Real-time and Doppler US after pediatric segmental liver transplantation : II. Hepatic vein stenosis.
BACKGROUND
Accurate diagnosis of hepatic vein (HV) stenosis by real-time and color Doppler US (CD-US) after segmental liver transplantation in children can decrease morbidity because it allows unnecessary biopsy, obstruction or thrombosis and loss of the graft to be avoided.


OBJECTIVE
To evaluate CD-US parameters to predict HV stenosis after segmental liver transplantation in children.


METHODS
Retrospective review of 79 CD-US examinations measuring velocity at the HV anastomosis (HV1) and the main trunk 1-2 cm proximal to the HV/IVC anastomosis (HV2), the HV1/HV2 ratio and the spectral waveform of HV2. The study group comprised patients with stenosis confirmed by angiography. The control group comprised patients with a good clinical outcome.


RESULTS
HV stenosis was seen in 12 CD-US examinations. The mean HV1/HV2 ratio was higher in the study group (6.0 versus 4.0). An HV1/HV2 ratio of >4.1 was predictive of HV stenosis (sensitivity 83%, specificity 76%).


CONCLUSIONS
An HV1/HV2 ratio of >4.1 is a highly predictive CD-US parameter for the detection of hemodynamically significant HV stenosis on angiography.
Suzuki
Lisa
L
Department of Radiology, Child Institute, University of São Paulo Medical School, São Paulo, Brazil. Lisa.suzuki@gmail.com
de Oliveira
Ilka R S
IR
Widman
Azzo
A
Gibelli
Nelson E M
NE
Gibeli
Nelson E M
NE
Carnevale
Francisco C
FC
Maksoud
João G
JG
Hubbard
Anne M
AM
Cerri
Giovanni G
GG
D000293:Adolescent; D000792:Angiography; D002648:Child; D002675:Child, Preschool; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging*; D006504:Hepatic Veno-Occlusive Disease / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color