Radiographic features of potential donor livers that precluded donation.

OBJECTIVE: The objective of our study was to catalog the anatomic features shown on preoperative CT that precluded living-donor liver donation. MATERIALS AND METHODS: We retrospectively reviewed the records of 159 consecutive candidates who were evaluated for potential right or left lobe liver donation from November 2007 to January 2012 using MDCT angiography and cholangiography. For the potential donors who were excluded secondary to findings depicted on preoperative imaging, we determined which findings precluded donation. RESULTS: In two (1%) patients who had no prohibitive preoperative imaging findings, anatomic abnormalities were detected intraoperatively that precluded transplantation. Sixty-one (38%) candidates were excluded from liver donation on the basis of imaging findings. Of these patients, 40 (66%) had inadequate liver volume, 14 (23%) had vascular or biliary variants, five (8%) had steatosis, and two (3%) were found to have renal cell carcinoma. Arterial and biliary variants were the most common reason for exclusion based on anatomic findings. CONCLUSION: Inadequate liver volume was the most common reason for exclusion based on preoperative imaging. Arterial and biliary anatomic variants precluded both right and left lobe transplantation in a number of cases.

Prospective assessment of dynamic CT and MR cholangiography in functional biliary pain.

OBJECTIVE: The objectives of our study were to assess the feasibility of dynamic CT and MR cholangiography during gallbladder stimulation, to compare CT and MR cholangiography with biliary scintigraphy, and to identify morphologic differences between patients with functional biliary pain and healthy control subjects. SUBJECTS AND METHODS: In this prospective study, 30 patients with functional biliary pain underwent biliary scintigraphy, CT cholangiography, and MR cholangiography before and during 45-minute sincalide infusions. Thirty healthy control subjects also underwent MR cholangiography with sincalide infusion. IV contrast agents (iodipamide meglumine or gadobenate dimeglumine) were administered before scanning. CT and MR images were qualitatively and quantitatively analyzed. RESULTS: Diagnostic images were obtained of all participants. There was good agreement for gallbladder ejection fraction (EF) at 40 minutes by all three methods (Lin's concordance correlation coefficient ≥ 0.6). Gallbladder contraction and refilling occurred more promptly by CT and MR cholangiography than scintigraphy. CT and MR cholangiography showed previously undiagnosed gallstones in two patients (7%). Gallbladder shape was categorized as straight, curved, or folded; a folded gallbladder was present in 37% and 23% of patients at baseline and 40 minutes, respectively, versus in 3% of control subjects at both times (p ≤ 0.004). Asymmetric patterns of gallbladder contraction occurred in 10 patients (33%) and four control subjects (13%) (p = 0.13). CONCLUSION: Dynamic CT cholangiography and MR cholangiography performed during pharmacologic stimulation accurately measure gallbladder EFs and detect missed gallstones. Gallbladder shape before and during contraction differs between patients with functional biliary pain and healthy control subjects. Dynamic CT cholangiography and MR cholangiography are promising techniques that might improve selection of patients to undergo cholecystectomy for functional biliary pain.

Comparison of multidetector computed tomography angiography and cholangiography performed at 80 and 120 kVp in live liver donors.

OBJECTIVE: The objective of this study was to compare the radiation exposure and image quality of contrast-enhanced multidetector computed tomography angiography (CTA) and computed tomography cholangiography (CTC) performed for living liver donor evaluation using 80 and 120 kVp. METHODS: Ninety-three potential liver donors who underwent preoperative contrast-enhanced 64 multidetector CTA and CTC were retrospectively divided into 2 groups: at 80 and at 120 kVp. An institutional review board waiver was obtained. Signal-to-noise ratio and contrast-to-noise ratio of the hepatic artery and common bile duct were obtained. The dose-length product was recorded. Image quality and visibility of hepatic artery and biliary tract anatomy were evaluated. Mann-Whitney U test was used for statistical evaluation. RESULTS: Mean hepatic artery/common bile duct signal-to-noise ratio was 28.9/28.6 (SD, 14.2/10.0) at 80 kVp and 27.6/25.8 (SD, 8.0/6.2) at 120 kVp (P = 0.61/0.099). Mean hepatic artery/common bile duct contrast-to-noise ratio was 24.8/23.3 (SD, 12.9/8.6) at 80 kVp and 22.2/19.3 (SD, 7.7/5.0) at 120 kVp (P = 0.76/0.005). Mean CTA/CTC dose-length product was 279/281 (SD, 42/52) mGy-cm at 80 kVp and 407/451 (SD, 208/243) mGy-cm at 120 kVp (P = 0.026/0.002). Computed tomography cholangiography image quality and visibility of biliary tract anatomy were not significantly different at 80 versus 120 kVp (all P > 0.13). Computed tomography angiography image quality was significantly lower (P < 0.01), and the noise scores significantly higher (P < 0.01) at 80 versus 120 kVp, but diagnostic. CONCLUSIONS: Contrast-enhanced CTA and CTC performed at 80 kVp result in comparable image quality and anatomical evaluation with reduced radiation exposure when compared with 120 kVp.

