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Abstracts
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Doppler US. This study was to assess the characteristics of blood flow at peripheral zone of the liver by B-Flow imaging. Methods: The characteristics of blood flow at the peripheral zone of the liver were examined in 15, 21 and 18 subjects with chronic hepatitis (CH), liver cirrhosis (LC) and normal controls (NC), respectively, by a B-Flow technique. Existence of few, straight and smooth vessels was graded as Grade-I, whereas that of abundant, tortuous and dilated vessels was regarded as Grade-III and the intermediate was regarded as Grade-II. Doppler parameters including PI were measured at 1 cm below liver border. Results: Hemodynamics of Grade-I, Grade-II and Grade-III was present in 5%, 9% and 86% of LC, respectively. Reversal portal blood flow and hepatic shunts were detected in LC only. PI was significantly increased in LC compared to control subjects. Conclusions: This study shows that liver blood flow at the periphery of the liver can be well assessed by B-Flow imaging. The data indicates the effect of portal hypertension on distal hepatic vasculature in hepatic cirrhosis.
(SAT), peak systolic velocity (PSV) and spectral waveform of hepatic artery. PSV and spectral waveform of portal vein and hepatic vein were also analyzed. In patients who had had abnormal findings on IODU, we compared those results with MDCT angiography or angiography. Results: Hepatic artery stenosis was identified in 20 patients of the transplants. Doppler parameters indicating hepatic artery stenosis were tardus-parvus pattern and SAT. The most useful indicator of hepatic artery stenosis was a change in spectral waveform to tardus-parvus pattern, with 60.0% sensitivity, 73.7% specificity and 84.9% negative predictive value (NPV). Sensitivity, specificity and NPV of SAT for hepatic artery stenosis were 40.0%, 83.6% and 80.9%, respectively. PSV of portal vein and hepatic vein was not reliable indicator of vascular complication. But loss of triphasity of hepatic vein was helpful for prediction of venous obstruction, with 98.4% NPV. Conclusions: Routine use of IODU does not reliably predict vascular complications following liver transplantation. Some Doppler parameters (tardus-parvus pattern, SAT and loss of triphasity) have acceptable NPV for identifying vascular complications.
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Comparison of hepatic artery and portal vein hemodynamics in patients with chronic Budd-Chiari Syndrome (CBCS) and healthy individuals: Effect of partial and complete occlusion of hepatic veins, portal flow inversion and portal thrombosis Marcelino A, Pinho M, Viana P, Saito O, de Oliveira A, Chammas M, Cerri G, Institute of Radiology, Clinical Hospital, University of Sao Paulo, Brazil; Department of Surgery and Liver Transplantation, Clinical Hospital, University of Sao Paulo, Brazil, Brazil
Diagnosis of hepatic artery thrombosis with SonoVue enhanced real time Ultrasonography after Orthotopic Liver Transplantation Li R, Guo Y, Hua X, Ding J, Guo A, Zhang X, Southwest Hospital, Third Military Medical University, Chongqing, China
Objectives: To evaluate the hepatic artery (HA) and portal vein (PV) hemodynamic indexes with Doppler sonography in patients with CBCS and in healthy individuals. Methods: Doppler sonography was performed in 24 patients with CBCS. The control group was composed of 45 candidates for liver donation in living donor liver transplantation. The following parameters were evaluated: HA resistive and pulsatility indexes, HA and PV velocities and flow direction in the PV. Results: The PV velocity was significantly lower in CBCS than in healthy individuals (p ⫽ 0.018). The pulsatility index (PI) of the HA (0.96 ⫾ 0.32) in CBCS with portal thrombosis or flow inversion is lower than in CBCS without portal thrombosis (1.43 ⫾ 0.44) (p ⫽ 0.057) but the peak systolic velocity and resistive index were similar in both groups. Conclusions: Hepatic arterial resistance decreases in CBCS, particularly when there is associated PV thrombosis and flow inversion. To support this finding, we found that the PI of the HA is lower in patients with CBCS than in controls, although this result was not significant in our study group. We believe that variations in the degree of occlusion of the hepatic veins, different draining routes and degrees of intrinsic flow regulation may explain these findings. 2413 The role of routine intraoperative Doppler ultrasound to evaluate complications of living-related donor liver transplantation Choi J-Y, Lee JY, Lee JM, Kim SH, Lee MW, Han JK, Choi BI, Seoul National University Hospital, Korea Objectives: To analyze role of routine intraoperative Doppler ultrasound (IODU) for predicting vascular complication after liver transplantation. Methods: IODU of 81 transplanted liver in 105 patients were analyzed for presence or absence of blood flow, RI, systolic acceleration time
