Horvat Natally, Marcelino Antonio Sergio Zafred, Horvat Joao Vicente, Yamanari Tássia Regina, Batista Araújo-Filho Jose de Arimateia, Panizza Pedro, Seda-Neto Joao, Antunes da Fonseca Eduardo, Carnevale Francisco Cesar, Mendes de Oliveira Cerri Luciana, Chapchap Paulo, Cerri Giovanni Guido
From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.).
Radiographics. 2017 Oct;37(6):1612-1631. doi: 10.1148/rg.2017170022.
Liver transplant is considered to be the last-resort treatment approach for pediatric patients with end-stage liver disease. Despite the remarkable advance in survival rates, liver transplant remains an intricate surgery with significant morbidity and mortality. Early diagnosis of complications is crucial for patient survival but is challenging given the lack of specificity in clinical presentation. Knowledge of the liver and vascular anatomy of the donor and the recipient or recipients before surgery is also important to avoid complications. In this framework, radiologists play a pivotal role on the multidisciplinary team in both pre- and postoperative scenarios by providing a road map to guide the surgery and by assisting in diagnosis of complications. The most common complications after liver transplant are (a) vascular, including the hepatic artery, portal vein, hepatic veins, and inferior vena cava; (b) biliary; (c) parenchymal; (d) perihepatic; and (e) neoplastic. The authors review surgical techniques, the role of each imaging modality, normal posttransplant imaging features, types of complications after liver transplant, and information required in the radiology report that is critical to patient care. They present an algorithm for an imaging approach for pediatric patients after liver transplant and describe key points that should be included in radiologic reports in the pre- and postoperative settings. Online supplemental material is available for this article. RSNA, 2017.
肝移植被认为是小儿终末期肝病患者的最后治疗手段。尽管存活率有了显著提高，但肝移植仍是一项复杂的手术，存在较高的发病率和死亡率。并发症的早期诊断对患者生存至关重要，但鉴于临床表现缺乏特异性，诊断颇具挑战性。术前了解供体与受体或受体的肝脏及血管解剖结构对于避免并发症也很重要。在此框架下，放射科医生在多学科团队中，在术前和术后场景中都发挥着关键作用，通过提供指导手术的路线图以及协助诊断并发症。肝移植后最常见的并发症包括：（a）血管性，包括肝动脉、门静脉、肝静脉和下腔静脉；（b）胆管性；（c）实质脏器性；（d）肝周性；（e）肿瘤性。作者回顾了手术技术、每种成像方式的作用、肝移植后的正常成像特征、肝移植后并发症的类型以及放射学报告中对患者护理至关重要的信息。他们提出了一种针对小儿肝移植患者的成像方法算法，并描述了术前和术后放射学报告中应包含的关键点。本文提供在线补充材料。RSNA，2017年。
