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Zhao NB, Luo Z, Li Y, Xia R, Zhang Y, Li YJ, Zhao D. Diagnostic value of ultrasonography for post-liver transplant hepatic vein complications. World J Transplant 2025; 15:100373. [DOI: 10.5500/wjt.v15.i2.100373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 01/09/2025] [Accepted: 01/18/2025] [Indexed: 02/21/2025] Open
Abstract
Liver transplantation (LT) is the most effective treatment for patients with end-stage liver disease, and maintaining vascular patency of the transplanted liver is one of the crucial prerequisites for surgical success. Despite hepatic vein complications following LT occurring at a relatively low frequency, ranging between 2% to 11%, delayed diagnosis and treatment may lead to graft dysfunction and even patient mortality. Clinical manifestations of hepatic vein complications are often subtle and nonspecific, posing challenges for early diagnosis. Signs may initially present as mild abnormalities in liver function, delayed recovery of liver function, unexplained ascites, lower limb edema, and perineal edema. Prolonged duration of these complications can lead to hepatic sinusoidal dilatation and eventual liver failure due to prolonged hepatic congestion. Ultrasonography has become the preferred imaging modality for post-liver transplant evaluation due to its convenience and non-invasiveness. Although hepatic vein complications may manifest as disappearance or flattening of the hepatic vein spectrum on routine ultrasound imaging, these findings lack specificity. Contrast-enhanced ultrasound that visualizes the filling of contrast agent in the hepatic veins and dynamically displays blood flow perfusion information in the drainage area can, however, significantly improve diagnostic confidence and provide additional information beyond routine ultrasound examination.
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Affiliation(s)
- Ning-Bo Zhao
- Department of Ultrasound, National Clinical Research Centre for Infectious Disease, Shenzhen Third People’s Hospital, The Second Hospital Affiliated With The Southern University of Science and Technology, Shenzhen 518112, Guangdong Province, China
| | - Zi Luo
- Department of Ultrasound, National Clinical Research Centre for Infectious Disease, Shenzhen Third People’s Hospital, The Second Hospital Affiliated With The Southern University of Science and Technology, Shenzhen 518112, Guangdong Province, China
| | - Ying Li
- Department of Ultrasound, National Clinical Research Centre for Infectious Disease, Shenzhen Third People’s Hospital, The Second Hospital Affiliated With The Southern University of Science and Technology, Shenzhen 518112, Guangdong Province, China
| | - Rui Xia
- Department of Thyroid and Hernia Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510000, Guangdong Province, China
| | - Yu Zhang
- Department of Ultrasound, National Clinical Research Centre for Infectious Disease, Shenzhen Third People’s Hospital, The Second Hospital Affiliated With The Southern University of Science and Technology, Shenzhen 518112, Guangdong Province, China
| | - Yi-Jun Li
- Department of Ultrasound, National Clinical Research Centre for Infectious Disease, Shenzhen Third People’s Hospital, The Second Hospital Affiliated With The Southern University of Science and Technology, Shenzhen 518112, Guangdong Province, China
| | - Dong Zhao
- Department of Liver Surgery and Organ Transplantation Center, Shenzhen Third People’s Hospital, The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen 518112, Guangdong Province, China
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Han T, Jeong WK, Shin J, Cha DI, Gu K, Rhu J, Kim JM, Choi GS. Comparison of micro-flow imaging and contrast-enhanced ultrasonography in assessing segmental congestion after right living donor liver transplantation. Ultrasonography 2024; 43:469-477. [PMID: 39390717 PMCID: PMC11532526 DOI: 10.14366/usg.24114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/22/2024] [Accepted: 08/27/2024] [Indexed: 10/12/2024] Open
Abstract
PURPOSE This study aimed to determine whether micro-flow imaging (MFI) offers diagnostic performance comparable to that of contrast-enhanced ultrasonography (CEUS) in detecting segmental congestion among patients undergoing living donor liver transplantation (LDLT). METHODS Data from 63 patients who underwent LDLT between May and December 2022 were retrospectively analyzed. MFI and CEUS data collected on the first postoperative day were quantified. Segmental congestion was assessed based on imaging findings and laboratory data, including liver enzymes and total bilirubin levels. The reference standard was a postoperative contrast-enhanced computed tomography scan performed within 2 weeks of surgery. Additionally, a subgroup analysis examined patients who underwent reconstruction of the middle hepatic vein territory. RESULTS The sensitivity and specificity of MFI were 73.9% and 67.5%, respectively. In comparison, CEUS demonstrated a sensitivity of 78.3% and a specificity of 75.0%. These findings suggest comparable diagnostic performance, with no significant differences in sensitivity (P=0.655) or specificity (P=0.257) between the two modalities. Additionally, early postoperative laboratory values did not show significant differences between patients with and without congestion. The subgroup analysis also indicated similar diagnostic performance between MFI and CEUS. CONCLUSION MFI without contrast enhancement yielded results comparable to those of CEUS in detecting segmental congestion after LDLT. Therefore, MFI may be considered a viable alternative to CEUS.
