Living donor workup for Liver Transplant -Multislice CT

Living donor workup for Liver Transplant  is ideally done by multislice CT presently with 2 phase  acquisition. 

Technique: 120 ml non ionic contrast with 5cc/sec with volume  acquisition using bolus tracking for arterial phase and 55 to 80 sec for portal and hepatic  venous study

Submitted by Dr Sudheer , Dr Krishna Mohan & Dr MGK Murthy

How to evaluate--

1. Is the study optimal- i.e. quality, timing and area covered?

2.Evaluation of hepatic parenchyma

    -look for any focal lesions 

   - presence of Fatty infiltration/hepatitis and haemochromatosis

Precontrast Liver Attenuation Index is calculated (LAI) = mean attenuation of liver -spleen by planning multiple ROIs 

LAI>5HU=0-5%steatosis          -10HU&5HU=6to 30%steatosis            <-10HU =>30%steatosis 

Upper limit of steatosis for donor liver is 30%

3.Reconstruction of hepatic vasculature 

Using three techniques MIP/SSD/Volume Rendering (VR)

1st phase is arterial using bolus track for any anomalies or abnormalities

2nd phase  for portal and hepatic venous evaluation

4.Calculation of hepatic volume --usually in portal venous phase (as hepatic veins are well visualised)

Can be done by Auto or Manual  technique  and exclude Portal vein, IVC and Gallbladder 

Whole Liver volume should include caudate in axial sections

Right lobe volume calculated by------ inserting imaginary line 1cm lateral to MHV 

                                              ------can also be done by excluding IVC and GB

5. Study Hepatic veins 

Middle hepatic vein-is it joining with common trunk with left to ivc or independently

if patency of segment IV lobe graft is not preserved , hepatic congestion will occur leading to heaptofugal flow and consequent atrophy