Hepatic veno-occlusive disease after myeloablative treatment and bone marrow transplantation: value of gray-scale and Doppler US in 100 patients.
OBJECTIVE
To determine the value of gray-scale ultrasonography (US) and Doppler US in the prediction, diagnosis, and prognostic assessment of hepatic veno-occlusive disease (HVOD).


METHODS
One hundred patients (median age, 22 years; range, 18 months to 59 years) receiving total body irradiation or busulfan therapy as intensive treatment before hematopoietic stem cell transplantation were studied prospectively. Each patient underwent gray-scale and Doppler US examination before transplantation and weekly thereafter while hospitalized (about four examinations per patient). Seven gray-scale morphologic criteria and seven Doppler criteria were studied, yielding three individual scores: gray-scale score, Doppler score, and total score.


RESULTS
Twenty-five patients developed HVOD; nine of these patients died. Positive predictive values of the 14 criteria were 31%-95%, and negative predictive values were 85%-96%. The three scores correlated with the clinical diagnosis of HVOD. Depending on the cutoff value, the positive predictive value of the total score was 44%-89% and the negative predictive value was 91%-98%. The gray-scale and Doppler criteria differed significantly between patients with HVOD and those with graft-versus-host disease of the liver (P = 10(-4)).


CONCLUSIONS
Even if there is overlap in findings between patients with and those without HVOD, gray-scale and Doppler US are valid for positive and differential diagnosis and have predictive and prognostic relevance.
Lassau
N
N
Department of Medical Imaging, Institut Gustave Roussy, Villejuif, France.
Leclère
J
J
Auperin
A
A
Bourhis
J H
JH
Hartmann
O
O
Valteau-Couanet
D
D
Benhamou
E
E
Bosq
J
J
Ibrahim
A
A
Girinski
T
T
Pico
J L
JL
Roche
A
A
D000328:Adult; D002066:Busulfan / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006086:Graft vs Host Disease / Q000000981:diagnostic imaging; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006504:Hepatic Veno-Occlusive Disease / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000401:mortality; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008107:Liver Diseases / Q000000981:diagnostic imaging; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D019172:Transplantation Conditioning / Q000009:adverse effects*; D018608:Ultrasonography, Doppler; D014916:Whole-Body Irradiation / Q000009:adverse effects
D007166:Immunosuppressive Agents; D002066:Busulfan