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Affiliation(s)
- Taewon Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaeseung Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyowon Gu
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Terasawa M, Imamura H, Allard MA, Pietrasz D, Ciacio O, Pittau G, Salloum C, Sa Cunha A, Cherqui D, Adam R, Azoulay D, Saiura A, Vibert E, Golse N. Intraoperative indocyanine green fluorescence imaging to predict early hepatic arterial complications after liver transplantation. Liver Transpl 2024; 30:805-815. [PMID: 38466885 DOI: 10.1097/lvt.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/19/2024] [Indexed: 03/13/2024]
Abstract
The purpose of this study was to propose an innovative intraoperative criterion in a liver transplantation setting that would judge arterial flow abnormality that may lead to early hepatic arterial occlusion, that is, thrombosis or stenosis, when left untreated and to carry out reanastomosis. After liver graft implantation, and after ensuring that there is no abnormality on the Doppler ultrasound (qualitative and quantitative assessment), we intraoperatively injected indocyanine green dye (0.01 mg/Kg), and we quantified the fluorescence signal at the graft pedicle using ImageJ software. From the obtained images of 89 adult patients transplanted in our center between September 2017 and April 2019, we constructed fluorescence intensity curves of the hepatic arterial signal and examined their relationship with the occurrence of early hepatic arterial occlusion (thrombosis or stenosis). Early hepatic arterial occlusion occurred in 7 patients (7.8%), including 3 thrombosis and 4 stenosis. Among various parameters of the flow intensity curve analyzed, the ratio of peak to plateau fluorescence intensity and the jagged wave pattern at the plateau phase were closely associated with this dreaded event. By combining the ratio of peak to plateau at 0.275 and a jagged wave, we best predicted the occurrence of early hepatic arterial occlusion and thrombosis, with sensitivity/specificity of 0.86/0.98 and 1.00/0.94, respectively. Through a simple composite parameter, the indocyanine green fluorescence imaging system is an additional and promising intraoperative modality for identifying recipients of transplant at high risk of developing early hepatic arterial occlusion. This tool could assist the surgeon in the decision to redo the anastomosis despite normal Doppler ultrasonography.
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Affiliation(s)
- Muga Terasawa
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroshi Imamura
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Marc Antoine Allard
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, Physiopathogénèse et traitement des maladies du foie, FHU Hepatinov, Villejuif, France
| | - Daniel Pietrasz
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, Physiopathogénèse et traitement des maladies du foie, FHU Hepatinov, Villejuif, France
| | - Oriana Ciacio
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
| | - Gabriella Pittau
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
| | - Chady Salloum
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
| | - Antonio Sa Cunha
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, Physiopathogénèse et traitement des maladies du foie, FHU Hepatinov, Villejuif, France
| | - Daniel Cherqui
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, Physiopathogénèse et traitement des maladies du foie, FHU Hepatinov, Villejuif, France
| | - René Adam
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
| | - Daniel Azoulay
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, Physiopathogénèse et traitement des maladies du foie, FHU Hepatinov, Villejuif, France
| | - Akio Saiura
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Eric Vibert
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, Physiopathogénèse et traitement des maladies du foie, FHU Hepatinov, Villejuif, France
| | - Nicolas Golse
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, Physiopathogénèse et traitement des maladies du foie, FHU Hepatinov, Villejuif, France
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Wiest I, Safai Zadeh E, Görg C, Teufel A, Michels G, Dietrich CF. Value of contrast-enhanced ultrasound for vascular diseases of the liver - current indications and open questions. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:1504-1517. [PMID: 36522165 DOI: 10.1055/a-1973-5731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Contrast-enhanced ultrasonography (CEUS) is a widely available and well-tolerated technique that can expand the diagnosis of a variety of vascular liver diseases. This paper presents an overview of the current possibilities of the use of CEUS in vascular liver diseases. Particularly where Doppler sonography has technical limitations, CEUS provides additional opportunities to visualize vascular thrombosis and other obstructions restricting blood flow. When CT or MRI contrast agents cannot be used because of severe allergy or renal insufficiency, CEUS can be a valuable diagnostic alternative and has demonstrated comparable diagnostic performance in at least some vascular liver diseases, such as portal vein thrombosis. In addition, CEUS works without radiation and, therefore, might be particularly suitable for young patients and children. This may be useful, for example, in congenital disorders such as persistent umbilical vein or preduodenal portal vein. Vascular liver disease is rare and comprehensive data are still lacking, but the available literature provides promising insights into potential new ways to study vascular liver disease. Although most studies are based on small sample sizes or even case reports, the high diagnostic utility is undisputed.