Preliminary experience of 256-row multidetector computed tomographic angiography for detecting cerebral aneurysms.

OBJECT: Multidetector computed tomographic angiography (MDCTA) has played an increasing role in detecting cerebral aneurysms. This study was performed to investigate the diagnostic accuracy of the upgraded 256-row MDCTA in the detection of cerebral aneurysms. METHODS: We identified 93 patients who had undergone both MDCTA and digital subtraction angiography (DSA) before surgery for the detection of cerebral aneurysms. Two and one independent blinded readers reviewed the MDCTA images and DSA images, respectively. The sensitivity, specificity, accuracy, and positive and negative predictive values were calculated for the image interpretation from the two CTA readers and one DSA reader using the combination of DSA and intraoperative findings as the reference standard. RESULTS: A total of 77 intracranial aneurysms were detected in 67 of the 93 patients. The overall sensitivity, specificity, and accuracy of the 256-row MDCTA in the detection of cerebral aneurysms were 96.10%, 92.31%, and 94.23%, respectively. For aneurysms larger than 5 mm, the overall sensitivity, specificity, and accuracy were 100%, 92.31%, and 96.83%, respectively. For aneurysms smaller than 5 mm, the overall sensitivity, specificity, and accuracy were 92.50%, 92.31%, and 92.42%, respectively. There was no significant difference for the sensitivity, specificity, and accuracy of 256-row MDCTA to detect cerebral aneurysm according to the conscious level of the patients. CONCLUSIONS: To detect cerebral aneurysms larger than 5 mm, 256-row MDCTA is an imaging method with a satisfactory diagnostic performance equal to that of DSA. However, its diagnostic performance for aneurysms smaller than 5 mm is still inferior to that of DSA.

[Constipation syndrome: methods for measuring the speed of intestinal transit]. / Síndrome estreñimiento: métodos para medir la velocidad de tránsito intestinal.

In the present article, I remind what I presented, in a symposium performed in our Society on the constipation syndrome, in relation with the definition and the determinant factors of this syndrome, and, in addition, with the methods we have created to determine physiologically the velocity of the intestinal transit, specially colonic.

Edge-enhanced spatiotemporal constrained reconstruction of undersampled dynamic contrast-enhanced radial MRI.

Dynamic contrast-enhanced magnetic resonance imaging (MRI) is a technique used to study and track contrast kinetics in an area of interest in the body over time. Reconstruction of images with high contrast and sharp edges from undersampled data is a challenge. While good results have been reported using a radial acquisition and a spatiotemporal constrained reconstruction (STCR) method, we propose improvements from using spatially adaptive weighting and an additional edge-based constraint. The new method uses intensity gradients from a sliding window reference image to improve the sharpness of edges in the reconstructed image. The method was tested on eight radial cardiac perfusion data sets with 24 rays and compared to the STCR method. The reconstructions showed that the new method, termed edge-enhanced spatiotemporal constrained reconstruction, was able to reconstruct images with sharper edges, and there were a 36%±13.7% increase in contrast-to-noise ratio and a 24%±11% increase in contrast near the edges when compared to STCR. The novelty of this paper is the combination of spatially adaptive weighting for spatial total variation (TV) constraint along with a gradient matching term to improve the sharpness of edges. The edge map from a reference image allows the reconstruction to trade-off between TV and edge enhancement, depending on the spatially varying weighting provided by the edge map.

Dual-energy, standard and low-kVp contrast-enhanced CT-cholangiography: a comparative analysis of image quality and radiation exposure.

