Prognostic value of doppler-ultrasonography in hepatic veno-occlusive disease.
BACKGROUND
Currently, the severity of veno-occlusive disease (VOD) is graded retrospectively on the basis of the evolution of clinical and biological criteria. The objective of this study was to describe a noninvasive method capable of predicting the severity of this disease at the time of the diagnosis.


METHODS
Seventy-one children who developed VOD after intensive myeloablative therapy with busulfan before hematopoietic stem cell transplantation were included in this study. Sixty-four patients underwent baseline ultrasonography (US) and Doppler examination before transplantation. All patients had posttransplantation US and Doppler examinations at the time of the clinical and biological diagnosis of VOD. Seven US morphological criteria and seven Doppler criteria were studied that yielded three individual scores: a US score, a Doppler score, and a total Doppler ultrasonography (DUS) score.


RESULTS
In the univariate analysis, three of 7 US criteria, three of 7 Doppler criteria, and the three scores were correlated with the severity of VOD after transplantation and at the time of the diagnosis. In the multivariate analysis, two US criteria (splenomegaly and ascites) and one Doppler criterion (flow recorded in para-umbilical vein) were correlated with the severity of VOD. The multivariate analysis of the pooled US and Doppler criteria showed that the flow recorded in the para-umbilical vein was the only criterion significantly associated with the grade of VOD (P=0.0001). All patients with a US-Doppler score >9 developed grade 2 or 3 VOD.


CONCLUSIONS
Postgraft US and Doppler examinations have a prognostic significance according to the grade of VOD.
Department of Medical Imaging, Pediatric Bone Marrow Transplantation Unit, Institut Gustave Roussy, Villejuif, France. lasaau@pobox.igr.fr
Nathalie
N
Lassau
Anne
A
Auperin
Jerome
J
Leclere
Annelise
A
Bennaceur
Dominique
D
Valteau-Couanet
Olivier
O
Hartmann
D000293:Adolescent; D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects; D001663:Bilirubin / Q000097:blood; D001932:Brain Neoplasms / Q000628:therapy; D002066:Busulfan / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006504:Hepatic Veno-Occlusive Disease / Q000139:chemically induced / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler
D018906:Antineoplastic Agents, Alkylating; D002066:Busulfan; D001663:Bilirubin