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Affiliation(s)
- Isabella Wiest
- Department of Medicine II, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ehsan Safai Zadeh
- University Hospital Giessen and Marburg, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, Philipps University Marburg, Marburg, Germany
| | - Christian Görg
- University Hospital Giessen and Marburg, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, Philipps University Marburg, Marburg, Germany
| | - Andreas Teufel
- Department of Medicine II, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Guido Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland, Eschweiler, Germany
| | - Christoph F Dietrich
- Allgemeine Innere Medizin (DAIM) Kliniken Beau Site, Salem und Permanence, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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Liu R, Yan Z, Zhang G, Ding Z, Li Y, Jiang Z. Comparison of digital subtraction angiography and contrast-enhanced ultrasound in assessment of carotid stenosis. Afr Health Sci 2020; 20:509-514. [PMID: 33402939 PMCID: PMC7750059 DOI: 10.4314/ahs.v20i1.57] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The performances of contrast-enhanced ultrasound (CEUS) and digital subtraction angiography (DSA) were used to establish an efficient as well as non-invasive clinical technique for the diagnosis of extra-cranial internal carotid artery (ICA) stenosis. MATERIALS AND METHODS Thirty-six successive patients (11 women and 25 men, mean age: 65.0 ± 9.2, range: 43-78 years) with internal carotid artery (ICA) stenosis were tested by CEUS and DSA. These tests were carried out by means of Hitachi Preirus ultrasound machine for CEUS and Allura Xper FD20 system (Philips Medical Systems, Nederland B.V.) for DSA. 1.2 ml SonoVue (Bracco, Switzerland) was used a s contrast agent. RESULTS The results clearly indicated that there were no noteworthy variations among the distributions recorded by CEUS as well as DSA for the four tested groups. The percentage of diameter stenosis calculated by CEUS was clearly in accordance with the DSA images. CEUS showed accurate results with good specificity and sensitivity at 50%, 70%, and 100%. Also, CEUS performance was relatively better than DSA in the diagnosis of ICA and suitability of CEA. CONCLUSION CEUS proved to be a precise non-invasive testing method for the diagnosis of carotid artery stenosis which is more feasible and well-tolerated in patients with various stages of carotid stenosis.
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Affiliation(s)
- Ronggui Liu
- Department of ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China, 266555
| | - Zhimei Yan
- Department of ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China, 266555
| | - Guijun Zhang
- Department of ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China, 266555
| | - Zhaoyan Ding
- Department of ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China, 266555
| | - Yunping Li
- Department of ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China, 266555
| | - Zhirong Jiang
- Department of ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China, 266555
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Kim JS, Kim KW, Choi SH, Jeong SY, Kwon JH, Song GW, Lee SG. Hepatic Artery Occlusion after Liver Transplantation in Patients with Doppler Ultrasound Abnormality: Increasing Sensitivity of Contrast-Enhanced Ultrasound Diagnosis. Korean J Radiol 2019; 20:459-468. [PMID: 30799577 PMCID: PMC6389810 DOI: 10.3348/kjr.2018.0464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/05/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To investigate whether diagnostic performance of contrast-enhanced ultrasound (CEUS) could be improved with modified criteria to diagnose significant hepatic artery occlusion (HAO) and to determine the role of CEUS in patients with a tardus-parvus hepatic artery (HA) pattern on Doppler US. MATERIALS AND METHODS Among 2679 adult liver transplantations performed over 7 years, HAO was suspected in 288 recipients, based on Doppler ultrasound. Among them, 130 patients underwent CEUS. After excluding two technical failures, 128 CEUS images were retrospectively reviewed to search for abnormal findings, such as no HA enhancement, abnormal HA enhancement (delayed, faint, and discontinuous enhancement), and perfusion defect in the liver parenchyma. The performance CEUS abnormalities were assessed in the patients overall and in subgroups based on Doppler ultrasound abnormality (group A, no flow; group B, tardus-parvus pattern) and were compared based on the area under the receiver operating characteristic curve (AUC). RESULTS HAO were diagnosed in 41 patients by surgery, angiography, or follow-up abnormality. By using the conventional criterion (no HA enhancement) to diagnose HAO in patients overall, the sensitivity, specificity, and AUC were 58.5%, 100%, and 0.793, respectively. Modified criteria for HAO (no HA enhancement, abnormal enhancement, or parenchymal perfusion defect) showed statistically significantly increased sensitivity (97.6%, 40/41) and AUC (0.959) (p < 0.001), although the specificity (95.4%, 83/87) was slightly decreased. The sensitivity and specificity of the modified criteria in Groups A and B were 97.1% (33/34) and 95.7% (22/23), and 100% (7/7) and 95.3% (61/64), respectively. CONCLUSION Modified criteria could improve diagnostic performance of CEUS for HAO, particularly by increasing sensitivity. CEUS could be useful for diagnosing HAO even in patients with a tardus-parvus HA pattern on Doppler US, using modified criteria.
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Affiliation(s)
- Jin Sil Kim
- Department of Radiology and Medical Research Institute, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Kyoung Won Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Yeong Jeong
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hyun Kwon
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi Won Song
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Gyu Lee
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Güven F, Karaca L, Ogul H, Sade R, Öztürk G, Kantarci M. The Value of Superb Microvascular Imaging in Detecting Hepatic Artery Occlusion in Liver Transplantation. Ultrasound Q 2019; 35:325-329. [PMID: 30601438 DOI: 10.1097/ruq.0000000000000416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim JS, Kim KW, Lee J, Kwon HJ, Kwon JH, Song GW, Lee SG. Diagnostic Performance for Hepatic Artery Occlusion After Liver Transplantation: Computed Tomography Angiography Versus Contrast-Enhanced Ultrasound. Liver Transpl 2019; 25:1651-1660. [PMID: 31206222 DOI: 10.1002/lt.25588] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/09/2019] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to compare the diagnostic performance of computed tomography angiography (CTA) and contrast-enhanced ultrasound (CEUS) when used to diagnose significant hepatic artery occlusion (HAO) in patients that was suspected on Doppler ultrasound (US). Among 3465 adult liver transplantations (LTs) performed between January 2010 and February 2018, 329 recipients were suspected of having HAO by Doppler US. In these patients, 139 recipients who had undergone both CTA and CEUS as second-line studies were included. CTA and CEUS were retrospectively reviewed using the criteria for HAO used in previous studies (CTA, ≥50% stenosis at the anastomosis; CEUS, no HA enhancement or delayed and discontinuous enhancement). The diagnostic values of CTA and CEUS were compared using the McNemar test. CEUS showed statistically significant better accuracy and specificity than CTA in patients with Doppler US abnormality seen after LT (accuracy, 99.3% versus 89.2%, P < 0.001; specificity, 100% versus 83.1%, P < 0.001). CTA had 15 false-positive diagnoses, and CEUS had 1 false-negative diagnosis. In conclusion, CEUS showed higher specificity and positive predictive value than CTA for the diagnosis of HAO in selected patients with a Doppler US abnormality. However, even if there is no HAO diagnosed on CEUS, continuous monitoring and follow-up imaging are required when HAO is strongly suspected in the clinical setting and on CTA.
