Boaz Karmazyn1, Dilek Sağlam2, Giresh S Rao3, S Gregory Jennings4, Richard S Mangus5. 1. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Room 1053, Indianapolis, IN, 46202, USA. bkarmazy@iupui.edu. 2. Department of Radiology, Malatya Education and Research Hospital, Malatya, Turkey. 3. Division of Pediatric Gastroenterology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA. 4. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Room 1053, Indianapolis, IN, 46202, USA. 5. Department of Transplant Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Abstract
BACKGROUND: Doppler US is the primary screening for post-liver transplant vascular complications, but indeterminate findings require further imaging. OBJECTIVE: To evaluate whether contrast-enhanced US improves diagnostic assessment of vascular complications suspected by Doppler US. MATERIALS AND METHODS: We retrospectively reviewed Doppler US and contrast-enhanced US studies obtained in the first week following liver transplant. Doppler US was performed twice daily for the first 5 postoperative days, and CEUS in the first postoperative day and when vascular complications were suspected. We correlated Doppler US and CEUS with surgical findings, and clinical and imaging follow-up. We evaluated Doppler US and CEUS quality in demonstrating the main hepatic artery (HA) at the porta hepatis as follows: Grade 0 = not seen, Grade 1 = only segments, Grade 2 = entire main HA, and Grade 3 = entire main HA to the intrahepatic branching. We used a Wilcoxon signed rank test to test the difference between Doppler US and CEUS methods. RESULTS: Twenty-nine children (15 girls, 14 boys) were identified, with median age 2.2 years (range 0.5-17.6 years). The most common transplant indication was biliary atresia (n=13). There was significantly (P<0.0001) improved main HA visualization with CEUS. In five children, CEUS was performed to evaluate suspected vascular complications; CEUS confirmed normal vascularity in two. CEUS demonstrated portal vein thrombosis (n=2) and main HA thrombosis (n=1), confirmed at surgery. In one child the main HA thrombosis was missed; marked HA narrowing was seen retrospectively on CEUS. CONCLUSION: Immediately following liver transplantation, CEUS improves main HA visualization and diagnostic assessment of vascular complications.
BACKGROUND: Doppler US is the primary screening for post-liver transplant vascular complications, but indeterminate findings require further imaging. OBJECTIVE: To evaluate whether contrast-enhanced US improves diagnostic assessment of vascular complications suspected by Doppler US. MATERIALS AND METHODS: We retrospectively reviewed Doppler US and contrast-enhanced US studies obtained in the first week following liver transplant. Doppler US was performed twice daily for the first 5 postoperative days, and CEUS in the first postoperative day and when vascular complications were suspected. We correlated Doppler US and CEUS with surgical findings, and clinical and imaging follow-up. We evaluated Doppler US and CEUS quality in demonstrating the main hepatic artery (HA) at the porta hepatis as follows: Grade 0 = not seen, Grade 1 = only segments, Grade 2 = entire main HA, and Grade 3 = entire main HA to the intrahepatic branching. We used a Wilcoxon signed rank test to test the difference between Doppler US and CEUS methods. RESULTS: Twenty-nine children (15 girls, 14 boys) were identified, with median age 2.2 years (range 0.5-17.6 years). The most common transplant indication was biliary atresia (n=13). There was significantly (P<0.0001) improved main HA visualization with CEUS. In five children, CEUS was performed to evaluate suspected vascular complications; CEUS confirmed normal vascularity in two. CEUS demonstrated portal vein thrombosis (n=2) and main HA thrombosis (n=1), confirmed at surgery. In one child the main HA thrombosis was missed; marked HA narrowing was seen retrospectively on CEUS. CONCLUSION: Immediately following liver transplantation, CEUS improves main HA visualization and diagnostic assessment of vascular complications.