Purpose or Case Report: To summarize our experience using Computed Tomography Angiography (CTA) of the liver as an imaging tool for pre-living donor liver transplantation (LDLT) evaluation in biliary atresia (BA) patients. This pictorial review will illustrate and discuss several aspects of imaging techniques and the important findings that clinician need to know before LDLT.

Key imaging findings for vascular anatomy/collateral vessels will be made, emphasizing what clinicians need to know. Correlation with intraoperative findings will also be provided.

Methods & Materials: Using our radiology database, a retrospective review of CTA liver studies in BA patients from 2001-2015 was performed. A hundred CTA studies were reviewed with intraoperative LDLT finding correlation. We will demonstrates the optimal imaging techniques including CT parameters, amount of contrast and delayed scan time.

Imaging checklists for both vascular anatomy/collateral vessels and potential intra/post-operative complications will be demonstrated.

Results: BA is one of the most common indication for LDLT, especially in Asian population. Details of pre LDLT of vascular anatomy/collateral vessels are crucial for safe and successful transplantation. CTA liver plays an important role to demonstrate vascular anatomy, portosystemic collateral pathway and potential complications. Awareness of the anatomical variations and potential post-operative complications is essential for the radiologist to generate a meaningful report to help surgeon preparing before LDLT. It is also mandatory for the radiologist to be aware of the surgeon’s perspective.

The optimal CT parameter are not only based on patient’s body weight but also the maximum abdominal thickness. Due to portal hypertension and portosystemic collaterals, amount of IV contrast should be given more than 2ml/kg but not exceed 4 ml/kg to get a better opacification of hepatic vessels. Further evaluation with Doppler US is recommended in selected case for better visualization of the vascular structure.

Conclusions: CT is a comprehensive non-invasive assessment of pre LDLT. Awareness of the anatomical variations and collateral vessels as well as potential intra/post-operative complications is important for the radiologist to generate a meaningful report.

To achieve a successful LDLT programs, radiologist should be an integral part of the team and is present during transplant planning discussions.