Right hepatic vein stenosis at anastomosis in patients after living donor liver transplantation: optimal Doppler US venous pulsatility index and CT criteria--receiver operating characteristic analysis.
OBJECTIVE
To establish optimal Doppler ultrasonographic (US) venous pulsatility index and computed tomographic (CT) criteria for right hepatic vein (RHV) stenosis after living donor liver transplantation (LDLT) and to compare accuracies of these methods by using receiver operating characteristic (ROC) analysis.


METHODS
This retrospective study was approved by an institutional review board; informed consent was waived. Eighty patients (48 men, 32 women; mean age, 51.5 years +/- 9.2 [standard deviation]) underwent Doppler US and CT within 8 days of hepatic venography following right lobe LDLT between October 2006 and September 2008. At venography, RHVs were classified into a stenosis or nonstenosis group. At Doppler US, venous pulsatility index was defined as the difference between maximum and minimum frequency shifts divided by maximum frequency shift. At CT, diameters of anastomosis and RHV were measured; percentage of stenosis was calculated. Mean Doppler US and CT parameters in the two groups were compared; ROC analysis was performed.


RESULTS
There were 30 stenotic and 50 nonstenotic RHVs. Mean venous pulsatility index and mean anastomosis diameter were significantly lower and mean percentage of stenosis was significantly higher in the stenosis than the nonstenosis group (P < .001 each). Optimal cutoffs for venous pulsatility index, anastomosis diameter, and percentage of stenosis were 0.16, 3.7 mm, and 47%, respectively. Sensitivity and specificity were 86.7% and 68.0% for venous pulsatility index, 96.7% and 88.0% for anastomosis diameter, and 96.7% and 86.0% for percentage of stenosis, respectively. At ROC analysis, anastomosis diameter (P = .002) and percentage of stenosis (P = .003) were significantly more accurate than venous pulsatility index.


CONCLUSIONS
CT is more accurate than Doppler US for RHV stenosis after LDLT, with venous pulsatility index as the sole sonographic criterion. Patients suspected of having RHV stenosis at Doppler US may benefit from CT to reduce unnecessary venography.
Hwang
Hye Jeon
HJ
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap 2-dong, Songpa-ku, Seoul 138-736, Korea.
Kim
Kyoung Won
KW
Jeong
Woo Kyoung
WK
Song
Gi-Won
GW
Ko
Gi-Young
GY
Sung
Kyu Bo
KB
Shin
Yong Moon
YM
Kim
Pyo Nyun
PN
Ha
Tae-Yong
TY
Moon
Deok-Bog
DB
Kim
Ki-Hun
KH
Ahn
Chul-Soo
CS
Hwang
Shin
S
Lee
Sung-Gyu
SG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging*; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D018617:Ultrasonography, Doppler, Pulsed; D055815:Young Adult