Kim Bong Soo, Kim Tae Kyoung, Kim Jung-Sun, Lee Moon-Gyu, Kim Jung Hoon, Kim Kyoung Won, Sung Kyu-Bo, Kim Pyo-Nyun, Ha Hyun Kwon, Lee Sung Gyu, Kang Weechang
Department of Radiology, Asan Medical Center, University of Ulsan, Seoul, Korea.
Radiology. 2004 Jul;232(1):173-80. doi: 10.1148/radiol.2321030482. Epub 2004 May 27.
To describe and determine clinical importance of two-phase computed tomographic (CT) findings of hepatic venous congestion after living donor liver transplantation (LDLT) with right lobe graft.
Forty-eight patients underwent two-phase (hepatic arterial phase and portal venous phase [PVP]) CT at 1, 2, and 4 weeks after LDLT. Images were evaluated for hepatic attenuation difference in areas of hepatic venous congestion, opacification of hepatic and peripheral portal veins in those areas, and changes in findings at follow-up CT. CT findings were correlated with serum bilirubin level. Fisher exact test and mixed model were applied. Histopathologic specimens were obtained in six patients.
Thirty patients (62%) had attenuation difference in segments V and VIII of right lobe transplant at initial CT scanning. Opacification of hepatic or peripheral portal veins was seen in 17 (63%) and 27 (100%) hyperattenuating areas of congestion during PVP and in none and three (19%) of 16 hypoattenuating areas, respectively. At 4-week follow-up CT, attenuation difference decreased in volume in 11 of 16 patients with hypoattenuation during PVP. All 14 patients with hyperattenuation showed no change in volume, but attenuation difference had decreased or disappeared. Histopathologic specimens showed evidence of hepatic venous congestion in all six patients. Hypoattenuation was seen at PVP CT in all three patients with severe hepatic venous congestion at histopathologic examination. Serum bilirubin level was significantly different between patients with hypoattenuation and those with hyperattenuation during PVP (P =.035) and between patients with hypoattenuation and those without attenuation difference (P =.009).
Areas possibly related to hepatic venous congestion after LDLT have variable attenuation at CT; decreased enhancement during PVP correlates with increased postoperative serum bilirubin level, which indicates severity of hepatic venous congestion.
描述并确定活体右半肝移植（LDLT）术后肝静脉淤血的双期计算机断层扫描（CT）表现及其临床重要性。
48例患者在LDLT术后1周、2周和4周接受了双期（肝动脉期和门静脉期[PVP]）CT检查。对肝静脉淤血区域的肝脏衰减差异、这些区域肝门静脉和外周门静脉的强化情况以及随访CT检查结果的变化进行评估。CT表现与血清胆红素水平进行相关性分析。采用Fisher精确检验和混合模型。6例患者获取了组织病理学标本。
30例患者（62%）在初次CT扫描时右半肝移植的V段和VIII段存在衰减差异。在PVP期间，17个（63%）高密度淤血区域可见肝门静脉或外周门静脉强化，而在16个低密度区域中，分别无强化和3个（19%）有强化。在4周随访CT时，16例PVP期间呈低密度的患者中有11例的衰减差异体积减小。所有14例高密度患者的体积无变化，但衰减差异减小或消失。组织病理学标本显示所有6例患者均有肝静脉淤血证据。组织病理学检查显示严重肝静脉淤血的3例患者在PVP CT上均表现为低密度。PVP期间低密度患者与高密度患者之间（P = 0.035）以及低密度患者与无衰减差异患者之间（P = 0.009）的血清胆红素水平存在显著差异。
LDLT术后可能与肝静脉淤血相关的区域在CT上有不同的衰减表现；PVP期间强化减弱与术后血清胆红素水平升高相关，提示肝静脉淤血的严重程度。
