3D modeling of accessory right hepatic veins in living donor liver transplantation based on multi-detector row CT

The purpose of this study was to evaluate the accessory right hepatic veins (ARHV) in planning living donor live transplantation (LDLT) using software based on computed tomography (CT). In 83 potential living liver donors, CT angiogram was performed after intravenous bolus administration of 120 ml of non-ionic contrast material and 60 ml of NaCl 0.9% at the rate of 4, ml/sec. For images, collimation was 2.5 mm with a table speed of 15 mm/gantry, and reconstructions of 2 mm for arterial and venous phases were analyzed using the software ''HepaVision''. Segmentation analysis of the liver and vessels was performed semi-automatically and the edited venous regions were analyzed. The diameter of ARHV was measured in units of 0.5 mm in 2D data. A total of 58 ARHVs were identified in 41 donors (54.1%). In those cases, an inferior ARHV that drained into the IVC was identified in 25 donors. One middle right hepatic vein and one inferior right hepatic vein were identified in 15 donors. Two middle right hepatic veins and one inferior right hepatic vein were identified in 1 donor. In 30 donors (39%,), 40 small accessory right hepatic veins (ARHVs) (diameter 5 mm) were identified and 18 large ARHVs (diameter >5 mm) were identified in 14 donors (18%). Regarding ARHV drainage, 5 ARHV branches drained into segment V, 8 into V and VI, 16 into VI, 7 into VI and VII, 21 into VII, and 1 branch into VII and VIII. A wide range of anatomic variations of ARHV can be detected and visualized 3-dimensionally using software based on multi-detector row CT data. The knowledge gained from this visualization facilitates accurate preoperative planning for LDLT. (author)