Department of Radiology and Medical Research Institute, College of Medicine, Ewha Womans University, Seoul, Korea.
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Radiol. 2019 Mar;20(3):459-468. doi: 10.3348/kjr.2018.0464.
To investigate whether diagnostic performance of contrast-enhanced ultrasound (CEUS) could be improved with modified criteria to diagnose significant hepatic artery occlusion (HAO) and to determine the role of CEUS in patients with a tardus-parvus hepatic artery (HA) pattern on Doppler US.
Among 2679 adult liver transplantations performed over 7 years, HAO was suspected in 288 recipients, based on Doppler ultrasound. Among them, 130 patients underwent CEUS. After excluding two technical failures, 128 CEUS images were retrospectively reviewed to search for abnormal findings, such as no HA enhancement, abnormal HA enhancement (delayed, faint, and discontinuous enhancement), and perfusion defect in the liver parenchyma. The performance CEUS abnormalities were assessed in the patients overall and in subgroups based on Doppler ultrasound abnormality (group A, no flow; group B, tardus-parvus pattern) and were compared based on the area under the receiver operating characteristic curve (AUC).
HAO were diagnosed in 41 patients by surgery, angiography, or follow-up abnormality. By using the conventional criterion (no HA enhancement) to diagnose HAO in patients overall, the sensitivity, specificity, and AUC were 58.5%, 100%, and 0.793, respectively. Modified criteria for HAO (no HA enhancement, abnormal enhancement, or parenchymal perfusion defect) showed statistically significantly increased sensitivity (97.6%, 40/41) and AUC (0.959) ( < 0.001), although the specificity (95.4%, 83/87) was slightly decreased. The sensitivity and specificity of the modified criteria in Groups A and B were 97.1% (33/34) and 95.7% (22/23), and 100% (7/7) and 95.3% (61/64), respectively.
Modified criteria could improve diagnostic performance of CEUS for HAO, particularly by increasing sensitivity. CEUS could be useful for diagnosing HAO even in patients with a tardus-parvus HA pattern on Doppler US, using modified criteria.
探讨改良的诊断显著肝动脉闭塞（HAO）的标准是否能提高对比增强超声（CEUS）的诊断性能，并确定 CEUS 在多普勒超声显示肝动脉（HA）出现迟滞-纤细（tardus-parvus）模式的患者中的作用。
在 7 年间进行的 2679 例成人肝移植中，基于多普勒超声，怀疑 288 例受者存在 HAO。其中，130 例患者接受了 CEUS。排除 2 例技术失败后，回顾性分析了 128 份 CEUS 图像，以寻找异常表现，如肝内无 HA 增强、HA 异常增强（延迟、微弱和不连续增强）和肝实质灌注缺损。根据整体患者和基于多普勒超声异常（A 组：无血流；B 组：迟滞-纤细模式）的亚组评估 CEUS 异常的表现，并根据受试者工作特征曲线（AUC）下面积进行比较。
手术、血管造影或随访异常诊断 41 例患者存在 HAO。使用常规标准（无 HA 增强）诊断整体患者的 HAO，其敏感性、特异性和 AUC 分别为 58.5%、100%和 0.793。HAO 的改良标准（无 HA 增强、异常增强或实质灌注缺损）显示出统计学上显著增加的敏感性（97.6%，40/41）和 AUC（0.959）（<0.001），尽管特异性（95.4%，83/87）略有下降。改良标准在 A 组和 B 组的敏感性和特异性分别为 97.1%（33/34）和 95.7%（22/23），以及 100%（7/7）和 95.3%（61/64）。
改良标准可以提高 CEUS 诊断 HAO 的性能，特别是通过增加敏感性。即使在多普勒超声显示肝动脉出现迟滞-纤细模式的患者中，使用改良标准，CEUS 也可用于诊断 HAO。
