الفهرس 
Anatomy Of The LiverOnly 14 pages are availabe for public view
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Abstract
In the last years the numbers of potential liver transplant recipients increased, and to meet this increasing alternative approaches have been developed (other than cadaveric liver transplantation) such as reduced-size transplantation, split transplantation, and living donor liver transplantation (LDLT)
However, LDLT may cause morbidity in an otherwise healthy donor who generously takes such an important risk for a loved one. Therefore, donor safety is a primary concern, and selection protocols are of paramount importance to preserve donor health by excluding unsuitable candidates for either medical or anatomic reasons.
With the development of the new multidetector computed tomographic (CT) techniques, the radiologist plays a relevant role, providing, with a minimally invasive procedure, valuable information that will be useful in choosing the most suitable candidate and in identifying anatomic variants that may alter the surgical approach
The most important anatomic issues that need to be clarified before surgery are graft size, arterial, portal and hepatic venous anatomy, and the presence or absence of focal liver masses or fatty infiltration.
In this thesis, we described the imaging protocol for multidetector CT evaluation of potential living liver donors. In addition, important data related to liver transplantation had been detected. These data include liver parenchyma, hepatic vasculature and liver volume.
As for liver parenchyma, Multislice CT could detect presence of fatty infiltration ( whether diffuse or fatty ) any focal lesions whether ( benign or malignant ) and thus we exclude inappropriate donors as those with diffuse fatty infiltration, which seen in two potential donors in our study.
Hepatic artery well detected in CT angiography, this concerning detection of hepatic artery variations and important branching inside the liver parenchyma as artery to segment IV. None of these variants were considered an exclusion from surgery , but the information detected about hepatic artery affect the surgical planning of the transplantation.
Portal vein branching well detected in CT portography and so any variation of branching could be detected. Some variations represent no diffculty or contraindication for transplantation. Certain variations in portal venous anatomy are accepted but represent difficulty in surgical technique due to two opening anastomosis such as trifurcation of PV. Other variations are considered as absolute contraindications to surgery, including undivided and quaderfurcated PV.
CT venography of hepatic veins give an important data in pre-operative evaluation of hepatic veins. Variations in branching and confluence of the hepatic veins are important because they may affect the hepatectomy plane.
So by using multi-slice CT, The arteries and veins of the liver are displayed in an anatomic orientation that can be easily evaluated by the surgeon. Branching points to relevant arteries and veins and their relation to the proposed site of incision can be viewed in 3D models. And it also important in hepatic resection techniques.
When the donor is being evaluated, lobar and total liver volumes must be known before transplantation. Small-for-size grafts are prone to dysfunction for donor and recipient, not only because of inadequate functional hepatic mass but also because the graft may sustain injury related to the excessive portal perfusion. Therefore, the critical volume and the quality of the remnant liver are important considerations in patient selection.