OBJECTIVE: Quantitative image quality assessment in terms of image noise (IN), contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) in relation to required radiation dose (RD) for dual-energy (DE), standard and low-kVp contrast-enhanced computed-tomography (CT) cholangiography. MATERIALS AND METHODS: For each of 22 DECT-cholangiography examinations, 3 image datasets were analyzed as independent single-source CT-acquisitions at different tube potential, i.e. 80 kVp, 120 kVp-equivalent (linear blended dataset M0.3: 30% 80 kVp, 70% 140 kVp), and 140 kVp. Analysis comprised determination of IN, CNR and SNR in regions of interest (ROI) placed in liver parenchyma and contrasted bile ducts. IN was evaluated as mean standard deviation of 3 ROI placed within liver parenchyma (segments 6/7, 5/8, 2/3); CNR was assessed as bile duct-to-liver parenchyma ratio, and SNR as bile duct-to-image noise ratio. RD in terms of CT dose index (CTDI(vol)), dose-length product (DLP) and effective dose (ED) has been determined for each of the datasets, and compared to console prediction and scan summary values. Using phantom measurements of CTDI(vol), a method for separating comprehensive RD values of DE-acquisitions into the original RD contribution of each tube (80 kVp/140 kVp) has been developed, enabling comparison of all 3 datasets as if independently acquired using single-source "single-energy" technique. RESULTS: Highest IN was detected for 80 kVp- (38.6 ± 5.1HU), lowest for 120 kVp-equivalent linear blended M0.3-datasets (23.1 ± 3.4HU) with significant differences between all datasets (P<0.001). Highest SNR and CNR were measured for M0.3- (SNR: 14.8 ± 4.1; CNR: 11.6 ± 3.8) and 80 kVp-datasets (SNR: 13.8 ± 4.8; CNR: 11.2 ± 4.5); lowest for 140 kVp-datasets (SNR: 9.5 ± 2.5; CNR: 7.1 ± 2.3) with significant differences between M0.3- and 140 kVp-datasets as well as between 80 kVp- and 140 kVp-datasets (both P<0.001 for both CNR, SNR). CTDI(vol), DLP and ED were reduced by 50% for low-kilovoltage acquisitions (CTDI(vol): 5.5 ± 1.4 mGy; DLP: 127.8 ± 40.1 mGy cm; ED: 1.9 ± 0.6 mSv) compared to comprehensive DE-acquisitions (CTDI(vol): 11.0 ± 2.3 mGy; DLP: 253.8 ± 67.5 mGy cm; ED: 3.8 ± 1.0 mSv, tube contribution: 80 kVp: 44.5%; 140 kVp: 55.5%), and by 20% compared to conventional acquisitions at 120 kVp (CTDI(vol): 6.71 mGy; DLP: 153.5 ± 16.9 mGy cm; ED: 2.3 ± 0.3 mSv). CONCLUSIONS: Despite higher IN, low-kilovoltage CT-cholangiography reveals no significant difference with respect to CNR and SNR when compared to linear blended images yielded by DECT. Compared to DECT or conventional CT at 120 kVp, contrast-enhanced low-kVp CT cholangiography potentially allows reduction of patient dose by up to 50% or 20%, respectively. Therefore, CT-cholangiography at 80 kVp should be considered as an alternative to DECT-cholangiography whenever DECT is unavailable, or if increased image quality of DECT regarding quantitative bile duct evaluation is not needed for diagnosis.

Iodine removal in intravenous dual-energy CT-cholangiography: is virtual non-enhanced imaging effective to replace true non-enhanced imaging?

PURPOSE: To evaluate whether virtual non-enhanced imaging (VNI) is effective to replace true non-enhanced imaging (TNI) applying iodine removal in intravenous dual-energy CT-cholangiography. MATERIALS AND METHODS: From April 2009 until February 2010, fifteen potential donors for living-related liver transplantation (mean age 37.6±10.8 years) were included. Potential donors underwent a two-phase CT-examination of the liver. The first phase consisted of a single-energy non-enhanced CT-acquisition that provided TNI. After administration of hepatobiliary contrast agent, the second phase was performed as a dual-energy cholangiographic CT-acquisition. This provided VNI. Objective image quality (attenuation values [bile ducts and liver parenchyma] and contrast-to-noise ratio) and subjective overall image quality (1 - excellent; 5 - non diagnostic) were evaluated. Effective radiation dose was compared. RESULTS: For TNI and VNI, attenuation values for bile ducts were 16.8±11.2HU and 5.5±17.0HU (p<0.05) and for liver parenchyma 55.3±8.4HU and 58.1±10.6HU (n.s.). For TNI and VNI, contrast-to-noise ratio was 2.6±0.6HU and 6.9±2.1HU (p<0.001). For VNI, subjective overall image quality was 1 in ten datasets, 2 in four datasets and 3 in one dataset. Effective radiation dose for the dual-energy cholangiographic CT-acquisition was 3.6±0.9mSv and for two-phase single-energy CT-cholangiography 5.1±1.3mSv (p<0.001). CONCLUSION: In this study on iodine removal in intravenous dual-energy CT-cholangiography, subjective image quality is equivalent, contrast-to-noise ratio is improved and effective radiation dose is reduced when VNI is performed. The differences between TNI and VNI with respect to attenuation values seem to have limited clinical relevance and therefore we consider VNI as effective to replace TNI.

