Platt J F, Yutzy G G, Bude R O, Ellis J H, Rubin J M
Department of Radiology, University of Michigan Hospital, Ann Arbor 48109-0030, USA.
AJR Am J Roentgenol. 1997 Feb;168(2):473-6. doi: 10.2214/ajr.168.2.9016229.
The goal of our study was to evaluate the use of duplex Doppler sonography for revealing hepatic artery stenosis (HAS) in patients who have undergone liver transplantation.
Forty-six patients with spectral Doppler waveforms obtained from the hepatic artery and with subsequent arteriography were reviewed retrospectively. Arterial waveforms, resistive indexes (RIs), and systolic acceleration times (SATs) were evaluated by one reviewer who was unaware of the arteriographic findings. The mean interval between the two examinations was 2.8 days. Arteriograms that revealed a stenosis of greater than 50% were classified as abnormal.
Of the 46 patients, 21 (46%) had a significant stenosis. Patients who had HAS had significantly (p < .05) prolonged SATs (0.08 +/- 0.03 sec versus 0.06 +/- 0.02 sec) and reduced RIs (0.49 +/- 0.05 versus 0.66 +/- 0.05) compared with patients who did not have HAS. Optimal thresholds for HAS detection were RIs less than 0.55 and SATs greater than 0.08 sec. HAS was found in 14 of 15 patients who had both abnormal RIs and SATs. Of the remaining 31 patients, 12 had abnormal values for RI or SAT. Of these 12 patients, three had HAS. Thus, 19 patients had normal RIs and SATs; however, four of these patients were found to have an arterial stenosis. In our 46 patients, abnormal values for both RI and SAT were 67% sensitive and 96% specific for stenosis. When at least one abnormal value was found on Doppler imaging, sensitivity and specificity for stenosis were 81% and 60%, respectively.
Duplex Doppler imaging can noninvasively reveal HAS. Abnormal values for both RI and SAT proved to be a more accurate predictor of stenosis than either RI or SAT as independent parameters.
我们研究的目的是评估双功多普勒超声检查在肝移植患者中用于揭示肝动脉狭窄（HAS）的应用情况。
回顾性分析46例有肝动脉频谱多普勒波形并随后接受血管造影的患者。由一位不知血管造影结果的观察者评估动脉波形、阻力指数（RIs）和收缩期加速时间（SATs）。两次检查之间的平均间隔时间为2.8天。血管造影显示狭窄大于50%的被分类为异常。
46例患者中，21例（46%）有显著狭窄。与无HAS的患者相比，有HAS的患者SATs显著延长（0.08±0.03秒对0.06±0.02秒）且RIs降低（0.49±0.05对0.66±0.05）（p<0.05）。检测HAS的最佳阈值为RIs小于0.55且SATs大于0.08秒。在15例RIs和SATs均异常的患者中，14例发现有HAS。其余31例患者中，12例RI或SAT值异常。在这12例患者中，3例有HAS。因此，19例患者RI和SAT正常；然而，这些患者中有4例被发现有动脉狭窄。在我们的46例患者中，RI和SAT均异常对狭窄的敏感性为67%，特异性为96%。当在多普勒成像上发现至少一个异常值时，对狭窄的敏感性和特异性分别为81%和60%。
双功多普勒成像可无创揭示HAS。RI和SAT均异常被证明比RI或SAT作为独立参数更准确地预测狭窄。