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Affiliation(s)
- Jin Sil Kim
- Department of Radiology and Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Kyoung Won Kim
- Department of Radiology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jeongjin Lee
- School of Computer Science and Engineering, Soongsil University, Seoul, South Korea
| | - Heon-Ju Kwon
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Hyun Kwon
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Gi Won Song
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Gyu Lee
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Torres A, Koskinen SK, Gjertsen H, Fischler B. Contrast-Enhanced Ultrasound for identifying circulatory complications after liver transplants in children. Pediatr Transplant 2019; 23:e13327. [PMID: 30536767 DOI: 10.1111/petr.13327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/29/2018] [Indexed: 12/18/2022]
Abstract
Our main goal with this study was to share our off-label experience with CEUS for identifying circulatory complications after liver transplantation in children. A total of 74 CEUS examinations performed on 34 pediatric patients who underwent a liver transplant were retrospectively included. About 53% of the examinations were performed on children 2 years old or younger. About 82% of the examinations were performed within 30 days from the transplant. About 62% of patients were transplanted due to a cholestatic disease, 11% due to a metabolic disease, 8% were re-transplanted due to graft failure, and 19% was due to other conditions. BA was the most common reason for transplantation and represented 38% of patients. About 38% of the transplantations were performed with whole grafts from DD, 40% with split liver grafts, and 22% with left lateral segments from LD. For diagnosing arterial circulatory complications, the PPV was 80%. For diagnosing portal vein circulatory complications, the PPV was 66.7%. NPV was 100%. In 28% of the examinations, the examiner could not visualize the normal arterial blood flow without CEUS. CEUS is a non-invasive and safe imaging technique that seems valuable in these patients and further efforts are needed to license its use in the post-transplant setting.
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Affiliation(s)
- Alvaro Torres
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Huddinge, Sweden
| | - Seppo K Koskinen
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Henrik Gjertsen
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden
| | - Björn Fischler
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Karolinska University Hospital, Huddinge, Sweden
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Chen S, Wang X, Zhang B, Liu B, Pan H. Meta-analysis of the diagnostic value of contrast-enhanced ultrasound for the detection of vascular complications after liver transplantation. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 111:388-396. [PMID: 30569729 DOI: 10.17235/reed.2018.5818/2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND contrast-enhanced ultrasound (CEUS) is increasingly used to identify vascular complications in patients after liver transplantation. The present study aimed to evaluate the diagnostic accuracy of CEUS using all available data. MATERIALS AND METHODS relevant studies published before February 2018 were retrieved from PubMed, EMBASE, ScienceDirect and Web of Science. Pooled sensitivity and specificity, diagnostic odds ratio (DOR) and summary receiver operating characteristic curve (SROC) were calculated to estimate the diagnostic performance of CEUS for vascular complications. Sensitivity analysis was performed that stratified studies according to age, study design and sample size in order to determine the influence of these factors on the overall effect. Meta-regression analyses were performed to examine the possible sources of heterogeneity. Quality assessment and publication bias of the included studies were also evaluated. RESULTS thirteen studies which consisted of 2,781 CEUS cases were included in the analysis. The pooled weighted estimates of sensitivity and specificity were 0.90 (95% CI, 0.84 to 0.95) and 1.00 (95% CI, 1.00 to 1.00), the diagnostic odds ratio (DOR) was 431.96 (95% CI, 164.60 to 1,133.59) and the area under the curve (AUC) of SROC was 0.9741. According to the sensitivity analysis, age, study design and sample size had an insignificant influence on the diagnostic performance of CEUS. The meta-regression analyses did not reveal a strong correlation between CEUS accuracy and study design, treatment time of patients and experience of the radiologists. CONCLUSION the results of our meta-analysis showed a high sensitivity, specificity and accuracy of the CEUS modality for the identification of vascular complications in patients after liver transplantation. Since this is the first meta-analysis investigating in this aspect, more evidence is required to validate the clinical utility of CEUS for the identification of vascular complications in patients with a transplanted liver.
