Introduction
Living donor liver transplantation has evolved into a widely accepted therapeutic option to alleviate the persistent shortage of cadaveric liver transplants. This innovative procedure allows healthy adults to donate a portion of their liver to compatible recipients suffering from end-stage liver disease.
This technique, called living-donor liver transplantation (LDLT), provides an effective alternative means of liver transplantation and is a method of expanding the donor pool in light of the demand and supply imbalance for organ transplants. Imaging plays an important role in LDLT programmes by providing robust evaluation of potential donors to ensure that only anatomically suitable donors with no significant co-existing pathology are selected and that crucial information that allows detailed preoperative planning is available.
Procedures
In the recent past, this preharvest assessment employed a multimodal radiologic evaluation protocol, including:
In an attempt to simplify and shorten such a time consuming and costly procedure to a minimum, both comprehensive “all-in-one” MRI and multidetector computed tomography (MDCT)-protocols have been advocated. Both approaches combine the advantage of minimal invasiveness with the simultaneous assessment of the hepatic parenchymal morphology and a detailed analysis of the biliary and vascular anatomy in a single diagnostic step.
Image analysis
Analysis of the image data is focused on the following aspects:
Conclusion
Both “all-in-one” MDCT and “all-in-one” MRI are well suited to extensively assess the liver anatomy of potential donors in a single diagnostic step. This might reduce the need for multimodality evaluation protocols, hence relieving the medical infrastructure, but also augmenting the candidate’s acceptance of the pretransplantation survey.
Further reading
CHRONIC ILDs
Brain Development and Congenital Malformations
Cerebral Vasculature, Trauma, Stroke
Brain Tumors
Brain Infections
White matter abnormalities & Degenerative diseases
Spine
Miscellaneous
Hyperparathyroidism is a disease of increased bone resorption and bone formation. Subsequently, plain radiographic findings may include resorption and sclerosis of numerous sites in the skeletal system.
Historically, osteitis fibrosa cystica was used to describe the advanced skeletal disease in primary hyperparathyroidism. Bone findings were characterized by the osteoclastic resorption of bone, osteoblastic bone formation, and fibrous replacement of marrow, with radiographic findings of subperiosteal resorption, brown tumors, bone cysts, and sclerosis.
These days, the most common radiologic finding in primary hyperparathyroidism is osteopenia, which may be generalized or asymmetric. Fine trabeculations are initially lost, with resultant coarse and thickened trabeculae. The disease may progress with further destruction that results in a ground-glass appearance in the trabeculae. About 30-50% of the bone density must be lost to show changes on radiographs. Other methods for the quantification of bone density, such as QCT scanning and DXA, are more sensitive in the evaluation of osteopenia.
Additional findings include bone resorption, which may occur at many different anatomic sites. Bone resorption may be classified as subperiosteal, intracortical, trabecular, endosteal, subchondral, subligamentous, or subtendinous. Subperiosteal bone resorption is an early and virtually pathognomonic sign of hyperparathyroidism, and this finding is marked by marginal erosions with adjacent resorption of bone and sclerosis. An unusual lacelike appearance may be seen beneath the periosteum with an occasional spiculated external cortex. The underlying resorptive process may progress to complete cortical disappearance.
Although subperiosteal bone resorption can affect many sites, the most common site in hyperparathyroidism is the middle phalanges of the index and middle fingers, primarily on the radial aspect.
After resection of an adenoma, lesions may become sclerotic on radiographs. Once considered a finding that was characteristic of primary hyperparathyroidism, brown tumors are more common in secondary hyperparathyroidism because of the increasing population and life expectancy of patients undergoing dialysis.
Calcium pyrophosphate dihydrate crystal deposition disease (CPPD) is more common in association with primary hyperparathyroidism than with secondary hyperparathyroidism. Chondrocalcinosis may affect the menisci of the knee, the triangular cartilage of the wrist, and the symphysis pubis. CPPD arthropathy is less common in these patients than in patients with idiopathic disease.
Other radiographic findings in primary hyperparathyroidism include varying degrees of sclerosis, although generalized sclerosis is more common in secondary hyperparathyroidism. Soft-tissue and vascular calcification is more common in secondary disease, as is superior and inferior band sclerosis of the spine, which is called rugger-jersey spine. The laxity of ligaments and tendons primarily affects the sacroiliac and acromioclavicular joints, whereas rupture may be seen at several sites, including the quadriceps, triceps, and patellar tendons.
In the setting of elevated serum calcium levels and elevated PTH levels, the diagnosis of primary hyperparathyroidism is certain. However, radiographic findings of subperiosteal resorption are most specific for the disease and should prompt consideration of the primary hyperparathyroidism.
Rad Reference 