title: Multidetector computed tomography for preoperative assessment of hepatic vasculature and prediction of splenic artery steal syndrome in patients with liver cirrhosis before transplantation.
abstract: The purpose of this study was to evaluate the accuracy of MDCT for preoperative assessment of hepatic vascular anatomy and the identification of liver-transplantation (OLT) patients at risk of developing subsequent splenic artery steal syndrome (SASS). A total of 145 patients with liver cirrhosis who had undergone OLT and had pre-operative three-phase MDCT (4- to 64-rows) within 100 days before OLT were enrolled retrospectively. MDCT and 3Ds were reviewed by two independent blinded observers (O1/O2). Pre-operative imaging findings were correlated with intra-operative results; findings indicative for SASS were correlated with clinical data and DSA. Among all 145 patients, 16 patients (11%) showed accessory hepatic arteries (accuracy O1/O2, 97%; with 3Ds, 100%); 32 (22%) patients had replaced hepatic arteries (accuracy O1, 97%; O2, 95%; with 3Ds, 100%; kappa = 0.87 and 0.89, P < 0.001). Among 119 patients, 12 patients developed SASS after OLT. The logistic regression model revealed the spleen volume (P = 0.0105) as a predictive factor of SASS. With spleen volumes >or=829 ml, an accuracy of 75% for prediction of SASS was obtained. MDCT with three-dimensional post-processing (3Ds) was highly accurate for pre-operative hepatic vessel evaluation in patients before OLT. In addition, spleen volume was a predictive factor for developing SASS after OLT.
authors: Klinik für Strahlenheilkunde, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. christian.grieser@charite.de
authors: Christian
authors: C
authors: Grieser
authors: Timm
authors: T
authors: Denecke
authors: Ingo G
authors: IG
authors: Steffen
authors: Maria
authors: M
authors: Avgenaki
authors: Vera
authors: V
authors: Fröhling
authors: Martina
authors: M
authors: Mogl
authors: Dirk
authors: D
authors: Schnapauff
authors: Lukas
authors: L
authors: Lehmkuhl
authors: Lars
authors: L
authors: Stelter
authors: Florian
authors: F
authors: Streitparth
authors: Jan
authors: J
authors: Langrehr
authors: Jan-Holger
authors: JH
authors: Rothe
authors: Bernd
authors: B
authors: Hamm
authors: Enrique Lopez
authors: EL
authors: Hänninen
mesh_terms: D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000601:surgery*; D016031:Liver Transplantation / Q000000981:diagnostic imaging* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013157:Splenic Artery / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*