Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
Department of Diagnostic Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
Eur Radiol. 2019 Jul;29(7):3736-3745. doi: 10.1007/s00330-018-5971-4. Epub 2019 Feb 1.
This study was conducted in order to investigate computed tomography (CT) findings associated with acute cellular rejection (ACR) following liver transplantation (LT) and their relevance to clinical outcomes.
We analyzed 120 patients with newly diagnosed ACR following LT for various liver diseases and 119 controls matched for age, sex, type of liver graft, and date of CT exam following LT. Two radiologists analyzed the images for morphological characteristics of the graft, morphological change in the major draining vein, graft enhancement in the portal venous phase, graft attenuation on noncontrast CT, and periportal halo. Univariate analysis was used to determine the association between radiological findings and ACR. Clinical outcomes, including treatment response and graft survival, were compared between patients with and without associated radiological findings.
Morphological characteristics of the graft (i.e., globular swelling), morphological change in the major draining vein (i.e., nonanastomotic luminal narrowing), and heterogeneous enhancement were significantly associated with ACR (all p < 0.001). On univariate analysis, the severity of morphological characteristics of the grafts (mild/severe: odds ratio [OR], 19.98/32.24) and morphological change in the major draining vein (without/with prestenotic dilatation: OR, 4.17/22.5) were significantly associated with the increased possibility of an ACR diagnosis. Clinical outcomes for treatment response and graft survival were not significantly different between patients with and without associated radiological findings.
Globular swelling, nonanastomotic stenosis with or without prestenotic dilatation of the major draining vein, and heterogeneous enhancement of the graft on portal venous-phase CT were significantly associated with ACR.
• Globular swelling of the graft, nonanastomotic narrowing in the major vein, and heterogeneous graft enhancement on CT were significantly associated with acute cellular rejection (ACR). • Associated CT findings were highly specific but not sensitive for differentiating ACRs from matched controls.
本研究旨在探讨肝移植（LT）后急性细胞排斥（ACR）的计算机断层扫描（CT）表现及其与临床结果的相关性。
我们分析了 120 例因各种肝脏疾病接受 LT 后新诊断为 ACR 的患者和 119 例年龄、性别、肝移植类型和 LT 后 CT 检查日期匹配的对照组。两位放射科医生分析了移植肝的形态特征、主要引流静脉的形态变化、门静脉期增强、非增强 CT 上的移植肝衰减以及门周晕环。采用单因素分析确定影像学表现与 ACR 之间的相关性。比较了有和无相关影像学表现的患者之间的临床结果，包括治疗反应和移植物存活率。
移植肝的形态特征（即球形肿胀）、主要引流静脉的形态变化（即非吻合口腔内狭窄）和不均匀增强与 ACR 显著相关（均 P<0.001）。单因素分析显示，移植肝形态特征的严重程度（轻度/重度：比值比[OR]，19.98/32.24）和主要引流静脉的形态变化（无/伴狭窄前扩张：OR，4.17/22.5）与 ACR 诊断的可能性增加显著相关。治疗反应和移植物存活率的临床结果在有和无相关影像学表现的患者之间没有显著差异。
球形肿胀、主要引流静脉的非吻合性狭窄伴或不伴狭窄前扩张以及门静脉期 CT 上的不均匀增强与 ACR 显著相关。
• 移植肝的球形肿胀、主要静脉的非吻合性狭窄和 CT 上不均匀的增强与急性细胞排斥（ACR）显著相关。• 相关 CT 表现对鉴别 ACR 与匹配对照组具有高度特异性，但敏感性不高。