Objectives: To assess the role of real time contrast-enhanced ultrasonography in the diagnosis of hepatic artery thrombosis after orthotopic liver transplantation. Methods: One hundred and seventy-five patients after orthotopic liver transplantation were examined with color Doppler flow imaging (CDFI). SonoVue enhanced low mechanical index (MI ⬍ 0.2) pulseinversion harmonic ultrasonography was performed on patients whose hepatic arteries were not visualized by CDFI. Results: Hepatic arteries were visualized in 153 patients (87.4%) with CDFI and 171 patients (97.7%) with real time contrast-enhanced ultrasonography (p ⬍ 0.01). Angiography was avoided in 18 patients out of 22 patients who did not show hepatic arteries with CDFI (p ⬍ 0.01). Contrast-enhanced ultrasonography showed no perfusion of hepatic artery in four patients who were confirmed thrombosis of hepatic artery by angiography. Conclusions: Visualization of hepatic artery improved significantly with the use of low mechanical index real time contrast-enhanced ultrasonography. Therefore, the number of additional confirmatory angiography might be reduced in the diagnosis of hepatic artery thrombosis after orthotopic liver transplantation. 2415 Role of Doppler US for the diagnosis of hepatic venous congestion in the anterior segment of the modified right lobe graft after living donor liver transplantation: A prospective study of 40 patients Kim SY, Kim KW, Park SH, Lee SS, Shin YM, Kim PN, Lee M-G, Lee SG, Asan Medical Center, University of Ulsan College of Medicine, Korea Objectives: To assess the value of Doppler US for the diagnosis of hepatic venous congestion (HVC) in anterior segment of the modified right-lobe graft (MRLG) after living donor liver transplantation (LDLT). Methods: Doppler US in 40 patients following LDLT with MRLG, in which middle hepatic vein tributaries(MHVT) larger than 5 mm were reconstituted with interposition vein graft, were prospectively evaluated. On color Doppler US, the number of MHVT of anterior segment
P175
Doppler US. This study was to assess the characteristics of blood flow at peripheral zone of the liver by B-Flow imaging. Methods: The characteristics of blood flow at the peripheral zone of the liver were examined in 15, 21 and 18 subjects with chronic hepatitis (CH), liver cirrhosis (LC) and normal controls (NC), respectively, by a B-Flow technique. Existence of few, straight and smooth vessels was graded as Grade-I, whereas that of abundant, tortuous and dilated vessels was regarded as Grade-III and the intermediate was regarded as Grade-II. Doppler parameters including PI were measured at 1 cm below liver border. Results: Hemodynamics of Grade-I, Grade-II and Grade-III was present in 5%, 9% and 86% of LC, respectively. Reversal portal blood flow and hepatic shunts were detected in LC only. PI was significantly increased in LC compared to control subjects. Conclusions: This study shows that liver blood flow at the periphery of the liver can be well assessed by B-Flow imaging. The data indicates the effect of portal hypertension on distal hepatic vasculature in hepatic cirrhosis.
(SAT), peak systolic velocity (PSV) and spectral waveform of hepatic artery. PSV and spectral waveform of portal vein and hepatic vein were also analyzed. In patients who had had abnormal findings on IODU, we compared those results with MDCT angiography or angiography. Results: Hepatic artery stenosis was identified in 20 patients of the transplants. Doppler parameters indicating hepatic artery stenosis were tardus-parvus pattern and SAT. The most useful indicator of hepatic artery stenosis was a change in spectral waveform to tardus-parvus pattern, with 60.0% sensitivity, 73.7% specificity and 84.9% negative predictive value (NPV). Sensitivity, specificity and NPV of SAT for hepatic artery stenosis were 40.0%, 83.6% and 80.9%, respectively. PSV of portal vein and hepatic vein was not reliable indicator of vascular complication. But loss of triphasity of hepatic vein was helpful for prediction of venous obstruction, with 98.4% NPV. Conclusions: Routine use of IODU does not reliably predict vascular complications following liver transplantation. Some Doppler parameters (tardus-parvus pattern, SAT and loss of triphasity) have acceptable NPV for identifying vascular complications.
