Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
Clin Radiol. 2021 Sep;76(9):708.e19-708.e25. doi: 10.1016/j.crad.2021.02.032. Epub 2021 Apr 24.
To evaluate the diagnostic accuracy of Doppler ultrasound (DUS) in detecting hepatic artery stenosis (HAS) after liver transplantation using computed tomography angiography (CTA) as the reference standard.
This study included data from January 2005 to November 2017, where DUS of the hepatic artery of living and deceased donor liver grafts were compared with the reference standard, CTA. DUS parameters, such as intrahepatic artery (IHA) peak systolic velocity (PSV), resistive index (RI), systolic acceleration time (SAT); and extrahepatic artery (EHA) PSV were taken. The optimum cut-off was estimated using area under the receiver operating characteristic curve (AUC). Multivariable logistic regression analysis was developed to predict HAS.
Ninety-nine liver transplant cases were retrieved, 50 met the inclusion criteria where nine patients had significant HAS. HAS patients had a significantly low IHAPSV with a cut-off of 35.1 cm/s (sensitivity 53.8%, specificity 78.4%, AUC 0.701). IHARI had a significantly low RI with a cut-off 0.585 (sensitivity 86.7%, specificity 85.4%, AUC 0.913). The IHASAT cut-off was 0.045 seconds (sensitivity 80%, specificity 91.4%, AUC 0.857). The EHAPSV cut-off was 197.4 cm/s (sensitivity 50%, specificity 99.1%, AUC 0.648). The prediction model using DUS parameters IHARI and IHASAT demonstrated good discrimination with an AUC of 0.930 (95% CI: 0.843, 1.000; sensitivity 93.3%, specificity 88%).
A prediction model using the DUS parameters IHARI and IHASAT showed good diagnostic accuracy of 88.6% for monitoring liver transplant patients. If validated externally, this DUS model could be utilised to diagnose HAS in liver transplant recipients.
使用计算机断层血管造影术（CTA）作为参考标准，评估多普勒超声（DUS）检测肝移植后肝动脉狭窄（HAS）的诊断准确性。
本研究纳入了 2005 年 1 月至 2017 年 11 月的数据，将活体和尸体供肝的 DUS 与参考标准 CTA 进行比较。获取肝内动脉（IHA）峰值收缩速度（PSV）、阻力指数（RI）、收缩加速时间（SAT）和肝外动脉（EHA）PSV 等 DUS 参数。采用受试者工作特征曲线（ROC）下面积（AUC）估计最佳截断值。采用多变量逻辑回归分析预测 HAS。
共检索到 99 例肝移植病例，其中 50 例符合纳入标准，9 例患者存在明显 HAS。HAS 患者 IHAPSV 明显较低，截断值为 35.1cm/s（灵敏度 53.8%，特异性 78.4%，AUC 0.701）。IHARI 有明显较低的 RI，截断值为 0.585（灵敏度 86.7%，特异性 85.4%，AUC 0.913）。IHASAT 截断值为 0.045 秒（灵敏度 80%，特异性 91.4%，AUC 0.857）。EHAPSV 截断值为 197.4cm/s（灵敏度 50%，特异性 99.1%，AUC 0.648）。使用 DUS 参数 IHARI 和 IHASAT 的预测模型具有良好的鉴别力，AUC 为 0.930（95%CI：0.843，1.000；灵敏度 93.3%，特异性 88%）。
使用 DUS 参数 IHARI 和 IHASAT 的预测模型对监测肝移植患者的 HAS 具有良好的诊断准确性（88.6%）。如果外部验证有效，该 DUS 模型可用于诊断肝移植受者的 HAS。
