Diagnosis of venoocclusive disease of the liver after bone marrow transplantation: value of duplex sonography.

Abstract

OBJECTIVE.The purpose of this study was to determine if duplex sonography of the hepatic vasculature can be used to detect venoocclusive disease in patients who have had bone marrow transplantation.SUBJECTS AND METHODS. Twenty-seven bone marrow transplant recipients were serially studied with hepatic duplex sonography before (n = 27) and biweekly after (n = 136) transplantation.Duplex waveforms were obtained from the hepatic artery and the portal and hepatic venous systems. Clinical records were reviewed to confirm the dinical diagnosis of venoocclusive disease (n = 5), including its time of onset and duration. Patients with venoocclusive disease were further split into two groups: those with clinically active disease and those with clinically inactive disease. The resistive index in the hepatic artery, the velocity in the portal vein, and the differences among bone marrow transplant values before and after transplantation were compared among the groups.RESULTS. On the basis of data obtained before transplantation, a resistive index greater than 0.76 and a change in resistive index greater than 0.10 after transplantation were considered abnormal. Similarly, velocity in the portal vein after transplantation was considered abnormal when the value was less than 4.3 cm/sec or more than 50.3 cm/sec.

Early Ultrasonographic Diagnosis and Clinical Follow-up of Hepatic Veno-Occlusive Disease after Allogeneic Bone Marrow Transplantation in a Patient with Acute Lymphoblastic Leukemia

“…The patient who is the subject of this report was noninvasively diagnosed as having VOD (8,10) although they were found to be not necessarily associated with VOD or were nonspecific for its diagnosis in several studies (7,11,12).…”

“…Jones et There are many reports on the role of ultrasonography in the diagnosis of VOD (7)(8)(9)(10)(11)(12)(13) T a b l e 1 . Ul t r a s o n o g r a p h i c Me a s u r e me n t s a n d L a b o r a t o r …”

Possible association between Budd‐Chiari syndrome and gemtuzumab ozogamicin treatment in a patient with refractory acute myelogenous leukemia

“…Moreover, the inferior vena cava and major hepatic veins are usually patent. In one study, hepatic and portal vein color doppler findings in VOD patients were investigated, and in all the patients involved, normal hepatic venous flow was demonstrated [6]. A similar study on Budd-Chiari patients demonstrated that, despite the variability of portal venous flow findings, all patients had abnormalities of anatomy or of flow in one or more of the main hepatic veins [7].…”

Demonstration of reversed flow in segmental branches of the portal vein with hand-held color Doppler ultrasonography after hematopoietic stem cell transplantation

“…18,19 However, in a later study, these findings resulted in being of no value in the diagnosis of VOD. 20 The progression of color Doppler ultrasonographic vascular imaging techniques has made it possible to detect reversed portal flow with high sensitivity and reproducibility. In addition, hand-held equipment makes it easy and safe to handle the patient at the bedside in a bioclean room.…”