Abstract
Background
Presence of a dorsal sector of liver that completely encircles the IVC may increase difficulty of IVC preservation for orthotopic liver transplantation (OLT). We sought to evaluate the incidence of IVC encirclement by hepatic parenchyma using preoperative MRI and CT and its effect on surgical technique and complications.
Methods
CT or MRI examinations less than 12 months before OLT were reviewed independently and blindly by two radiologists in 95 patients, with patient consent waived by IRB. IVC preservation was attempted for all patients without regard to imaging findings. Surgical records were reviewed regarding choice of technique or operative difficulties, and their relationship to complete IVC encirclement was calculated using ROC analysis and Fischer exact test.
Results
Complete encirclement was found by both readers in 16 of 95 patients (17%). Resection of the recipient IVC was required in three of 95 patients, two of whom had complete IVC encirclement. Association of complete IVC encirclement with surgical IVC resection had an area under the ROC curve of 0.752.
Conclusion
Routine pretransplant assessment of IVC encirclement by dorsal sector hepatic tissue using MRI and CT may help identifying patients in whom IVC preservation will be difficult.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Filipponi F, Romagnoli P, Mosca F, Couinaud C (2000). The dorsal sector of human liver: embryological, anatomical and clinical relevance. Hepatogastroenterology 47:1726–1731
Calne RY, Williams R (1968) Liver transplantation in man. I. Observations on technique and organization in five cases. Br Med J 4:535–540
Lazaro JL, Charco R, Revhaug A, et al. (1997) Hemodynamics in human liver transplantation with inferior vena cava preservation. Transplant Proc 29:2851–2852
Shokouh-Amiri MH, Gaber AO, Bagous WA et al (2000) Choice of surgical technique influences perioperative outcomes in liver transplantation. Ann Surg 231:814–823
Lerut J, Ciccarelli O, Roggen F, et al. (2003) Cavocaval adult liver transplantation and retransplantation without venovenous bypass and without portocaval shunting: a prospective feasibility study in adult liver transplantation. Transplantation 75:1740–1745
Ito K, Mitchell DG (2000) Hepatic morphologic changes in cirrhosis: MR imaging findings. Abdom Imaging 25:456–461
Harbin WP, Robert NJ, Ferrucci JT (1980) Diagnosis of cirrhosis based on regional changes in hepatic morphology. Radiology 135:273–283
Awaya H, Mitchell DG, Kamishima T et al (2002) Cirrhosis: modified caudate-right lobe ratio. Radiology 224:769–774
Navarro F, Le Moine MC, Fabre JM, et al. (1999) Specific vascular complications of orthotopic liver transplantation with preservation of the retrohepatic vena cava: review of 1361 cases. Transplantation 68:646–650
Pannu HK, Maley WR, Fishman EK (2001) Liver transplantation: preoperative CT evaluation. Radiographics 21:S133–S146
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mehta, R.I., Mitchell, D.G., Kayler, L. et al. Inferior vena cava encirclement by caudate lobe hypertrophy: evaluation by MRI and CT and its impact on caval preservation during orthotopic liver transplantation. Abdom Imaging 35, 322–327 (2010). https://doi.org/10.1007/s00261-009-9518-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-009-9518-7