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Li JW, Lu Q, Luo Y. Hepatic Venous Outflow Stenosis After Auxiliary Left Hemiliver Transplantation Diagnosed by Ultrasonic Shear Wave Elastography Combined With Doppler Ultrasonography. Ultrasound Q 2017; 33:289-292. [PMID: 29190228 PMCID: PMC5704733 DOI: 10.1097/ruq.0000000000000306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 05/03/2017] [Indexed: 02/05/2023]
Abstract
Hepatic vein stenosis after liver transplantation is a relatively rare complication that could even result in graft loss. However, it is difficult to arrive at a definite diagnosis at the early stage of postoperation, and there are few researches on ultrasonic shear wave elastography in the diagnosis of hepatic vein stenosis. We report the case of an 11-year-old male patient with cirrhosis due to hepatolenticular degeneration who received an auxiliary left hemiliver graft from his uncle. Massive ascites developed in 4 days after the operation. Stenosis was suspected at the site of anastomosis by Doppler ultrasonography when elevating the velocity of the left hepatic vein. Meanwhile, increased stiffness of the graft was revealed by ultrasonic shear wave elastography. The stenosis was confirmed by subsequent digital subtraction angiography. Ascites decreased gradually after the stent implantation. Our case indicates that ultrasonic shear wave elastography combined with Doppler ultrasonography is a promising method for noninvasive diagnosis of hepatic venous outflow stenosis following liver transplantation.
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Affiliation(s)
- Jia-Wu Li
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Is Routine Intraoperative Contrast-Enhanced Ultrasonography Useful During Whole Liver Transplantation? World J Surg 2017; 42:1523-1535. [DOI: 10.1007/s00268-017-4295-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Ren X, Luo Y, Gao N, Niu H, Tang J. Common ultrasound and contrast-enhanced ultrasonography in the diagnosis of hepatic artery pseudoaneurysm after liver transplantation. Exp Ther Med 2016; 12:1029-1033. [PMID: 27446316 PMCID: PMC4950670 DOI: 10.3892/etm.2016.3343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/17/2016] [Indexed: 12/19/2022] Open
Abstract
The diagnostic value of common ultrasound and contrast-enhanced ultrasonography (CEUS) in hepatic artery pseudoaneurysm (HAP) after liver transplantation was investigated. From January 2005 to November 2015, information was collected on 2,085 cases of orthotopic liver transplantation. The cases included 1,617 men and 468 women. Common ultrasound and CEUS were used to monitor arterial blood flow following surgery, and the complications were assessed. Instruments used included Acuson Sequoia 512 and Mylab Twice, and the contrast agent was SonoVue. The standard of common ultrasound in the diagnosis of HAP was follicular structure, which had arterial blood flow signal present beside the hepatic artery. The diagnostic criteria of HAP using CEUS were abnormal and round contrast enhancement zone and perfusion of the contrast agent in the zone near the hepatic artery. The diagnostic standard of HAP was computed tomographic angiography (CTA) and emergency operation. Eight cases of HAP were diagnosed in 2,085 patients after liver transplantation (0.38%). Three cases of HAP were diagnosed successfully by common ultrasound while 5 cases were missed. Sensitivity, specificity and diagnostic accuracy for common ultrasound was 37.5, 100 and 99.76%, respectively. Six cases of HAP were diagnosed by CEUS and 2 cases were missed. Sensitivity, specificity and diagnostic accuracy for CEUS was 75, 100 and 99.9%, respectively. Collectively, CEUS is a convenient and effective diagnostic method for HAP following liver transplantation, the diagnostic sensitivity was obviously higher than that of the common ultrasound, and it was more convenient than CTA. Nevertheless, the diagnosis of pseudoaneurysm with deep location, and unsatisfactory grayscale images were easily missed.
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Affiliation(s)
- Xiuyun Ren
- Department of Ultrasound, The General Hospital of Chinese People's Liberation Army, Beijing 100853, P.R. China; Department of Ultrasound, The General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
| | - Yukun Luo
- Department of Ultrasound, The General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
| | - Nong Gao
- Department of Ultrasound, The General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
| | - Hong Niu
- Department of Ultrasound, The General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
| | - Jie Tang
- Department of Ultrasound, The General Hospital of Chinese People's Liberation Army, Beijing 100853, P.R. China
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Ma L, Chen K, Lu Q, Ling W, Luo Y. Case report of hepatic artery dissection secondary to hepatic artery pseudoaneurysm after living donor liver transplantation. BMC Gastroenterol 2016; 16:44. [PMID: 27036207 PMCID: PMC4818394 DOI: 10.1186/s12876-016-0458-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/19/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic artery pseudoaneurysm (HAP) and Hepatic artery dissection are rare vascular complications after living donor liver transplantation (LDLT), which may lead to graft loss and death of the recipients. Conventional gray-scale and Doppler ultrasound, as well as contrast-enhanced ultrasound (CEUS), play important roles in identifying vascular complications in the early postoperative period and during follow-up. We report a case of hepatic artery dissection secondary to HAP after LDLT, which was diagnosed and followed for one year by ultrasound. To the best of our knowledge, few studies have reported similar cases after liver transplantation in the English literature. CASE PRESENTATION A 43-year-old man underwent right-lobe LDLT for treatment of a severe acute hepatitis B infection and was followed up with ultrasound examinations for one year. Conventional gray-scale and Doppler ultrasound combined with contrast-enhanced ultrasound (CEUS) accurately revealed the occurrence of HA dissection secondary to HAP and accompanied by thrombosis and collateral circulation, as well as secondary biliary complications, which provided a prompt diagnosis and guidance for the treatment. CONCLUSION Our case suggests that ultrasound can help detect hepatic artery pseudoaneurysm and dissection, as well as secondary biliary lesions after LDLT in an accurate and timely manner and provide useful information for the treatment chosen. CEUS shows potential as an important complementary technique to gray-scale and Doppler ultrasound.
