Correlation between 3D-MRCP and intra-operative findings in right liver donors

A correct preoperative definition of the hepatic duct confluence anatomy of right liver livingdonors is a pivotal step in determining their candidacy for donation and planning the surgery. The purposesof this study are to evaluate the accuracy of three-dimensional Magnetic Resonance Cholangiography (3DMRCP) when compared with intraoperative cholangiography (IOC) in assessing biliary anatomy and toidentify imaging characteristics that may help predict the yield of hepatic duct orifices in the right liver graft.Twenty consecutive right liver donors were imaged with 3D MRCP and IOC. The MRCP and IOC findingswere compared, and the results confirmed against actual donor anatomy. Three-D MRCP accuratelypredicted the biliary anatomy in 18 of 20 cases. Specificity and positive predictive value of 3D MRCP indefining normal biliary anatomy was 100%. In 2 patients, 3D MRCP failed to indentify abnormal anatomy.The yield of more than one hepatic duct was associated with: (I) The presence of abnormal biliary anatomy, (II)The length of the main right hepatic duct, and (III) The presence of an acute angle at the confluence of rightand left hepatic duct. In conclusion, 3D MRCP reliably represents normal biliary anatomy. The presenceof anatomical variations decreases MRCP sensitivity and makes IOC or duct probing a necessary tool foraccurately performing the transection of the right hepatic duct.