3DCT angiography for detection of vascular complications in pediatric liver transplantation.
Catheter angiography for early diagnosis of vascular complications in pediatric liver transplant yields excellent results but remains an extremely invasive examination for younger children, precluding its routine use. We assessed the efficacy of three-dimensional multislice computed tomographic angiography (3DCTA) as an alternative option in these patients.


METHODS
Twenty children suspected of vascular complications on clinical grounds, laboratory findings, or Doppler ultrasound underwent 3DCTA between April 2000 and April 2003. Interventional procedures via conventional angiography were subsequently performed in 5 cases, thrombolytic therapy in 4, surgical in 1, and conservative treatment in 10.


RESULTS
Two hepatic artery stenosis,1 hepatic artery thrombosis, 5 hepatic vein stenosis, 4 portal vein occlusion, 1 portal vein stenosis, and 7 non-vascular lesions were detected, all of which paralleled the findings of catheter angiography, Doppler ultrasound, and operations. The diagnostic accuracy for vascular complication was 90%. The sensitivity and specificity were 86.7% and 100%, respectively. The positive and negative predictive values were 100% and 71.4%, respectively. To date 19 patients are alive, with a median follow-up period of 24.8 months. In conclusion, 3DCTA is accurate and efficient in the identification of pathological vascular insults and offers essential information for major decision on further management of the vascular complications in pediatric recipients of liver transplant.
Cheng
Yu Fan
YF
Department of Diagnostic Radiology and Liver Transplant Program, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung 83305, Taiwan.
Chen
Chao Long
CL
Huang
Tung Liang
TL
Chen
Tai Yi
TY
Chen
Yaw Sen
YS
Wang
Chih Chi
CC
Tsang
Leo Leung-chit
LL
Chiu
King Wah
KW
Jawan
Bruno
B
Eng
Hock Liew
HL
D000792:Angiography / Q000592:standards; D002648:Child; D002675:Child, Preschool; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000592:standards; D007223:Infant; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D011169:Portal Vein / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000592:standards; D014652:Vascular Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*