Computed tomographic cholangiography in living liver transplant donors: factors determining the degree of contrast enhancement.

OBJECTIVE: To determine factors affecting liver and bile duct contrast enhancement during computed tomographic cholangiography (CTC) in living-donor transplant candidates. METHODS: Forty-four candidates underwent preoperative triphasic CT followed by intravenous infusion of 20 mL of iodipamide for CTC. Body size indices and liver volume were correlated to parenchymal and biliary enhancement. Bile duct visibility was compared to duct enhancement. RESULTS: Poorly visualized first- and second-order bile ducts demonstrated diminished enhancement (P < 0.015). Both CTC parenchymal and biliary enhancement correlated inversely with body surface area, height, and weight (P < 0.001); inverse correlation was also seen between liver volume and parenchymal enhancement (P < 0.001). A moderately positive correlation was noted between CTC biliary and parenchymal portal venous enhancement (r = 0.421; P = 0.004). CONCLUSIONS: Computed tomographic cholangiography parenchymal and biliary enhancement diminishes with increased body size and liver volume, supporting a need for adjustable contrast dosing. Portal venous parenchymal enhancement may serve as a preinfusion indicator.

Intravenous 64-multi-detector row CT-cholangiography of porcine livers: a feasibility study with definition of the temporal window for optimal bile duct delineation.

BACKGROUND/PURPOSE: To assess the feasibility of intravenous 64-multi-detector row computed tomography (CT)-cholangiography of porcine livers with definition of the temporal window for optimal bile duct delineation. METHODS: Six healthy Landrace pigs, each weighing 28.97 +/- 2.99 kg, underwent 64-multi-detector row CT-cholangiography. Each pig was infused with 50 ml of meglumine iotroxate continuously over a period of 20 min and, starting with the initiation of the infusion, 18 consecutive CT scans of the abdomen at 2-min intervals were acquired. All series were evaluated for bile duct visualization scores and maximum bile duct diameters as primary study goals and bile duct attenuation and liver enhancement as secondary study goals. RESULTS: Of the 16 analyzed biliary tract segments, maximum bile duct visualization scores ranged between 4.00 +/- 0.00 and 2.83 +/- 1.47. Time to maximum bile duct visualization scores ranged between 10 and 34 min. Average bile duct visualization scores for the 10- to 34-min interval ranged between 3.99 +/- 0.05 and 2.78 +/- 0.10. Maximum bile duct diameters ranged between 6.47 +/- 1.05 and 2.65 +/- 2.23 mm. Time to maximum bile duct diameters ranged between 24 and 34 min. Average bile duct diameters for the 10- to 34-min interval ranged between 6.00 +/- 0.38 and 2.40 +/- 0.13 mm. CONCLUSIONS: Intravenous 64-multi-detector row CT-cholangiography of non-diseased porcine liver is feasible, with the best bile duct delineation acquired between 10 and 34 min after initiation of the contrast agent infusion.

Cystic artery bleeding due to blunt gallbladder injury: computed tomography findings and treatment with transcatheter arterial embolization.

Blunt gallbladder injury is rare, and bleeding from the cystic artery due to blunt trauma is even rarer. We report herein a case of extraluminal bleeding of the gallbladder in a patient following blunt abdominal trauma. Contrast-enhanced computed tomography revealed pericholecystic fluid and extravasation of contrast material in the subcapsular liver space adjacent to the gallbladder. Abdominal digital subtraction angiography revealed pseudoaneurysm originating from a branch of the cystic artery. Successful treatment was achieved using selective transcatheter embolization, and cholecystectomy was not required.

CT cholangiography in potential liver donors: effect of premedication with intravenous morphine on biliary caliber and visualization.