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Affiliation(s)
- Lin Ma
- />Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province 610041 China
| | - Kefei Chen
- />Department of liver and Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province China
| | - Qiang Lu
- />Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province 610041 China
| | - Wenwu Ling
- />Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province 610041 China
| | - Yan Luo
- />Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province 610041 China
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Ma L, Lu Q, Luo Y. Vascular complications after adult living donor liver transplantation: Evaluation with ultrasonography. World J Gastroenterol 2016; 22:1617-1626. [PMID: 26819527 PMCID: PMC4721993 DOI: 10.3748/wjg.v22.i4.1617] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/12/2015] [Accepted: 11/13/2015] [Indexed: 02/06/2023] Open
Abstract
Living donor liver transplantation (LDLT) has been widely used to treat end-stage liver disease with improvement in surgical technology and the application of new immunosuppressants. Vascular complications after liver transplantation remain a major threat to the survival of recipients. LDLT recipients are more likely to develop vascular complications because of their complex vascular reconstruction and the slender vessels. Early diagnosis and treatment are critical for the survival of graft and recipients. As a non-invasive, cost-effective and non-radioactive method with bedside availability, conventional gray-scale and Doppler ultrasonography play important roles in identifying vascular complications in the early postoperative period and during the follow-up. Recently, with the detailed vascular tracing and perfusion visualization, contrast-enhanced ultrasound (CEUS) has significantly improved the diagnosis of postoperative vascular complications. This review focuses on the role of conventional gray-scale ultrasound, Doppler ultrasound and CEUS for early diagnosis of vascular complications after adult LDLT.
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Ren J, Wu T, Zheng BW, Tan YY, Zheng RQ, Chen GH. Application of contrast-enhanced ultrasound after liver transplantation: Current status and perspectives. World J Gastroenterol 2016; 22:1607-1616. [PMID: 26819526 PMCID: PMC4721992 DOI: 10.3748/wjg.v22.i4.1607] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/14/2015] [Accepted: 11/24/2015] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation is an effective treatment for patients with end-stage liver disease. Accurate imaging evaluation of the transplanted patient is critical for ensuring that the limited donor liver is functioning appropriately. Ultrasound contrast agents (UCAs), in combination with contrast-specific imaging techniques, are increasingly accepted in clinical use for the assessment of the hepatic vasculature, bile ducts and liver parenchyma in pre-, intra- and post-transplant patients. We describe UCAs, their technical requirements, the recommended clinical indications, image interpretation and the limitations for contrast-enhanced ultrasound applications in liver transplantation.
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Onaca N, Klintmalm GB. Clinical Management of Necrotic Liver Before and After Transplantation. TRANSPLANTATION OF THE LIVER 2015:811-817. [DOI: 10.1016/b978-1-4557-0268-8.00065-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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García-Criado A, Gilabert R, Bianchi L, Vilana R, Burrel M, Barrufet M, Oliveira R, García-Valdecasas JC, Brú C. Impact of contrast-enhanced ultrasound in the study of hepatic artery hypoperfusion shortly after liver transplantation: contribution to the diagnosis of artery steal syndrome. Eur Radiol 2014; 25:196-202. [PMID: 25117745 DOI: 10.1007/s00330-014-3377-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 07/17/2014] [Accepted: 07/24/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the value of contrast-enhanced ultrasound (CEUS) in the absence of hepatic artery signal on Doppler ultrasound (DUS) in the immediate postoperative period after liver transplant. METHODS This prospective study included 675 consecutive liver transplants. Patients without hepatic artery signal by DUS within 8 days post-transplant were studied with CEUS. If it remained undetectable, a thrombosis was suspected. In patent hepatic artery, a DUS was performed immediately after CEUS; if low resistance flow was detected, an arteriography was indicated. Patients with high resistance waveform underwent DUS+/CEUS follow-up. Arteriography was indicated when abnormal flow persisted for more than 5 days or liver dysfunction appeared. RESULTS Thirty-four patients were studied with CEUS. In 11 patients CEUS correctly diagnosed hepatic artery thrombosis. In two out of 23 non-occluded arteries, a low resistance flow lead to a diagnosis of stenosis/proximal thrombosis. Twenty-one patients had absence of diastolic flow, which normalized in the follow-up in 13 patients. In the remaining eight patients, splenic artery steal syndrome (ASS) was diagnosed. CONCLUSIONS CEUS allows us to avoid invasive tests in the diagnostic work-up shortly after liver transplant. It identifies the hepatic artery thrombosis and points to a diagnosis of ASS. KEY POINTS • CEUS is useful in the diagnostic work-up shortly after liver transplant • CEUS identifies the hepatic artery thrombosis with reliability • There is little information about DUS and CEUS findings in the ASS • DUS and CEUS offer functional information useful in the diagnosis of ASS.
