Chong Wui K, Beland Jason C, Weeks Susan M
Department of Radiology, CB 7510, University of North Carolina Hospitals, 101 Manning Dr., Chapel Hill, NC 27599-7510, USA.
AJR Am J Roentgenol. 2007 Jun;188(6):W515-21. doi: 10.2214/AJR.06.1262.
The purpose of our study was to identify specific Doppler criteria for portal vein and outflow vein (hepatic veins and inferior vena cava) obstruction in liver transplants.
A retrospective review was performed of Doppler sonographic studies and angiograms in 94 liver transplant cases (72 whole liver, 22 lobar) with suspected vascular obstruction. The angiograms were classified as normal, occluded, or stenosed on the basis of appearance and elevated pressure gradient. Sonography was correlated with angiography. The following Doppler parameters were evaluated: for the portal vein, peak anastomotic velocity and anastomotic-to-preanastomotic velocity ratio; and for the outflow veins, venous pulsatility index. Receiver operating characteristic curves were constructed and optimum thresholds for stenosis were defined.
There were 16 cases of portal vein obstruction (11 stenosis, five occlusion) and 35 cases of outflow vein obstruction (34 stenoses, one occlusion). Mean peak anastomotic velocity in normal portal veins was 58 cm/s, whereas mean peak anastomotic velocity in stenosed veins was 155 cm/s (p = 0.0007). Peak anastomotic velocity threshold of > 125 cm/s was 73% sensitive and 95% specific for stenosis. Mean anastomotic-to-preanastomotic velocity ratio in normal portal veins was 1.5, and mean anastomotic-to-preanastomotic velocity ratio in stenosed veins was 4.69 (p = 0.001). A 3:1 ratio was 73% sensitive and 100% specific for stenosis. Mean venous pulsatility index for normal outflow veins was 0.75, and mean venous pulsatility index in stenosed veins was 0.39. A venous pulsatility index of < 0.45 was 95.7% specific for stenosis. The areas under the receiver operating characteristic curve were 0.83 for peak anastomotic velocity, 0.86 for anastomotic-to-preanastomotic velocity ratio, and 0.84 for venous pulsatility index, indicating good correlation.
Peak anastomotic velocity, anastomotic-to-preanastomotic velocity ratio, and venous pulsatility index are useful parameters for diagnosing venous stenosis in liver transplants.
我们研究的目的是确定肝移植中门静脉和流出静脉（肝静脉和下腔静脉）梗阻的特定多普勒标准。
对94例疑似血管梗阻的肝移植病例（72例全肝移植，22例肝叶移植）的多普勒超声检查和血管造影进行回顾性分析。根据外观和压力梯度升高将血管造影分为正常、闭塞或狭窄。超声检查与血管造影进行相关性分析。评估以下多普勒参数：门静脉的吻合口峰值流速和吻合口与吻合前流速比值；流出静脉的静脉搏动指数。绘制受试者工作特征曲线并确定狭窄的最佳阈值。
有16例门静脉梗阻（11例狭窄，5例闭塞）和35例流出静脉梗阻（34例狭窄，1例闭塞）。正常门静脉的平均吻合口峰值流速为58 cm/s，而狭窄静脉的平均吻合口峰值流速为155 cm/s（p = 0.0007）。吻合口峰值流速阈值>125 cm/s对狭窄的敏感性为73%，特异性为95%。正常门静脉的平均吻合口与吻合前流速比值为1.5，狭窄静脉的平均吻合口与吻合前流速比值为4.69（p = 0.001）。3:1的比值对狭窄的敏感性为73%，特异性为100%。正常流出静脉的平均静脉搏动指数为0.75，狭窄静脉的平均静脉搏动指数为0.39。静脉搏动指数<0.45对狭窄的特异性为95.7%。受试者工作特征曲线下面积，吻合口峰值流速为0.83，吻合口与吻合前流速比值为0.86，静脉搏动指数为0.84，表明相关性良好。
吻合口峰值流速、吻合口与吻合前流速比值和静脉搏动指数是诊断肝移植静脉狭窄的有用参数。
