application to living related hepatic transplantation

Variations in the anatomy of intrahepatic bile ducts complicate operations in living related hepatic transplantation (LRHT). Preoperative delineation of the biliary system is important to achieve successful results. The purpose of this study was to assess the utility and accuracy of three-dimensional helical computed tomographic cholangiography (3DHCTC) as a replacement for endoscopic retrograde cholangiography (ERC) in evaluating the anatomy of the intersegmental biliary connection of the potential donors in LRHT. Helical CT was performed in 16 potential donors after a slow infusion of 100 cm3 meglumine iodipamide. By using the maximum intensity projection and shaded surface displaced image reconstruction technique, three-dimensional images of the bile ducts were isolated from the surrounding hepatic parenchyma. Among the 16 potential donors, 3 cases underwent an ERC study and another 7 cases donated liver graft during LRHT. In all 16 cases the anatomy of the bilateral essential intrahepatic ducts was well displayed with and without the liver parenchyma background in an axial and three-dimensional fashion which had good correlation with images from ERC and intra-operative cholangiography. Two variants were found, including drainage of the right posterior intrahepatic duct into the left hepatic duct and direct drainage of the segment II bile duct into the common hepatic duct, respectively. It is concluded that unusual routes of intrahepatic ducts may necessitate a change in the cutting plane during graft retrieval and patterns of ductoenteral anastomosis to avoid potential complications to both donors and recipients. With the advantages of non-invasiveness and comparable accuracy in demonstrating biliary anatomy, 3DHCTC may replace the traditional ERC in the pre-transplant survey of potential donors for LRHT.