Rationale and Objectives
The objective of this study was to determine the diagnostic accuracy of contrast-enhanced magnetic resonance angiography (MRA) when used in the preoperative evaluation of hepatic vascular anatomy in living liver donors.
Materials and Methods
A computer-assisted literature searching of EMBASE, PubMed (MEDLINE), and the Cochrane library databases was conducted to identify potentially relevant articles which primarily examined the utility of contrast-enhanced MRA in the preoperative evaluation of hepatic vascular anatomy in living liver donors. We used the Q statistic of chi-squared value test and inconsistency index (I-squared, I 2 ) to estimate the heterogeneity of the data extracted from all selected studies. Meta-Disc software (version 1.4) ( ftp://ftp.hrc.es/pub/programas/metadisc/Metadisc_update.htm ) was used to perform our analysis.
Results
Eight studies were included in the present meta-analysis. A total of 289 living liver donor candidates and 198 patients who underwent liver harvesting were included in the present study. The pooled sensitivities of hepatic artery (HA), portal vein (PV), and hepatic vein (HV) in this meta-analysis were 0.84, 0.97, and 0.94, respectively. The pooled specificities of HA, PV, and HV were 1.00, 1.00, and 1.00, respectively. The pooled diagnostic odds ratios of HA, PV, and HV were 127.28, 302.80, and 256.59, respectively. The area under the summary receiver-operating characteristic curves of HA, PV, and HV were 0.9917, 0.9960, and 0.9813, respectively.
Conclusions
The high sensitivity and specificity demonstrated in this meta-analysis suggest that contrast-enhanced MRA was a promising test for the preoperative evaluation of hepatic vascular anatomy in living liver donors.
Living donors liver transplantation (LDLT) is becoming more and more common recently because of the shortage of donor livers . One of the main clinical issues of this procedure is the risk to the donors who are healthy until the date of transplantation. To reduce the morbidity and mortality and to ensure a successful LDLT, careful preoperative evaluations of the hepatic vascular and biliary anatomy, as well as the parenchyma, are essential for us to get useful information and help us in the surgical planning for vascular and biliary anastomoses .
Digital subtraction angiography (DSA) is considered as the diagnostic criterion standard for the preoperative evaluation of hepatic vascular anatomy in living liver donors. However, DSA is not an ideal screening test. One of the most important reasons is because DSA is not only associated with high cost but also have an invasive nature. Because of this, DSA is associated with some potential complications . Computed tomographic (CT) angiography has also been used recently in the preoperative evaluation of the hepatic vasculature of living liver donors . In particular, multidetector CT can now provide detailed images of the arterial system in a short breath-hold. However, because CT requires using ionizing radiation and potentially nephrotoxic iodinated contrast material, it could also potentially lead to nephrotoxicity, thus contraindicated in those patients with decreased renal function.
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Materials and methods
Literature Searching Strategy
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Study Selection
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Inclusion and Exclusion Criteria
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Data Extraction and Quality Assessment
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Meta-analysis
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Results
Literature Search
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Excluded Studies
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Included Studies
Demographics
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Table 1
Characteristics of Included Studies
Study (year) Potential Donor Patients Hepatectomy Age Range (Mean) Percentage of Men Brand Tesla Contrast Agents Reference Standard Hepatic Vascular TP FP FN TN Sens Spec Carr et al. (2003) 25 24 20–54 (35) 48.0 Siemens, 1.5 Gd-DTPA, Berlex Laboratories 24 Surgery, 2 DSA HA 12 0 1 11 92.3 100 PV 6 0 0 19 100 100 HV 15 0 0 10 100 100 An et al. (2006) 44 24 20–58 (28) 66.7 Siemens, 1.5 Gd-BOPTA, Bracco Imaging 24 Surgery HA 5 0 5 14 50 100 PV 5 0 0 19 100 100 HV 8 0 1 15 88.9 100 Lim et al. (2005) 43 11 16–52 (31.6) 69.8 Philips, 1.5 Gd-BOPTA, Bracco Imaging 11 Surgery HA 1 0 0 10 100 100 PV 1 0 0 10 100 100 HV 9 0 0 2 100 100 Goyen et al. (2002) 38 16 20–50 (38) 60.5 Siemens, 1.5 Gd-BOPTA, Bracco Imaging 20 DSA, 16 surgery HA 9 0 0 11 100 100 PV 2 0 0 18 100 100 HV 1 0 0 19 100 100 Lee et al. (2001) 25 9 18–51 (35) NA Siemens, 1.5 Gd-DTPA; Berlex Laboratories 13 DSA, 9 surgery HA 2 0 1 10 66.7 100 PV 0 0 0 9 NA 100 HV 1 0 0 8 100 100 Streitparth et al. (2007) 55 55 18–68 (42) 34.5 Philips, 1.5 Gd-DTPA, Schering 55 Surgery HA 16 0 1 38 94.1 100 PV 7 0 0 48 100 100 HV 20 0 3 32 86.9 100 Lee et al. (2007) 27 27 16–44 (31) 85.2 Siemens, 1.5 Gd-BOPTA, Bracco Imaging 27 Surgery HA 9 0 2 16 81.8 100 PV 5 0 1 21 83.3 100 Wang et al. (2008) 32 32 21–63 (35) 56.3 Siemens, 3.0 Gd-BOPTA, Bracco Imaging 32 Surgery HA 5 0 1 26 83.3 100 PV 4 0 0 28 100 100 HV 8 0 0 24 100 100Total289198 HA5901113684.3100 PV300117296.8100 HV620411093.9100
DSA, digital subtraction angiography; FN, false negative; FP, false positive; Gd-BOPTA, gadobenate dimeglumine; Gd-DTPA, gadopentetate dimeglumine; HA, hepatic artery; HV, hepatic vein; NA, not available; PV, portal vein; TN, true negative; TP, true positive; Sens, sensitivity; Spec, specificity.
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Assessment of study quality
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Diagnostic accuracy and the evaluation of clinical utility
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Potential biases
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Discussion
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