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Comparison of hepatic artery and portal vein hemodynamics in patients with chronic Budd-Chiari Syndrome (CBCS) and healthy individuals: Effect of partial and complete occlusion of hepatic veins, portal flow inversion and portal thrombosis Marcelino A, Pinho M, Viana P, Saito O, de Oliveira A, Chammas M, Cerri G, Institute of Radiology, Clinical Hospital, University of Sao Paulo, Brazil; Department of Surgery and Liver Transplantation, Clinical Hospital, University of Sao Paulo, Brazil, Brazil
Diagnosis of hepatic artery thrombosis with SonoVue enhanced real time Ultrasonography after Orthotopic Liver Transplantation Li R, Guo Y, Hua X, Ding J, Guo A, Zhang X, Southwest Hospital, Third Military Medical University, Chongqing, China
Objectives: To evaluate the hepatic artery (HA) and portal vein (PV) hemodynamic indexes with Doppler sonography in patients with CBCS and in healthy individuals. Methods: Doppler sonography was performed in 24 patients with CBCS. The control group was composed of 45 candidates for liver donation in living donor liver transplantation. The following parameters were evaluated: HA resistive and pulsatility indexes, HA and PV velocities and flow direction in the PV. Results: The PV velocity was significantly lower in CBCS than in healthy individuals (p ⫽ 0.018). The pulsatility index (PI) of the HA (0.96 ⫾ 0.32) in CBCS with portal thrombosis or flow inversion is lower than in CBCS without portal thrombosis (1.43 ⫾ 0.44) (p ⫽ 0.057) but the peak systolic velocity and resistive index were similar in both groups. Conclusions: Hepatic arterial resistance decreases in CBCS, particularly when there is associated PV thrombosis and flow inversion. To support this finding, we found that the PI of the HA is lower in patients with CBCS than in controls, although this result was not significant in our study group. We believe that variations in the degree of occlusion of the hepatic veins, different draining routes and degrees of intrinsic flow regulation may explain these findings. 2413 The role of routine intraoperative Doppler ultrasound to evaluate complications of living-related donor liver transplantation Choi J-Y, Lee JY, Lee JM, Kim SH, Lee MW, Han JK, Choi BI, Seoul National University Hospital, Korea Objectives: To analyze role of routine intraoperative Doppler ultrasound (IODU) for predicting vascular complication after liver transplantation. Methods: IODU of 81 transplanted liver in 105 patients were analyzed for presence or absence of blood flow, RI, systolic acceleration time
Objectives: To assess the role of real time contrast-enhanced ultrasonography in the diagnosis of hepatic artery thrombosis after orthotopic liver transplantation. Methods: One hundred and seventy-five patients after orthotopic liver transplantation were examined with color Doppler flow imaging (CDFI). SonoVue enhanced low mechanical index (MI ⬍ 0.2) pulseinversion harmonic ultrasonography was performed on patients whose hepatic arteries were not visualized by CDFI. Results: Hepatic arteries were visualized in 153 patients (87.4%) with CDFI and 171 patients (97.7%) with real time contrast-enhanced ultrasonography (p ⬍ 0.01). Angiography was avoided in 18 patients out of 22 patients who did not show hepatic arteries with CDFI (p ⬍ 0.01). Contrast-enhanced ultrasonography showed no perfusion of hepatic artery in four patients who were confirmed thrombosis of hepatic artery by angiography. Conclusions: Visualization of hepatic artery improved significantly with the use of low mechanical index real time contrast-enhanced ultrasonography. Therefore, the number of additional confirmatory angiography might be reduced in the diagnosis of hepatic artery thrombosis after orthotopic liver transplantation. 2415 Role of Doppler US for the diagnosis of hepatic venous congestion in the anterior segment of the modified right lobe graft after living donor liver transplantation: A prospective study of 40 patients Kim SY, Kim KW, Park SH, Lee SS, Shin YM, Kim PN, Lee M-G, Lee SG, Asan Medical Center, University of Ulsan College of Medicine, Korea Objectives: To assess the value of Doppler US for the diagnosis of hepatic venous congestion (HVC) in anterior segment of the modified right-lobe graft (MRLG) after living donor liver transplantation (LDLT). Methods: Doppler US in 40 patients following LDLT with MRLG, in which middle hepatic vein tributaries(MHVT) larger than 5 mm were reconstituted with interposition vein graft, were prospectively evaluated. On color Doppler US, the number of MHVT of anterior segment