Evaluation of Living Liver Donors Using Dual-Contrast-Agent Magnetic Resonance Imaging (MRI) and Cholangiopancreatography (MRCP)-Technical Development.

The indications for liver transplantation continue to expand to meet the growing need of patients with end-stage liver disease and select hepatic malignancies. Living donor liver transplantation allows for access to transplant with recipient outcomes superior to deceased donor liver transplantation. To ensure absolute safety of the donor and optimal outcome of the recipient, potential liver donors are subjected to an exhaustive preoperative evaluation. Radiological studies play a pivotal role in assessing the donor liver anatomy to assess suitability for donation and to facilitate surgical planning. Many living donor centers supplement single-agent contrast-enhanced MRCP (gadobenate dimeglumine or gadoxetate disodium) with contrast-enhanced CT angiography (CTA) for delineation of arterial anatomy. Excellent hepatic and portal venous mapping as well as biliary tract visualization has been seen, eliminating the need for CTA in studies. This review provides a case-based analysis of the proposed dual-contrast-enhanced MRCP protocol, emphasizing the advantages of a single diagnostic study over traditional multi-modality approaches while also discussing potential limitations and areas requiring further investigation. Evidence level: 4. Technical efficacy: Stage 1.