Teefey S A, Brink J A, Borson R A, Middleton W D
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
AJR Am J Roentgenol. 1995 Jun;164(6):1397-401. doi: 10.2214/ajr.164.6.7754881.
The purpose of this study was to determine if duplex sonography of the hepatic vasculature can be used to detect venoocclusive disease in patients who have had bone marrow transplantation.
Twenty-seven bone marrow transplant recipients were serially studied with hepatic duplex sonography before (n = 27) and biweekly after (n = 136) transplantation. Duplex waveforms were obtained from the hepatic artery and the portal and hepatic venous systems. Clinical records were reviewed to confirm the clinical diagnosis of venoocclusive disease (n = 5), including its time of onset and duration. Patients with venoocclusive disease were further split into two groups: those with clinically active disease and those with clinically inactive disease. The resistive index in the hepatic artery, the velocity in the portal vein, and the differences among bone marrow transplant values before and after transplantation were compared among the groups.
On the basis of data obtained before transplantation, a resistive index greater than 0.76 and a change in resistive index greater than 0.10 after transplantation were considered abnormal. Similarly, velocity in the portal vein after transplantation was considered abnormal when the value was less than 4.3 cm/sec or more than 50.3 cm/sec. There was no statistically significant difference in the resistive index in the hepatic artery or velocity in the portal vein among patient groups. Hepatopetal portal venous flow was shown in 26 of 27 patients during the study. Portal venous flow was reversed in one patient with venoocclusive disease. Appropriately directed hepatic venous flow was demonstrated in all 27 patients.
Our study shows that resistive index in the hepatic artery, velocity and flow direction in the portal vein, and flow direction in the hepatic vein as detected by duplex sonography are of no value in the diagnosis of venoocclusive disease after transplantation.
本研究旨在确定肝脏血管的双功超声检查能否用于检测接受骨髓移植患者的肝静脉闭塞病。
对27例骨髓移植受者在移植前（n = 27）及移植后每两周（n = 136）进行肝脏双功超声检查。获取肝动脉、门静脉和肝静脉系统的双功波形。查阅临床记录以确认肝静脉闭塞病（n = 5）的临床诊断，包括发病时间和病程。肝静脉闭塞病患者进一步分为两组：临床活动期患者和临床非活动期患者。比较各组肝动脉阻力指数、门静脉流速以及移植前后骨髓移植值的差异。
根据移植前获得的数据，肝动脉阻力指数大于0.76且移植后阻力指数变化大于0.10被视为异常。同样，移植后门静脉流速小于4.3 cm/秒或大于50.3 cm/秒时被视为异常。各患者组之间肝动脉阻力指数或门静脉流速无统计学显著差异。研究期间27例患者中有26例显示门静脉向肝血流。1例肝静脉闭塞病患者门静脉血流逆转。所有27例患者均显示肝静脉血流方向正常。
我们的研究表明，双功超声检测的肝动脉阻力指数、门静脉流速和血流方向以及肝静脉血流方向对移植后肝静脉闭塞病的诊断无价值。
