Non‐Contrast‐Enhanced MR Arteriography of Potential Living‐Related Liver Donor: Using Contrast Enhanced CT Arteriography as Standard Reference

• Published in: Journal of magnetic resonance imaging Vol. 58; no. 3; pp. 894 - 904
• Main Authors: Lin, Wei‐Ching, Chen, Chun‐Ming, Westphalen, Antonio Carlos, Lin, Tzu‐Yang, Chang, Chia Hao, Chen, Li‐Kuang, Lin, Chia‐Wei, Yeh, Chun‐Chieh, Yu, Jiaxin, Jeng, Long‐Bin, Chen, Jeon‐Hor
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.09.2023; Wiley Subscription Services, Inc
• Subjects: Angiography; Arteries; Arteriography; balanced steady‐state free‐precession; Blood vessels; Computed tomography; Contrast media; Evaluation; Field strength; Hepatic artery; Image contrast; Image quality; inflow inversion recovery; Liver; liver transplantation; Liver transplants; Magnetic resonance; magnetic resonance angiography; Magnetic resonance imaging; Medical imaging; Organ donors; Population studies; Quality assessment; Radiation; Rank tests; Segments; Statistical analysis; Statistical tests; Variance analysis; Veins & arteries; Visualization; balanced steady-state free-precession; hepatic artery; inflow inversion recovery; magnetic resonance angiography; liver transplantation
• ISSN: 1053-1807; 1522-2586
• DOI: 10.1002/jmri.28571

Background Contrast‐enhanced computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are the primary modalities to assess donors' vessels before transplant surgery. Radiation and contrast medium are potentially harmful to donors. Purpose To compare the image quality and visualization scores of hepatic arteries on CTA and balanced steady‐state free‐precession (bSSFP) non‐contrast‐enhanced MRA (NC‐MRA), and to evaluate if bSSFP NC‐MRA can potentially be a substitute for CTA. Study Type Prospective. Population Fifty‐six consecutive potential living‐related liver donors (30.9 ± 8.4 years; 31 men). Field Strength/Sequence 1.5T; four bSSFP NC‐MRA sequences: respiratory‐triggered (Inhance inflow inversion recovery [IFIR]) and three breath‐hold (BH); and CTA. Assessment The artery‐to‐liver contrast (Ca‐l) was quantified. Three radiologists independently assigned visualization scores using a four‐point scale to potential origins, segments, and branches of the hepatic arteries, determined the anatomical variants based on Hiatt's classification, and assessed the image quality of NC‐MRA sequences. Statistical Tests Fleiss' kappa to evaluate the readers' agreement. Repeat measured ANOVA or Friedman test to compare Ca‐l of each NC‐MRA. Friedman test to compare overall image quality and visualization scores; post hoc analysis using Wilcoxon signed‐rank test. P‐value <0.05 was considered statistically significant. Results Inhance IFIR Ca‐l was significantly higher than all BH bSSFP Ca‐l (0.56 [0.45–0.64] vs. 0.37 [0.29–0.47] to 0.41 [0.23–0.51]). Overall image quality score of BH bSSFP TI1200 was significantly higher than other NC‐MRA (4 [4–4] vs. 4 [3 to 4–4]). The median visualization scores of almost all arteries on CTA were significantly higher than on NC‐MRA (4 [3 to 4–4] vs. 1 [1–2] to 4 [4–4]). The median visualization scores were all 4 [4–4 ] on Inhance IFIR with >92.3% observed scores ≥3, except the segment 4 branch (3 [1–4], 53.6%). The identification rates of arterial variants were 92.9%–97% on Inhance IFIR. Data Conclusions Although CTA is superior to the NC‐MRA, all NC‐MRA depict the donor arterial anatomy well. Inhance IFIR can potentially be an alternative image modality for CTA to evaluate the arterial variants of living donors. Level of Evidence 3 Technical Efficacy Stage 2