PURPOSE: To retrospectively determine whether premedication with intravenously administered morphine improves bile duct caliber and visualization in potential liver donors undergoing computed tomographic (CT) cholangiography. MATERIALS AND METHODS: This was a retrospective single institution study approved by the institutional review board and compliant with requirements of the HIPAA. Multidetector CT cholangiography was performed after slow infusion of 20 mL of iodipamide meglumine 52% diluted in 80 mL of normal saline in 143 consecutive potential liver donors (81 men and 62 women; mean age, 37 years); 43 received premedication with intravenous morphine sulfate (0.04 mg per kilogram of body weight) and 100 did not. Two independent readers recorded common bile duct diameter and area on axial CT images. Readers also scored bile duct visualization, including all second-order biliary branches, on a four-point scale (0, not seen; 3, excellent visualization). RESULTS: For scans obtained without and those obtained with morphine, there was no significant difference in the mean common bile duct diameter (4.1 vs 4.3 mm for reader 1 and 4.4 vs 4.6 mm for reader 2, respectively; P > .39 for both readers), in common bile duct area (20.7 vs 21.5 mm(2), for reader 1 and 21.3 vs 20.2 mm(2) for reader 2, respectively, P > .60 for both), or in second-order bile duct visualization score (2.34 vs 2.36 for reader 1 and 2.58 vs 2.50 for reader 2, respectively; P > .5 for both). CONCLUSION: The results suggest that premedication with intravenous morphine prior to CT cholangiography in potential liver donors does not increase bile duct caliber or improve biliary visualization.

Cholecystocolonic fistula diagnosed with CT-intravenous cholangiography.

Cholecystoenteric fistulas are often not diagnosed preoperatively and delineation of fistula can have an influence on surgical planning. We report a case of cholecystocolonic fistula diagnosed preoperatively using CT-i.v. cholangiography and review the published reports.

Spiral computed tomography-intravenous cholangiography with three-dimensional reconstructions for imaging the biliary tree.

This study aimed to assess the ability of CT-i.v. cholangiography to show the perihilar biliary and cystic duct anatomy and to assess the relative performance of axial, maximum intensity projection and surface rendered displays. We also assessed the correlation between serum bilirubin levels and adequacy of biliary opacification. Spiral CT was carried out following infusion of 100 mL of Biliscopin in 181 patients with suspected biliary disease. The display of biliary anatomy was of high quality, with 91% of patients having good opacification of at least first-order bile ducts and 84% having good opacification of at least third-order right and left hepatic ducts. The quality of biliary opacification correlated inversely to serum bilirubin levels, with levels above two to three times the normal value being associated with lower rates of good opacification. Maximum intensity projection and surface rendered reformats aided anatomical interpretation to a similar degree. The relative frequency of types of perihilar branching patterns and cystic duct junctional anatomy correlated closely to those reported from previous anatomical studies.

Volume rendering of three-dimensional drip infusion CT cholangiography in patients with suspected obstructive biliary disease: a retrospective study.

The purpose of this study was to evaluate the diagnostic potential of prolonged drip infusion CT cholangiography (DIC-CT) using meglumine iotroxate (Biliscopin) and 3D volume rendering in patients with suspected obstructive biliary disease. From a material of 142 patients who had undergone a drip infusion CT, all cases with a verified surgical or endoscopic retrograde cholangiography (ERC) diagnosis (n=33) were selected. Age-matched controls were selected from the remaining examinations. Three radiologists reviewed all 66 examinations in retrospect, independently as well as in consensus. The image quality and the estimated diagnostic quality were rated as good or moderate in 91% of the 198 reviews. The consensus sensitivity and specificity for diagnosing biliary stones was 88% and 94%, respectively (with sensitivities ranging from 88% to 94% for individual observers, and specificities from 86% to 96%). Two out of three strictures were observed. No false positive strictures were described. The use of volume rendering technique (VRT) improved diagnostic certainty in 28/198 (14%) of the evaluations. The visualization of ductal stones was improved in 18/48 (38%). No differences in diagnostic quality between single and multislice CT were observed. We conclude that a detailed image of the biliary tree with good sensitivity and specificity can be obtained by means of bilirubin-governed infusion time DIC-CT with volume rendering reconstruction.

The value of drip infusion cholangiography using multidetector-row helical CT in patients with choledocholithiasis.

