Ragibe KANTARCI, Cihan DURAN, Selim DOĞANAY, K. Yalçın POLAT, S. Selçuk ATAMANALP, Mecit KANTARCI, Hayri OĞUL, Bülent AYDINLI, Durur Irmak SUBAŞI

Imaging liver transplantation candidates using gadolinium enhanced MDCT angiography

Aim: To report our experience with gadolinium enhanced computed tomography angiography (Gd-CTA) for end-stage liver disease patients who are candidates for liver transplantation as an alternative to iodinated contrast enhanced CTA and gadolinium enhanced magnetic resonance (MR) angiography. Materials and methods: Seventeen patients with end-stage liver disease were evaluated with Gd-CTA. The patients were 10 men (58.8%) and 7 women (41.1%) (age range: 37-59 years). Multidetector CT (MDCT) was performed using 16-detector-row CT scanners. 3D images of the celiac artery, superior mesenteric artery, portal vein, and inferior vena cava (IVC) were obtained for thorough assessment using multiple plane reconstruction and maximum-intensity projection. Adequate images were defined by complete opacification of the celiac, superior mesenteric, hepatic propria, bilateral hepatic arteries, main portal vein and bilateral intrahepatic portal branches, and IVC. Results: All 17 Gd-CTAs were rated as diagnostic. Adequate CT arteriography (celiac, common hepatic, hepatic propia, and bilateral hepatic artery) and portography were obtained in all the patients. Engorged gastric and coronary varices were detected in 5 patients (29.4%). Severe splenorenal shunt was found in 2 patients (11.7%). Thrombus of the portal vein was observed in 3 patients (17.6%). The radiological findings and operational findings were not discordant in any of the operated patients. Conclusion: The degree of enhancement and image quality achieved using these gadolinium-enhanced MDCT angiographies appear adequate for angiographic evaluation of liver transplantation. Therefore, the use of 3D Gd-CTA in selected cases and settings can be advantageous in the pretransplantation evaluation.

Anahtar Kelimeler:

Key words: Liver Transplantation, candidates, gadolinium, MDCT angiography

Imaging liver transplantation candidates using gadolinium enhanced MDCT angiography

Keywords:

Key words: Liver Transplantation, candidates, gadolinium, MDCT angiography,

PDF

___

1. Zibari GB, Edwin D, Wall L, Diehl A, Fair J, Burdick J et al. Liver transplantation for alcoholic liver disease. Clin Transplant 1996; 10: 676-9.
2. Diem HV, Evrard V, Vinh HT, Sokal EM, Janssen M, Otte JB et al. Pediatric liver transplantation for biliary atresia: results of primary grafts in 328 recipients. Transplantation 2003; 75: 1692- 7.
3. Hammer FD, Malaise J, Goffette PP, Mathurin P. Gadolinium dimeglumine: an alternative contrast agent for digital subtraction angiography in patients with renal failure. Transplant Proc 2000; 32: 432-3.
4. Yang X, Manninen H, Soimakallio S. Carbon dioxide in vascular imaging and intervention. Acta Radiol 1995; 36: 330-7.
5. Hawkins IF Jr, Wilcox CS, Kerns SR, Sabatelli FW. CO2 digital angiography: a safer contrast agent for renal vascular imaging? Am J Kidney Dis 1994; 24: 685-94.
6. Karcaaltincaba M, Foley WD. Gadolinium-enhanced multidetector CT angiography of the thoracoabdominal aorta. J Comput Assist Tomogr 2002; 26: 875-8.
7. Gupta AK, Alberico RA, Litwin A, Kanter P, Grossman ZD. Gadopentetate dimeglumine is potentially an alternative contrast agent for three-dimensional computed tomography angiography with multidetector-row helical scanning. J Comput Assist Tomogr 2002; 26: 869-74.
8. Carrascosa P, Merletti PG, Capuñay C, Goldsmit A, Bettinotti M, Carrascosa J. New approach to noninvasive coronary angiography by multidetector computed tomography: initial experience using gadolinium. J Comput Assist Tomogr 2007; 31: 441-3.
9. Yan SX, Liang TB, Fujii M, Kawamitsu H, Sugimura K, Zheng SS. Modified magnetic resonance angiography of the liver using sensitivity encoding in comparison with digital subtraction angiography and CT arterial portography. Hepatobiliary Pancreat Dis Int 2005; 4: 185-91.
10. Wang X, Li G, Li X, Zhang F, Qian J, Kong L et al. Multimodal approach to clinical liver transplantation. Zhonghua Wai Ke Za Zhi 2002; 40: 758-61.
11. Cohen AJ, Stegall MD, Rosen CB, Wiesner RH, Leung N, Kremers WK et al. Chronic renal dysfunction late after liver transplantation. Liver Transpl 2000; 8: 916-21.
12. Bilbao I, Charco R, Balsells J, Lazaro JL, Hidalgo R, Llopart L et al. Risk factors for acute renal failure requiring dialysis after liver transplantation. Clin Transplant 1998; 12: 123-9.
13. Rosioreanu A, Alberico RA, Litwin A, Hon M, Grossman ZD, Katz DS. Gadolinium-enhanced computed tomographic angiography: current status. Curr Probl Diagn Radiol 2005; 34: 207-19.
14. Davis CL, Gonwa TA, Wilkinson AH. Pathophysiology of renal disease associated with liver disorders: Implications for liver transplantation. Part I. Liver Transpl 2002; 8: 91-109.
15. Gonwa TA, Klintmalm GB, Levy M, Levy M, Jennings LS, Goldstein RM, Husberg BS. Impact of pretransplant renal function on survival after liver transplantation. Transplantation 1995; 59: 361-5.
16. Haustein J, Niendorf HP, Krestin G, Louton T, SchuhmannGiampieri G, Clauss W et al. Renal tolerance of gadoliniumDTPA/dimeglumine in patients with chronic renal failure. Invest Radiol 1992; 27: 153-6.
17. Niendorf HP, Haustein J, Louton T, Beck W, Laniado M. Safety and tolerance after intravenous administration of 0.3 mmol/kg Gd-DTPA. Results of a randomized controlled clinical trial. Invest Radiol 1991; 26 Suppl 1: S221-3: discussion S232-5.
18. Weinmann HJ, Brasch RC, Press WR, Wesbey GE. Characteristics of gadolinium-DTPA complex: a potential NMR contrast agent. AJR Am J Roentgenol 1984; 142: 619-24.
19. Bloem JL, Wondergem J. Gd-DTPA as a contrast agent in CT. Radiology 1989; 171: 578-9. 20. Quinn AD, O’hare NJ, Wallis FJ, Wilson GF. Gd-DTPA: an alternative contrast medium for CT. J Comput Assist Tomogr 1994; 18: 634-6.
21. Lumboldt W, De Santis M, Von Smekal A, Reiser M. Attenuation characteristics and application of gadoliniumDTPA in fast helical computed tomography. Invest Radiol 1997; 35: 690-5.
22. Peña CS, Kaufman JA, Geller SC, Waltman AC. Gadopentetate dimeglumine: a possible alternative contrast agent for CT angiography of the aorta. J Comput Assist Tomogr 1999; 23: 23- 4.
23. Chryssidis S, Davies RP, TIE ML. Gadolinium-enhanced computed tomographic aortography. Australas Radiol 2002; 46: 97-100.
24. Coche EE, Hammer FD, Goffette PP. Demonstration of pulmonary embolism with dynamic gadolinium enhanced spiral CT. Eur Radiol 2001; 11: 2306-9.
25. Sam AD, Morasch MD, Collins J, Song G, Chen R, Pereles FS. Safety of gadolinium contrast angiography in patients with chronic renal insufficiency. J Vasc Surg 2003; 38: 313-8.
26. Wicky S, Greenfield A, Fan CM, Geller SC, Hamberg LM, Hoffmann U et al. Aortoiliac gadoliniumenhanced CT angiography: improved results with a 16-detector row scanner compared with a four detector row scanner. J Vasc Interv Radiol 2004; 15: 947-54.
27. Spinosa DJ, Kaufmann JA, Hartwell GD. Gadolinium chelates in angiography and interventional radiology: a useful alternative to iodinated contrast media for angiography. Radiology 2002; 223: 319-25.
28. Gierada DB, Bae KT. Gadolinium as a CT contrast agent: assessment in a porcine model. Radiology 1999; 210: 829-34. 29. Penfield JG, Reilly RF JR. What nephrologists need to know about gadolinium? Nat Clin Pract Nephrol 2007; 3: 654-68.
30. Kirchin MA, Runge VM. Contrast agents for magnetic resonance imaging: safety update. Top Magn Reson Imaging 2003; 14: 426-35.
31. Shinkai M, Ohhama Y, Nishi T, Yamamoto H, Fujita S, Take H et al. Congenital absence of the portal vein and role of liver transplantation in children. J Pediatr Surg 2001; 36: 1026-31.
32. Tzakis A, Todo S, Stieber A, Starzl TE. Venous jump grafts for liver transplantation in patients with portal vein thrombosis. Transplantation 1989; 48: 530-1.
33. Tzakis AG, Kirkegaard P, Pinna AD, Jovine E, Misiakos EP, Maziotti A et al. Liver transplantation with cavoportal hemitransposition in the presence of diffuse portal vein thrombosis. Transplantation 1998; 65: 619-24.
34. Castaldo P, Langnas AN, Stratta RJ, Lieberman RP, Wood RP, Shaw BW Jr. Successful liver transplantation in a patient with a thrombosed portomesenteric system after multiple failed shunts. Am J Gastroenterol 1991; 86: 506-8.
35. Lilly JR, Starzl TE. Liver transplantation in children with biliary atresia and vascular anomalies. J Pediatr Surg 1974; 9: 707.
36. Cheng YF, Chen CL, Jawan B, Huang TL, Chen TY, Chen YS et al. Multislice computed tomography angiography in pediatric liver transplantation. Transplantation 2003; 76: 353-7.
37. De Carlis L, Del Favero E, Rondinara G, Belli LS, Sansalone CV, Zani B et al. The role of spontaneous portosystemic shunts in the course of orthotopic liver transplantation. Transpl Int 1992; 5: 9-14.