Tomita Hirofumi, Fuchimoto Yasushi, Ohkuma Kiyoshi, Hoshino Ken, Fujino Akihiro, Kato Mototoshi, Fujimura Takumi, Ishihama Hideo, Takahashi Nobuhiro, Tanami Yutaka, Nakatsuka Seishi, Ebinuma Hirotoshi, Saito Hidetsugu, Shinoda Masahiro, Kitagawa Yuko, Kuroda Tatsuo
Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Pediatr Radiol. 2015 Apr;45(5):658-66. doi: 10.1007/s00247-014-3215-6. Epub 2014 Dec 12.
Living donor liver transplantation in children often results in venous complications, leading to portal hypertension. Spleen stiffness measurements have been recently proposed as a new, noninvasive parameter for portal hypertension in cirrhotic patients.
To evaluate the diagnostic value of spleen stiffness measurements by acoustic radiation force impulse (ARFI) imaging in diagnosing venous complications after pediatric living donor liver transplantation.
We prospectively enrolled 69 patients after pediatric living donor liver transplantation using a left-side liver allograft. Around the time of the protocol liver biopsy examination, spleen stiffness measurements by ARFI imaging were performed via the left intercostal space at the center of the spleen parenchyma and repeated five times. Imaging examinations around the time of the spleen stiffness measurements were retrospectively reviewed. Regarding venous complications, significant portal and hepatic venous stenosis was defined as >50% stenosis on multiphasic computed tomography.
After post hoc exclusion, 62 patients were studied. Portal and hepatic venous stenosis was identified in three and two patients, respectively. The median spleen stiffness values were 2.70 and 4.00 m/s in patients without and with venous complications, respectively (P < 0.001). Spleen stiffness measurements showed good diagnostic power for venous complications, and the cutoff value was determined as 2.93 m/s, with 100% sensitivity and 78.9% specificity. Spleen stiffness measurements decreased with the relief of venous stenosis resulting from an interventional radiology procedure.
Spleen stiffness measurements by ARFI imaging might provide a useful quantitative index for venous complications after pediatric living donor liver transplantation.
儿童活体肝移植常导致静脉并发症，进而引发门静脉高压。近期有人提出脾脏硬度测量可作为肝硬化患者门静脉高压的一种新的无创参数。
评估声学辐射力脉冲（ARFI）成像测量脾脏硬度在诊断儿童活体肝移植术后静脉并发症中的诊断价值。
我们前瞻性纳入了69例接受左侧肝脏同种异体移植的儿童活体肝移植患者。在进行方案规定的肝活检检查时，通过左侧肋间间隙在脾实质中心部位采用ARFI成像测量脾脏硬度，并重复5次。对脾脏硬度测量前后的影像检查进行回顾性分析。对于静脉并发症，多期计算机断层扫描显示门静脉和肝静脉狭窄>50%被定义为显著狭窄。
经过事后排除，共研究了62例患者。分别在3例和2例患者中发现门静脉和肝静脉狭窄。无静脉并发症和有静脉并发症患者的脾脏硬度中位数分别为2.70 m/s和4.00 m/s（P<0.001）。脾脏硬度测量对静脉并发症具有良好的诊断效能，截断值确定为2.93 m/s，敏感性为100%，特异性为78.9%。随着介入放射学手术使静脉狭窄缓解，脾脏硬度测量值下降。
ARFI成像测量脾脏硬度可能为儿童活体肝移植术后静脉并发症提供一个有用的定量指标。
