Role of multidetector CT in evaluation of liver transplantation donors

Several factors have contributed to an increasing demand for liver transplantation including an Increasing incidence of cirrhosis caused by hepatitis C and the early detection of small hepatomas that are potentially curable with transplantation. Living donors can help alleviate the shortage of available livers for transplantation. Multidetector CT is a technologic advance that permits highspeed and high-resolution helical imaging of the entire liver volume during a single breath-hold. Rapid helical data acquisition has resulted in increased body coverage, decreased motion artifact, better use of contrast bolus, and multiphase organ scanning that allows accurate vascular mapping. The combination of fast helical scanning and image processing in three-dimensional [3D] and multiplanar reconstructions has resulted in dramatic improvement of image quality and the ability to depict fine anatomic-vascular detail The study included 50 potential living liver donors to asses the impact of multidetector multiphase CT in facilitating patient selection and surgical planning in potential donors being evaluated for living adult right lobe liver transplantation. Results: the mean age of the donors was 27.4 years including 28 females and 22 males. Calculated total liver volumes mean was 1523 +/- 239 gm, right lobe mean weight with middle hepatic vein was 893 +/- 153 gm and 621 +7-772 gm without middle hepatic vein, intra operative mean graft weight was 1043.46 +7-763.77 gm while that measured intra operatively had a mean weight of 853.14 +7-122.69 with a mean weight difference of 190.32 gm. CT calculated graft recipient weight ratio was 1.34 while actual GRWR was 1.068. meal L/S ratio 1.12. The classic anatomy of right main hepatic artery originating from the caeliac trunk [Michel type I] is seen in 35 cases [70%], while RHA originating from SMA [Michel s' type HI] seen in 8 cases [16%], CHA originating from SMA [Michel s' type IX] in 4 cases [8%], RHA from the aorta [Michel s' type XI] in 2 cases [4%] and two LHAs [Michel s' type VII] in one case [2%]. Variation in portal venous anatomy occurred in 20% of patients and includes:1-trifurcation of the portal vein [type B] in 9 cases [18%] 2-posterior right portal vein from main portal vein [separate branch for posterior inferior segment, segment VII] Type D in lease [2%]. hepatic veins showed early confluence to the right was present in j patients [6%] and accessory inferior right hepatic vein was detected in 2 patients [4%] Multidetector CT is a valuable tool in the evaluation of potential living liver donors that provides complete and comprehensive information on the hepatic vascular anatomy, the liver parenchyma, and volumetric measurements

Role of spiral CT scan and endoscopic ultrasonography in assessing operability of peri-ampullary tumors

Pancreatic cancer is associated with an extremely poor prognosis with less than 5% of patients surviving 5 years after the diagnosis. Current preoperative staging modalities include various cross sectional imaging techniques. including spiral CT and endoscopic ultrasound [EUS]. This prospective study aimed at demonstrating the role of spiral CT and endoscopic ultrasonography in early diagnosis staging and assessment of operability of periampullary tumors. Sixty-two patients with periampullary tumors were included in this study. All cases were subjected to abdominal ultrasound. Spiral CT. ERCP. EUS and operative interference. Surgical findings were considered the gold standard for assessing the sensitivity of spiral CT and EUS in diagnosing, staging arid estimating resectability of periampullary tumors. Endoscopic Ultrasonography was very sensitive in detecting periampullary masses [93.5%] especially masses smaller than 20mm while the sensitivity of spiral CT was 71%. EUS was also very sensitive in detecting ampullary masses [100%] in contrast to spiral CT chat missed the diagnosis of the 14 ampullary masses found in our work. EUS was more sensitive than Spiral CT in detecting malignant vascular invasion [95% versus 75%] while it was slightly less specific than spiral CT in that context [74 versus 80%]. The predictive value of spiral CT was 60% for tumor resectability while it was 100% for tumor unresectability. The predictive value of EUS was 735% for tumor resectability while it was 96.4% for tumor unresectability. When combining both techniques the predictive value for tumor resectability was 65% while it was 100% for tumor unresectability. No complications were encountered in both techniques. We concluded that EUS is more sensitive than spiral CT in detection and staging of periampullary masses. Also. the non-invasive spiral CT and the minimally invasive EUS are very valuable tools in predicting uresectability of periampullary masses while EUS is slightly more valuable in detecting tumor resectability