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Affiliation(s)
- Angeles García-Criado
- Department of Radiology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Spain,
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Fontanilla T, Noblejas A, Cortes C, Minaya J, Mendez S, Van den Brule E, Hernando CG, Alfageme M, Baños I, Aguirre E. Contrast-enhanced ultrasound of liver lesions related to arterial thrombosis in adult liver transplantation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:493-500. [PMID: 23744551 DOI: 10.1002/jcu.22069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 04/06/2013] [Accepted: 05/03/2013] [Indexed: 06/02/2023]
Abstract
PURPOSE To describe the contrast-enhanced ultrasound (CEUS) features of liver and biliary lesions related to hepatic artery thrombosis in adult patients with orthotopic liver transplantation. METHODS Gray-scale ultrasound (US), Doppler US, and CEUS using a hexafluoride-based US contrast media were performed on a series of eight patients with liver transplantation and hepatic artery thrombosis. RESULTS Six of the cases presented infarctions, seen as parenchymal geographic areas of lack of enhancement. Biliary necrosis, seen as nonenhancing periportal cuff, was seen in one case. Infected biloma, seen as a nonenhancing hilar collection, was present in two cases. Infarction and biloma coexisted in one patient. Two abscesses were seen as a late complication in one case. One of them was seen as a typical necrotic abscess with a central nonenhancing area and peripheral rim enhancement higher than the surrounding liver. The other one was seen as a partially liquefied abscess. CONCLUSION CEUS was useful to diagnose lesions related to hepatic artery thrombosis in liver transplantation. It enabled distinguishing between them and to define their size and extension better than conventional gray-scale US.
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Affiliation(s)
- Teresa Fontanilla
- Servicio de Radiodiagnóstico, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Lee SJ, Kim KW, Kim SY, Park YS, Lee J, Kim HJ, Lee JS, Song GW, Hwang S, Lee SG. Contrast-enhanced sonography for screening of vascular complication in recipients following living donor liver transplantation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:305-312. [PMID: 23553428 DOI: 10.1002/jcu.22044] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 10/22/2012] [Accepted: 02/04/2013] [Indexed: 06/02/2023]
Abstract
The purpose of this article is to discuss the role of CEUS for screening of vascular complication in recipients admitted to ICU following LDLT, effect of microbubble contrast agent on Doppler phenomenon, CEUS technique, and illustrate CEUS findings in recipients with complication following LDLT. CEUS can enhance the role of US in the diagnosis of postoperative vascular complication in recipients following living donor liver transplantation at the bedside.
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Affiliation(s)
- So Jung Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil Songpa-gu, Seoul, 138-736, Korea
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Claudon M, Dietrich CF, Choi BI, Cosgrove DO, Kudo M, Nolsøe CP, Piscaglia F, Wilson SR, Barr RG, Chammas MC, Chaubal NG, Chen MH, Clevert DA, Correas JM, Ding H, Forsberg F, Fowlkes JB, Gibson RN, Goldberg BB, Lassau N, Leen ELS, Mattrey RF, Moriyasu F, Solbiati L, Weskott HP, Xu HX. Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver - update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:187-210. [PMID: 23137926 DOI: 10.1016/j.ultrasmedbio.2012.09.002] [Citation(s) in RCA: 501] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Initially, a set of guidelines for the use of ultrasound contrast agents was published in 2004 dealing only with liver applications. A second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some non-liver applications. Time has moved on, and the need for international guidelines on the use of CEUS in the liver has become apparent. The present document describes the third iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS) using contrast specific imaging techniques. This joint WFUMB-EFSUMB initiative has implicated experts from major leading ultrasound societies worldwide. These liver CEUS guidelines are simultaneously published in the official journals of both organizing federations (i.e., Ultrasound in Medicine and Biology for WFUMB and Ultraschall in der Medizin/European Journal of Ultrasound for EFSUMB). These guidelines and recommendations provide general advice on the use of all currently clinically available ultrasound contrast agents (UCA). They are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis and improve the management of patients worldwide.
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Affiliation(s)
- Michel Claudon
- Department of Pediatric Radiology, INSERM U947, Centre Hospitalier Universitaire de Nancy and Université de Lorraine, Vandoeuvre, France
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Park YS, Kim KW, Kim SY, Lee SJ, Lee J, Kim JH, Lee JS, Kim HJ, Song GW, Hwang S, Lee SG. Obstruction at middle hepatic venous tributaries in modified right lobe grafts after living-donor liver Transplantation: diagnosis with contrast-enhanced US. Radiology 2012; 265:617-26. [PMID: 22923713 DOI: 10.1148/radiol.12112042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate the ability of contrast material-enhanced ultrasonography (US) to help diagnose obstruction of middle hepatic venous (MHV) tributaries soon after living-donor liver transplantation with modified right lobe grafts. MATERIALS AND METHODS The institutional review board approved the study and waived requirement for informed consent. Sixty-five consecutive patients (48 men, 17 women; mean age, 52.8 years; range, 33-69 years) who underwent living-donor liver transplantation with modified right lobe grafts between February and May 2009 were included. All patients underwent contrast-enhanced US and Doppler US on postoperative day 1 and underwent computed tomography (CT) within 7 days after US. At contrast-enhanced US, parenchymal enhancement patterns in the territory of each MHV tributary during arterial and portal venous phases were evaluated. With use of most frequent enhancement patterns in patients with obstruction at MHV tributaries as a criterion, diagnostic performance of contrast-enhanced US was compared with that of Doppler US for diagnosis of obstruction at MHV tributaries; CT was the reference standard. Generalized estimating equations were used to adjust for data clustering. RESULTS Of 148 MHV tributaries in 65 patients, 36 (24.3%) in 31 patients were diagnosed as obstructed at CT. With arterial high echogenicity or portal low echogenicity used as a criterion for hepatic venous obstruction, contrast-enhanced US had sensitivity, specificity, and accuracy of 91% (33 of 36), 97% (109 of 112), and 95% (142 of 148), respectively, whereas Doppler US had values of 83% (30 of 36), 86% (97 of 112), and 85% (127 of 148), respectively. Contrast-enhanced US was significantly more specific and accurate than Doppler US for diagnosis of obstruction at MHV tributaries (P=.024 and .01, respectively). Arterial high echogenicity was noted only in the hepatic venous obstruction group. CONCLUSION Contrast-enhanced US can help accurately assess hepatic venous obstruction at MHV tributaries after living-donor liver transplantation with a modified right lobe graft. Contrast-enhanced US was significantly more specific than Doppler US, with arterial hyperenhancement in the affected area being specific to hepatic venous obstruction.
