Prospective Evaluation of Vascular Complications after Liver Transplantation: Comparison of Conventional and Microbubble Contrast-enhanced US

Hom, Benjamin K.; Shrestha, Ruchi; Palmer, Suzanne; Katz, Michael; Selby, Rick; Asatryan, Zhanna; Wells, Jabali K.; Grant, Edward G.

doi:10.1148/radiol.2411050597

Cited by 96 publications

(85 citation statements)

References 11 publications

(13 reference statements)

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“…Clinically significant complications include hepatic venous congestion, arterial and venous thrombosis and stenosis, biliary disorders, fluid collections, neoplasms, and graft rejection (39−41). Imaging plays an important role in the early diagnosis of complications, which is crucial to their successful management (39). Hemodynamic alterations may occur after transplantation, particularly venous congestion which most often takes place in the anterior segment as a result of the ligation of large middle hepatic vein (MHV) tributaries, including the veins of segment V or VIII.…”

Section: Perfusion Imaging In Liver Transplantationmentioning

confidence: 99%

Perfusion CT imaging of the liver: review of clinical applications

Oğul

Kantarcı²,

Genç³

et al. 2014

Diagn Interv Radiol

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Perfusion computed tomography (CT) has a great potential for determining hepatic and portal blood flow; it offers the advantages of quantitative determination of lesion hemodynamics, distinguishing malignant and benign processes, as well as providing morphological data. Many studies have reported the use of this method in the assessment of hepatic tumors, hepatic fibrosis associated with chronic liver disease, treatment response following radiotherapy and chemotherapy, and hepatic perfusion changes after radiological or surgical interventions. The main goal of liver perfusion imaging is to improve the accuracy in the characterization of liver disorders. In this study, we reviewed the clinical application of perfusion CT in various hepatic diseases. The advent of multidetector CT has given rise to the acquisition of images with higher quality and accuracy. Multidetector CT has been developed as a noninvasive imaging modality for evaluation of vascular anatomy. It has also made it possible to perform CT angiography of the hepatic vessels. New generation CT systems with multidetector are capable of performing volumetric imaging. These systems provide a single rotational acquisition and almost the whole upper abdomen can be appraised by means of serial rotational acquisitions at a single location in the z-direction. Multidetector CT imaging is used extensively for the preoperative selection of living related liver donors, as well as evaluation of the vascular anatomy of the recipients (1). This imaging technique is also used for the initial evaluation and follow-up of most patients with hepatic metastases, providing valuable information about the number, size, and distribution of hepatic metastases and the presence and extent of extrahepatic disease (1).Perfusion CT imaging permits the qualitative and quantitative assessment of liver perfusion. In perfusion CT, a quantitative tissue perfusion map is obtained from dynamic CT data and displayed using a color scale permitting the quantification of tissue perfusion in absolute units at high spatial resolution (2). Perfusion CT efficiently locates abnormal tissue perfusion which is difficult to detect accurately with conventional CT (3). Functional assessment of the perfusion of normal and pathologic tissues is performed by means of quantitative or semiquantitative parameters, such as blood flow (BF), blood volume (BV), mean transit time (MTT), portal liver perfusion (PLP), arterial liver perfusion (ALP) and hepatic perfusion index (HPI). Perfusion CT measures the temporal changes in tissue density through a series of dynamically acquired CT images after intravenous injection of an iodinated contrast material (4, 5). Perfusion CT may be performed quickly and provide valuable data for diagnosis. However, there are some limitations of this method such as long breath-holding for portal flow measurement, separation of arterial and portal blood flow, additional radiation exposure, limited craniocaudal scan range, and standardization of analytic methods (2). In this a...

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Section: Perfusion Imaging In Liver Transplantationmentioning

confidence: 99%

Perfusion CT imaging of the liver: review of clinical applications

Oğul

Kantarcı²,

Genç³

et al. 2014

Diagn Interv Radiol

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“…Ultrasound findings can be false positive if the hepatic artery is small or stenotic, if the flow is very slow, or if there is coexistent systemic hypotension. If US does not show an arterial flow, administration of contrast media (microbubble) can help to improve the flow visualization in the HA, differentiating between thrombosis and a patent artery in patients without HA flow on conventional Doppler US [46][47][48][49] . Hepatic artery stenosis is reported in 5%-10% of transplant recipients and can be anastomotic (in 70% of cases), perianastomotic or intrahepatic.…”

Section: Radiological Assessment Of Post-transplant Complicationsmentioning

confidence: 99%

“…It is most frequently caused by an error in surgical technique or by arterial damage during explantation. Near the stenosis, the Doppler ultrasound shows a focal velocity greater than 2 mL/s, and turbulence; more distally, it detects a tardus parvus arterial waveform with a resistance index lower than 0.5 and a systolic acceleration time (between the end of the diastole and the first systolic peak) greater than 0.08 s [46][47][48][49] (Figures 6 and 7). Post-transplant PVT is extremely rare in adults.…”

Section: Radiological Assessment Of Post-transplant Complicationsmentioning

confidence: 99%

“…The suspicion of stenosis arises if color Doppler shows a turbulent flow with focal aliasing in the stenotic tract, and a velocity gradient of > 4-fold [46][47][48][49] . Post-liver transplant stenosis of the inferior vena cava is rare and generally secondary to technical issues.…”

Section: Radiological Assessment Of Post-transplant Complicationsmentioning

confidence: 99%

“…Post-liver transplant stenosis of the inferior vena cava is rare and generally secondary to technical issues. CDUS shows an increased trans-anastomotic velocity gradient (> 4 times) and the loss of the tracing's normal phasicity [44,46,49] (Figure 8). In partial liver transplants, hepatic vein stenosis is a frequent complication.…”

Section: Radiological Assessment Of Post-transplant Complicationsmentioning

confidence: 99%

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