Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 1 Deaconess Rd., Boston, MA 02215, USA.
AJR Am J Roentgenol. 2010 Dec;195(6):1438-43. doi: 10.2214/AJR.10.4636.
The purpose of our study was to determine whether Doppler sonography, using a strict reference standard, can specifically identify hemodynamically significant portal vein anastomotic stenosis after liver transplantation in adults.
The duplex and color Doppler examinations of 13 consecutive adult patients who underwent portal venography for suspected portal vein stenosis after liver transplantation were retrospectively examined. Peak systolic velocity (PSV) and change in PSV (ΔPSV) along the portal vein were correlated with portal venography. Stenoses above 50% on the basis of strict venographic criteria were considered hemodynamically significant. The Doppler studies before and after intervention were also assessed. Fourteen randomly chosen subjects with transplants without suspicion of portal anastomotic stenosis acted as controls.
Six patients had significant portal vein stenosis (> 50%) and seven had stenosis below 50%. PSV and ΔPSV were significantly greater for patients with > 50% stenosis in comparison with those with ≤ 50% stenosis and control subjects. Optimal threshold values for PSV and ΔPSV were 80 and 60 cm/s, respectively, with either value alone yielding sensitivity of 100% and specificity of 84% for significant stenosis. Threshold values also included cases of stenosis below 50%. Five of six patients with > 50% stenosis underwent stenting, with poststent PSV and ΔPSV significantly declining to match that of control subjects. Three of seven with stenosis below 50% had stents placed but no significant change in the Doppler examination.
Doppler threshold criteria reliably exclude those without posttransplantation portal vein stenosis and have high sensitivity for detecting portal stenosis. However, these criteria cannot discern the extent of stenosis.
本研究旨在确定多普勒超声检查是否能在成人肝移植后使用严格的参考标准特异性识别具有血流动力学意义的门静脉吻合口狭窄。
回顾性分析 13 例连续成人患者，这些患者因疑似肝移植后门静脉狭窄而行门静脉造影，对其双功和彩色多普勒检查结果进行分析。门静脉的收缩期峰值速度（PSV）和 PSV 变化（ΔPSV）与门静脉造影相关。根据严格的血管造影标准，狭窄超过 50%的狭窄被认为具有血流动力学意义。还评估了介入前后的多普勒研究。 14 名随机选择的无门静脉吻合口狭窄怀疑的移植受者作为对照组。
6 例患者存在明显的门静脉狭窄（>50%），7 例患者狭窄程度<50%。与狭窄程度≤50%和对照组相比，PSV 和 ΔPSV 对于狭窄程度>50%的患者明显更大。PSV 和 ΔPSV 的最佳阈值值分别为 80 和 60cm/s，任一个值的单独诊断具有 100%的敏感性和 84%的特异性。阈值值还包括狭窄程度<50%的病例。6 例>50%狭窄的患者中有 5 例行支架置入术，术后支架内 PSV 和 ΔPSV 显著下降至与对照组匹配。狭窄程度<50%的 7 例中有 3 例行支架置入术，但多普勒检查无明显变化。
多普勒阈值标准可靠地排除了那些没有移植后门静脉狭窄的患者，并具有高敏感性来检测门静脉狭窄。但是，这些标准不能区分狭窄的程度。