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Affiliation(s)
- Yang Shin Park
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, and Department of Radiology, Korea University Guro Hospital, Seoul, Korea
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Lu Q, Zhong XF, Huang ZX, Yu BY, Ma BY, Ling WW, Wu H, Yang JY, Luo Y. Role of contrast-enhanced ultrasound in decision support for diagnosis and treatment of hepatic artery thrombosis after liver transplantation. Eur J Radiol 2012; 81:e338-e343. [PMID: 22153745 DOI: 10.1016/j.ejrad.2011.11.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 11/01/2011] [Accepted: 11/02/2011] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess role of contrast-enhanced ultrasound (CEUS) in decision support for diagnosis and treatment of hepatic artery thrombosis (HAT) after liver transplantation. MATERIALS AND METHODS Between January 2005 and January 2011, 605 patients underwent liver transplantation in our medical center. All the liver transplant recipients received Doppler ultrasound scanning and CEUS examination was performed in 45 patients with suspected HAT on Doppler ultrasound. Sensitivity, specificity, accuracy, positive predict value and negative predictive value of CEUS in diagnosing HAT were determined based on the results from angiography, surgery and clinical follow-up. RESULTS Fourteen HATs, including one late HAT, were diagnosed by CEUS. Twelve HAT cases were confirmed by angiographic and/or surgical findings, while the late HAT and other 31 patients with negative CEUS finding were confirmed by the clinical follow-up. There was a false positive HAT diagnosed by CEUS in which angiography revealed a patent hepatic artery. The sensitivity, specificity, accuracy, positive predict value and negative predictive value of CEUS in diagnosing HAT were 100%, 96.9%, 97.8%, 92.9% and 100%, respectively. In our series of 605 liver transplants, the incidence and mortality of HAT was 2.2% (13/605) and 53.8% (7/13), respectively. CONCLUSIONS Our study demonstrates the important role of CEUS in decision support for diagnosis and treatment of HAT after liver transplantation. When HAT is suspected by Doppler ultrasound, CEUS shall immediately be performed to elucidate its nature. A negative CEUS finding shall avoid invasive angiography. Such as, CEUS may alter the clinical workflow on HAT detection after liver transplantation.
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Affiliation(s)
- Qiang Lu
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
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Yang Y, Yan LN, Zhao JC, Ma YK, Huang B, Li B, Wen TF, Wang WT, Xu MQ, Yang JY. Microsurgical reconstruction of hepatic artery in A-A LDLT: 124 consecutive cases without HAT. World J Gastroenterol 2010; 16:2682-2688. [PMID: 20518092 PMCID: PMC2880783 DOI: 10.3748/wjg.v16.i21.2682] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 02/23/2010] [Accepted: 03/02/2010] [Indexed: 02/06/2023] Open
Abstract
AIM To retrospectively investigate microsurgical hepatic artery (HA) reconstruction and management of hepatic thrombosis in adult-to-adult living donor liver transplantation (A-A LDLT). METHODS From January 2001 to September 2009, 182 recipients with end-stage liver disease underwent A-A LDLT. Ten of these patients received dual grafts. The 157 men and 25 women had an age range of 18 to 68 years (mean age, 42 years). Microsurgical techniques and running sutures with back-wall first techniques were performed in all arterial reconstructions under surgical loupes (3.5 x) by a group of vascular surgeons. Intimal dissections were resolved by interposition of the great saphenous vein (GSV) between the donor right hepatic artery (RHA) and recipient common HA (3 cases) or abdominal aorta (AA) (2 cases), by interposition of cryopreserved iliac vessels between the donor RHA and recipient AA (2 cases). RESULTS In the 58 incipient patients in this series, hepatic arterial thrombosis (HAT) was encountered in 4 patients, and was not observed in 124 consecutive cases (total 192 grafts, major incidence, 2.08%). All cases of HAT were suspected by routine color Doppler ultrasonographic examination and confirmed by contrast-enhanced ultrasound and hepatic angiography. Of these cases of HAT, two occurred on the 1st and 7th d, respectively, following A-A LDLT, and were immediately revascularized with GSV between the graft and recipient AA. HAT in one patient occurred on the 46th postoperative day with no symptoms, and the remaining case of HAT occurred on the 3rd d following A-A LDLT, and was cured by thrombolytic therapy combined with an anticoagulant but died of multiorgan failure on the 36th d after A-A LDLT. No deaths were related to HAT. CONCLUSION Applying microsurgical techniques and selecting an appropriate anastomotic artery for HA reconstruction are crucial in reducing the high risk of HAT during A-A LDLT.
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