MR cholangiopancreatography with T2-weighted prospective acquisition correction turbo spin-echo sequence of the biliary anatomy of potential living liver transplant donors

OBJECTIVE. The objective of our study was to evaluate the ability of a respiratory navigator-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 sensitivity, 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 donors ( 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 differentiating 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 sensitivity 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-weighted TSE sequence with a PACE technique accurately depicts the biliary anatomy in LDLT donors and may guide intraoperative management of the biliary tract.