Contrast‐enhanced ultrasound for the evaluation of hepatic artery stenosis after liver transplantation: potential role in changing the clinical algorithm

Hepatic artery stenosis (HAS) is a common complication in liver transplant patients. Conventional angiography remains the gold standard for diagnosis. Recently, contrast‐enhanced ultrasound (CEUS) has begun providing real‐time angiographic‐like images of vessels and allowing the accurate diagnosis o...

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Bibliographic Details
Published in:Liver transplantation 2010-06, Vol.16 (6), p.729-735
Main Authors: Zheng, Rong‐Qin, Mao, Ren, Ren, Jie, Xu, Er‐Jiao, Liao, Mei, Wang, Ping, Lu, Min‐Qiang, Yang, Yang, Cai, Chang‐Jie, Chen, Gui‐Hua
Format: Article
Language:English
Subjects:
Adult
Aged
Algorithms
Arterial Occlusive Diseases - diagnostic imaging
Arterial Occlusive Diseases - etiology
Clinical Protocols
Constriction, Pathologic
Contrast Media - administration & dosage
Female
Hepatic Artery - diagnostic imaging
Humans
Injections, Intravenous
Liver Transplantation - adverse effects
Male
Microbubbles
Middle Aged
Phospholipids - administration & dosage
Predictive Value of Tests
Sensitivity and Specificity
Severity of Illness Index
Sulfur Hexafluoride - administration & dosage
Tomography, X-Ray Computed
Treatment Outcome
Ultrasonography, Doppler, Color
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Summary:Hepatic artery stenosis (HAS) is a common complication in liver transplant patients. Conventional angiography remains the gold standard for diagnosis. Recently, contrast‐enhanced ultrasound (CEUS) has begun providing real‐time angiographic‐like images of vessels and allowing the accurate diagnosis of arterial diseases such as hepatic artery thrombosis. The purpose of this study was to evaluate the efficacy of CEUS in depicting HAS after liver transplantation. Forty‐seven liver transplant recipients underwent CEUS examinations with the intravenous injection of microbubble contrast agents. The reference standard was conventional angiography for 15 patients and computed tomographic angiography for 32 patients. The presence, degree, location, and type of HAS were evaluated. For the detection of HAS by CEUS, the following was found: an accuracy of 91.5% (43/47), a sensitivity of 92.3% (36/39), a specificity of 87.5% (7/8), a positive predictive value of 97.3% (36/37), and a negative predictive value of 70% (7/10). CEUS corrected false‐positive findings on color Doppler ultrasound in 7 of 47 cases (14.9%). The accuracy of CEUS in identifying the location and type of HAS was 92.3% (36/39) and 84.6% (33/39), respectively. CEUS is a useful noninvasive technique for the detection of HAS in liver transplant patients because it provides comprehensive information, including the presence, location, degree, and type. A positive CEUS finding suggests angiography as the next step rather than a computed tomography scan and may thereby alter the clinical imaging algorithm. Liver Transpl 16:729‐735, 2010. © 2010 AASLD.
ISSN:1527-6465
1527-6473
DOI:10.1002/lt.22054