title: Role of contrast-enhanced ultrasound in decision support for diagnosis and treatment of hepatic artery thrombosis after liver transplantation.
abstract: OBJECTIVE
  To assess role of contrast-enhanced ultrasound (CEUS) in decision support for diagnosis and treatment of hepatic artery thrombosis (HAT) after liver transplantation.
  
  
  METHODS
  Between January 2005 and January 2011, 605 patients underwent liver transplantation in our medical center. All the liver transplant recipients received Doppler ultrasound scanning and CEUS examination was performed in 45 patients with suspected HAT on Doppler ultrasound. Sensitivity, specificity, accuracy, positive predict value and negative predictive value of CEUS in diagnosing HAT were determined based on the results from angiography, surgery and clinical follow-up.
  
  
  RESULTS
  Fourteen HATs, including one late HAT, were diagnosed by CEUS. Twelve HAT cases were confirmed by angiographic and/or surgical findings, while the late HAT and other 31 patients with negative CEUS finding were confirmed by the clinical follow-up. There was a false positive HAT diagnosed by CEUS in which angiography revealed a patent hepatic artery. The sensitivity, specificity, accuracy, positive predict value and negative predictive value of CEUS in diagnosing HAT were 100%, 96.9%, 97.8%, 92.9% and 100%, respectively. In our series of 605 liver transplants, the incidence and mortality of HAT was 2.2% (13/605) and 53.8% (7/13), respectively.
  
  
  CONCLUSIONS
  Our study demonstrates the important role of CEUS in decision support for diagnosis and treatment of HAT after liver transplantation. When HAT is suspected by Doppler ultrasound, CEUS shall immediately be performed to elucidate its nature. A negative CEUS finding shall avoid invasive angiography. Such as, CEUS may alter the clinical workflow on HAT detection after liver transplantation.
authors.affiliation: Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Lu
authors.forename: Xiao Fei
authors.initials: XF
authors.lastname: Zhong
authors.forename: Zi Xing
authors.initials: ZX
authors.lastname: Huang
authors.forename: Bo Yang
authors.initials: BY
authors.lastname: Yu
authors.forename: Bu Yun
authors.initials: BY
authors.lastname: Ma
authors.forename: Wen Wu
authors.initials: WW
authors.lastname: Ling
authors.forename: Hong
authors.initials: H
authors.lastname: Wu
authors.forename: Jia Ying
authors.initials: JY
authors.lastname: Yang
authors.forename: Yan
authors.initials: Y
authors.lastname: Luo
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D003287:Contrast Media; D003661:Decision Support Techniques; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D018608:Ultrasonography, Doppler / Q000379:methods*
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride