Foshager M C, Hedlund L J, Troppmann C, Benedetti E, Gruessner R W
Department of Radiology, Fairview University Medical Center, Minneapolis, MN 55455-0392, USA.
AJR Am J Roentgenol. 1997 Nov;169(5):1269-73. doi: 10.2214/ajr.169.5.9353440.
Our objective was to determine whether elevated pancreatic transplant arterial resistive index (RI) and absence of venous flow correlate with pancreatic transplant venous thrombosis.
Thirteen episodes of surgically documented pancreatic venous thrombosis occurred in 175 pancreases that had been transplanted over a 3-year period. Duplex sonography was performed before surgical exploration in 11 cases. We retrospectively reviewed these 11 sonograms to determine whether blood was flowing in the veins and arteries of the graft. The RI was calculated from all pancreatic artery waveforms. We compared these arterial RIs and the presence or absence of venous flow with those of pancreatic grafts without venous thrombosis to determine sensitivity and specificity.
In the venous thrombosis group, thrombosis occurred within 12 days of transplantation (mean, 3.5 days) in all 11 cases. Six cases of thrombosis (55%) occurred within 1 day. Arterial flow was detected within the graft in nine cases (82%) and in the stump of the donor artery between the graft and the recipient iliac artery in the two remaining cases. Antegrade diastolic flow was absent in all arterial tracings. Diastolic flow reversal was present in seven (78%) of nine grafts with detectable intrapancreatic arterial flow. Arterial RIs ranged from 1.00 to 2.00 (mean +/- SD, 1.27 +/- 0.29). Intrapancreatic venous flow was absent in all 11 cases. In the control group (43 examinations in 34 patients) RIs ranged from 0.46 to 1.29 (mean +/- SD, 0.72 +/- 0.18). Two of 43 arterial tracings had diastolic flow reversal (RI > 1.0). Venous flow was present in all examinations in the control group. A statistically significant difference existed between the RIs in the thrombosis group and the RIs in the control group (p = .0001).
Reversal of diastolic flow in pancreatic transplant arteries is highly specific for detection of graft venous thrombosis during the first 12 days after transplantation. Our findings suggest that an RI greater than or equal to 1.00 and absence of venous flow, in combination, are highly sensitive and specific for the diagnosis of pancreatic graft venous thrombosis.
我们的目的是确定胰腺移植动脉阻力指数（RI）升高及静脉血流缺失是否与胰腺移植静脉血栓形成相关。
在3年期间移植的175个胰腺中发生了13例经手术证实的胰腺静脉血栓形成事件。11例在手术探查前进行了双功超声检查。我们回顾性分析这11份超声图像，以确定移植物的动静脉内是否有血流。根据所有胰腺动脉波形计算阻力指数。我们将这些动脉阻力指数以及静脉血流的有无与无静脉血栓形成的胰腺移植物进行比较，以确定敏感性和特异性。
在静脉血栓形成组中，所有11例血栓形成均发生在移植后12天内（平均3.5天）。6例血栓形成（55%）发生在1天内。9例（82%）移植物内检测到动脉血流，其余2例在移植物与受体髂动脉之间的供体动脉残端检测到动脉血流。所有动脉描记图均无舒张期正向血流。9例可检测到胰腺内动脉血流的移植物中有7例（78%）出现舒张期血流逆转。动脉阻力指数范围为1.00至2.00（平均±标准差，1.27±0.29）。11例均无胰腺内静脉血流。在对照组（34例患者的43次检查）中，阻力指数范围为0.46至1.29（平均±标准差，0.72±0.18）。43次动脉描记图中有2次出现舒张期血流逆转（阻力指数>1.0）。对照组所有检查均有静脉血流。血栓形成组与对照组的阻力指数存在统计学显著差异（p = 0.0001）。
胰腺移植动脉舒张期血流逆转对于移植后12天内移植物静脉血栓形成的检测具有高度特异性。我们的研究结果表明，阻力指数大于或等于1.00且无静脉血流，两者结合对于胰腺移植物静脉血栓形成的诊断具有高度敏感性和特异性。
