Preoperative helical computerized tomography estimation of donor liver volume.

BACKGROUND: The purpose of this study was to evaluate the accuracy of spiral computed tomography (CT) and 3-D imaging models in measuring total and segmental liver volume in potential living donors. METHODS: A prospective study was undertaken to assess the correlation between the volumes of potential donor livers determined via helical CT and the actual volumes measured during operation in 150 donor candidates. Left-lateral segment (S2,3) or left-lobe (S2,3,4) transplantation was performed in 36 cases with 96 right-lobe liver transplants (S5,6,7,8). Ten donor candidates were refused owing to inadequate liver volumes, and 8 for other reasons. RESULTS: The regression analysis model showed a significant correlation between the preoperative CT estimates of graft volume and intraoperative weight measurement of harvested grafts in living liver donors (F: 5525.37; P < .05); 97.7% of changes in CT volume were explained by differences in graft mass (R2: 0.977). CONCLUSION: Preoperative estimation of segmental volumes of the donor liver is necessary to avoid donor-recipient size disparity, thereby preventing hepatic failure of donors after harvesting. It has a major impact on donor selection and type of surgical management. The accuracy of helical CT was high to determine total and segmental liver volumes.

Variations of hepatic veins: helical computerized tomography experience in 100 consecutive living liver donors with emphasis on right lobe.

Anatomical variations in the venous system of liver are not a rarity. A prospective helical computerized tomography (CT) study was undertaken to determine the prevalence of surgically significant hepatic venous anatomic variations among 100 consecutive living liver donors. The studies evaluated the ramification pattern of hepatic veins, the presence of accessory hepatic veins, and of segment 5 or 8 veins (or both) draining into middle hepatic vein. These data obtained by CT influenced surgical planning. Sixty-four donors donated their right lobes and 24 donors, left lateral segments. Only one donor candidate was refused due to combined hepatic and portal venous variations accompanied by multiple bile ducts. Eleven donors were also refused due to reasons other than anatomical variations. Seventeen segment 5 and 17 segment 8 veins draining into middle hepatic vein were anastomosed to inferior vena cava in 23 (36%) of the right lobe liver transplantations. The middle hepatic vein was harvested in only one of the donors. Among the 100 cases, 47 had accessory right inferior hepatic veins, 13 of which were multiple. Twenty-two of the right lobe grafts required surgical anastomoses of these accessory hepatic veins (34%). An isolated hepatic vein anomaly or the presence of accessory hepatic veins are not contraindications to be a living liver donor candidate. However, preoperative knowledge of vascular variations alters surgical management. Helical CT is a valuable tool to delineate the hepatic venous anatomy for surgical planning in living liver donors.

Clinical, radiographic and echocardiographic findings in a patient with ochronosis.

Hereditary alkaptonuric ochronosis is an autosomal recessive metabolic disorder that affects approximately one in one million individuals. The most common clinical features are homogentisic aciduria, pigmentation of cartilages and other connective tissues, ochronotic arthritis and cardiovascular ochronosis. We report a case of ochronosis which has all these clinical features mentioned above. We detected homogentisic acid in the patient's plasma and urine sample by using a high-performance liquid-chromatographic method. The patient was HLA-B27 negative. The case was evaluated with both conventional radiography and helical CT. The main characteristic manifestations of ochronotic arthritis were observed in conventional radiographs. We also obtained Ray-Sum and maximum intensity projections (MIP) images of ankylosed ochronotic spine of our patient. Such images of an ochronotic patient were not encountered in the literature. Echocardiographic examination revealed thickening of the right coronary cusp which may be related to ochronotic calcific deposition, along with coaptation deficiency and slight aortic regurgitation (grade I-II). No other abnormalities concerning the other valves and ventricular function were detected.