The purposes of this study were to investigate the feasibility of drip infusion cholangiography computed tomography (CTCh) for choledocholithiasis and to compare the detection of the stone on CTCh with that of MR cholangiopancreatography (MRCP). CTCh examinations were performed after infusion of intravenous biliary contrast material (iotroxic acid meglumine, 100 ml) for patients with suspected biliary diseases and were reconstructed to maximum intensity projection (MIP) and multiplanar reformation (MPR). Of 432 patients who underwent CTCh, we identified 15 who underwent surgery or cholangioscopic removal for choledocholithiasis and 32 patients who underwent cholecystectomy due to cholecystolithiasis. Their MRCP images were compared with the CTCh images. The sensitivity and specificity of CTCh for detecting choledochal stones were 87% and 96% whereas those of MRCP were 80% and 88%. The sensitivity and specificity of CTCh for detecting gallstones were 78% and 100% whereas those of MRCP were 94% and 88%. CTCh allowed high sensitivity and specificity for detecting choledochal stones but diminished the detection for cholecystolithiasis compared with MRCP.

Stability of doxorubicin combined with Radioselectan, a contrast agent, for chemoembolization.

OBJECTIVE: To assess the stability of doxorubicin combined with Radioselectan. METHODS: Solutions of doxorubicin 5 mg/mL were prepared from commercially available 50 mg powder with 10 mL of Radioselectan. They were stored in glass syringes at 4, 25 and 45 degrees C. The concentrations of doxorubicin were determined using a stability-indicating high-performance liquid chromatography method. The initial and final pHs of solutions were compared. The times (t90) needed for doxorubicin to fall to 90% of its initial concentration were calculated by a linear regression analysis. RESULTS: The t90 [95% confidence limits] were 79 [75-83], 56 [53-59] and 22 [21-23] hours for the solutions stored at 4, 25 and 40 degrees C respectively. The initial pH of the solutions stored at 4, 25 and 40 degrees C were 6.52, 6.50 and 6.51 respectively. The final pH of solutions stored at 25 and 40 degrees C decreased significantly by 0.3 and 0.9 respectively. No change of pH solution stored at 4 degrees C was observed. CONCLUSION: Doxorubicin combined with Radioselectan stored at room temperature is stable for 48 h.

Accuracy of computed tomographic intravenous cholangiography (CT-IVC) with iotroxate in the detection of choledocholithiasis.

To determine the accuracy of computed tomographic intravenous cholangiography (CT-IVC) for detection of choledocholithiasis. Sixty-five patients undergoing endoscopic retrograde cholangiography (ERC) underwent CT-IVC prior to ERC, using a single detector helical CT following intravenous infusion of 100 ml iotroxate. Patients with bilirubin levels >3 times normal were excluded. ERC was indeterminate in three patients (4.7%) and CT-IVC in four (6.3%). Twenty-three patients had ductal calculi at ERC, and CT-IVC was positive in 22, with two false positives and one false negative: sensitivity 95.6%, specificity 94.3%. Stones were multiple in nine and solitary in 14. Of the 14 solitary stones, ten were

Concordance of second-order portal venous and biliary tract anatomies on MDCT angiography and MDCT cholangiography.

OBJECTIVE: We sought to investigate the concordance between second-order portal venous and biliary tract anatomies using MDCT angiography and MDCT cholangiography. MATERIALS AND METHODS: We retrospectively identified 56 living related potential liver donors who underwent both MDCT angiography and MDCT cholangiography. Two reviewers independently rated axial images and 3D reconstructions of MDCT angiograms and cholangiograms as diagnostic or nondiagnostic with respect to depiction of second-order portal venous and biliary tract anatomies. In images rated as diagnostic, second-order portal venous and biliary tract anatomies were categorized as conventional or variant. The concordance between portal venous and biliary tract anatomies was analyzed using McNemar exact chi-square test. RESULTS: All examinations were diagnostic. Second-order portal venous variants were seen in 10 (18%) and biliary branch variants were seen in 23 (41%) of the 56 patients. Patients with variant portal venous anatomy (6/10, 60%) were more likely to have variant biliary tract anatomy than patients with conventional portal venous anatomy (17/46, 37%; p < 0.01). The sensitivity of variant portal venous anatomy as a marker for variant biliary anatomy was 26% (6/23 patients). CONCLUSION: Concordance between second-order portal venous and biliary tract anatomies is statistically significant. However, in our series, a number of patients with conventional portal venous anatomy had variant biliary anatomy; therefore, the finding of conventional portal venous anatomy does not obviate preoperative biliary tract imaging in patients before liver donation.