Sachal Sharma

Abstract

Duplication of infra-renal inferior vena cava(IVC) is a rare entity with most of them being detected incidentally. Information about the presence of infra-renal IVC has great surgical significance while performing transplant surgeries and operating on retro peritoneum. Here we present a case of a prospective renal donor who was incidentally detected with this anatomical variant. Keywords: Inferior vena cava duplication, MDCT angiography.

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Abstract

Introduction: Liver transplantation has become an ideal management for end stage liver diseases. The preoperative volumetric assessment of donor liver is an important factor in determining the surgical strategy and in predicting post operative donor and recipient mortality and morbidity. CT has high spatial and contrast resolution and provides comprehensive parenchymal vascular and volumetric preoperative evaluation of donor undergoing live donor liver transplant and its accuracy can be established by comparing it with the intraoperative actual graft volume. Materials and Methods : 52 patients who underwent donor right hepatectomy were included in the study and underwent CT scanning during the period from July 2017 to June 2019. Manual tracing of CT volumetry was done for calculating liver volume. The actual liver volume is obtained by weighing the graft immediately after resection. The difference between preoperative CT volume and intraoperative graft weight was defined as a percentage error ratio, which was classified as overestimation (+) and underestimation (-). Results: In 28 (53.8%) cases, right lobe liver grafts obtained including MHV, whereas in 24(46.2%) cases right liver lobe grafts obtained excluding MHV. The mean preoperative liver volume calculated was 816.5+ 142.5g, while the mean volume measured intraoperatively was 812.6 g + 136.8g. The mean volume difference between preoperative and actual graft volume was 51.96+33.65cm3(range 4-131cm3). The mean error ratio was 6.59+4.623%. 30(57.7%) cases had underestimation, whereas 22(42.3%) cases had overestimation of liver volume. The mean preoperative volume had a good correlation with actual graft volume. Conclusion: The present study concludes that CT volumetry accurately predicted preoperative graft volume and showed excellent correlation with actual graft volume. Keywords: Transplantation, Graft, Volumetry, Donor, .CT

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Background: Diffusion weighted Imaging (DWI) is a useful noninvasive tool in MRI as it can be performed quickly and does not require contrast injection. In addition to it, DWI imaging and apparent diffusion coefficient (ADC) quantification not only can add additional anatomical data about the lesion but can also help in characterization of focal liver lesions into malignant or benign. The study attempts to establish a cut off value of ADC differentiating a benign from malignant lesion. Materials and Methods : 32 patients with age group of 40-85 years with 46 diagnosed focal liver lesions on CT and MRI were included in the study. MRI was performed using 1.5 Tesla GE Healthcare HDxT machine. Conventional sequences followed by diffusion weighted sequences were acquired. Quantitative analysis was derived from ADC maps with calculation of ADC values. ADC values of the hepatic lesions were compared with histopathology as reference standard and analyzed statistically. Results: In this study, 25 focal lesions in 18 patients had histopathological diagnosis of malignant pathology and had mean ADC value 1.13(x10(????3)mm2/s) and 21 lesions in 14 patients with histopathological diagnosis of benign pathology had ADC value of 1.63(x10(????3)mm2/s). Statistically significant difference between ADC value of benign and malignant lesions was found. Conclusion: The study proclaimed that DWI with ADC quantification be used as an additional non invasive MRI tool to differentiate benign and malignant hepatic lesions with a sensitivity of 85.7%, specificity of 88%, PPV of 88% and NPV of 85.7%. Keywords: Diffusion, ADC, Benign, Malignant, Histopathology.

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CT angiography is a common modality used to study the anatomy of hepatic arterial system. Literature reports various unclassified variants of hepatic artery, which prompted us to take this study to see the same in our cohort of population. CT angiograms were performed using 40 slice CT scanner on 110 patients for the investigation of arterial variants in case of hepatic donors and patients for aortic evaluation with angiography. The Results were analyzed as per Michels as well as Modified Michels / Hiatt classification of Hepatic artery variants. The typical/classical most common anatomy (type I variant) as proposed by Michels in 1955, was Right and left hepatic artery arising from common hepatic artery which is a branch of celiac artery. In our study we did not find any type X variant and more so vascular anatomy in 5 patients (8%) did not fit into Michels’ classification or Modified Michels/Hiatt classification. These variants have not been reported before, and its importance lies in the fact that variants can predispose to increased risk of surgical complications during liver transplantation and hepatobiliary surgery. It may also influence the choice of vascular technique and materials used in interventional procedures. Keywords: Hepatic artery, Multidetector CT scanner.

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