Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, and Department of Radiology, Korea University Guro Hospital, Seoul, Korea.
Radiology. 2012 Nov;265(2):617-26. doi: 10.1148/radiol.12112042. Epub 2012 Aug 24.
To investigate the ability of contrast material-enhanced ultrasonography (US) to help diagnose obstruction of middle hepatic venous (MHV) tributaries soon after living-donor liver transplantation with modified right lobe grafts.
The institutional review board approved the study and waived requirement for informed consent. Sixty-five consecutive patients (48 men, 17 women; mean age, 52.8 years; range, 33-69 years) who underwent living-donor liver transplantation with modified right lobe grafts between February and May 2009 were included. All patients underwent contrast-enhanced US and Doppler US on postoperative day 1 and underwent computed tomography (CT) within 7 days after US. At contrast-enhanced US, parenchymal enhancement patterns in the territory of each MHV tributary during arterial and portal venous phases were evaluated. With use of most frequent enhancement patterns in patients with obstruction at MHV tributaries as a criterion, diagnostic performance of contrast-enhanced US was compared with that of Doppler US for diagnosis of obstruction at MHV tributaries; CT was the reference standard. Generalized estimating equations were used to adjust for data clustering.
Of 148 MHV tributaries in 65 patients, 36 (24.3%) in 31 patients were diagnosed as obstructed at CT. With arterial high echogenicity or portal low echogenicity used as a criterion for hepatic venous obstruction, contrast-enhanced US had sensitivity, specificity, and accuracy of 91% (33 of 36), 97% (109 of 112), and 95% (142 of 148), respectively, whereas Doppler US had values of 83% (30 of 36), 86% (97 of 112), and 85% (127 of 148), respectively. Contrast-enhanced US was significantly more specific and accurate than Doppler US for diagnosis of obstruction at MHV tributaries (P=.024 and .01, respectively). Arterial high echogenicity was noted only in the hepatic venous obstruction group.
Contrast-enhanced US can help accurately assess hepatic venous obstruction at MHV tributaries after living-donor liver transplantation with a modified right lobe graft. Contrast-enhanced US was significantly more specific than Doppler US, with arterial hyperenhancement in the affected area being specific to hepatic venous obstruction.
探讨增强超声（CEUS）在活体肝移植右半肝改良供肝后即刻诊断肝中静脉（MHV）属支阻塞的能力。
本研究经机构审查委员会批准，豁免了知情同意书的要求。2009 年 2 月至 5 月连续纳入 65 例行活体肝移植右半肝改良供肝的患者（男 48 例，女 17 例；平均年龄 52.8 岁；范围 33-69 岁）。所有患者术后第 1 天行 CEUS 和多普勒超声检查，且均在 US 后 7 天内行 CT 检查。CEUS 评价动脉期和门静脉期 MHV 属支区域实质增强模式。以 MHV 属支阻塞患者中最常见的增强模式为标准，对比 CEUS 和多普勒超声对 MHV 属支阻塞的诊断效能；CT 为参考标准。采用广义估计方程校正数据聚类。
65 例患者的 148 条 MHV 属支中，31 例患者的 36 条（24.3%）在 CT 上诊断为阻塞。以动脉期高回声或门静脉期低回声作为肝静脉阻塞的标准，CEUS 的敏感性、特异性和准确性分别为 91%（33/36）、97%（109/112）和 95%（142/148），而多普勒超声的相应值分别为 83%（30/36）、86%（97/112）和 85%（127/148）。CEUS 对 MHV 属支阻塞的诊断特异性和准确性均显著高于多普勒超声（P=.024 和.01）。动脉期高回声仅见于肝静脉阻塞组。
CEUS 可帮助准确评估活体肝移植右半肝改良供肝后 MHV 属支的肝静脉阻塞。CEUS 的特异性显著高于多普勒超声，受影响区域的动脉高增强是肝静脉阻塞的特异性表现。
