title: Spleen stiffness measurements by acoustic radiation force impulse imaging after living donor liver transplantation in children: a potential quantitative index for venous complications.
abstract: BACKGROUND
  Living donor liver transplantation in children often results in venous complications, leading to portal hypertension. Spleen stiffness measurements have been recently proposed as a new, noninvasive parameter for portal hypertension in cirrhotic patients.
  
  
  OBJECTIVE
  To evaluate the diagnostic value of spleen stiffness measurements by acoustic radiation force impulse (ARFI) imaging in diagnosing venous complications after pediatric living donor liver transplantation.
  
  
  METHODS
  We prospectively enrolled 69 patients after pediatric living donor liver transplantation using a left-side liver allograft. Around the time of the protocol liver biopsy examination, spleen stiffness measurements by ARFI imaging were performed via the left intercostal space at the center of the spleen parenchyma and repeated five times. Imaging examinations around the time of the spleen stiffness measurements were retrospectively reviewed. Regarding venous complications, significant portal and hepatic venous stenosis was defined as >50% stenosis on multiphasic computed tomography.
  
  
  RESULTS
  After post hoc exclusion, 62 patients were studied. Portal and hepatic venous stenosis was identified in three and two patients, respectively. The median spleen stiffness values were 2.70 and 4.00 m/s in patients without and with venous complications, respectively (P < 0.001). Spleen stiffness measurements showed good diagnostic power for venous complications, and the cutoff value was determined as 2.93 m/s, with 100% sensitivity and 78.9% specificity. Spleen stiffness measurements decreased with the relief of venous stenosis resulting from an interventional radiology procedure.
  
  
  CONCLUSIONS
  Spleen stiffness measurements by ARFI imaging might provide a useful quantitative index for venous complications after pediatric living donor liver transplantation.
authors.affiliation: Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Tomita
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Fuchimoto
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ohkuma
authors.forename: Ken
authors.initials: K
authors.lastname: Hoshino
authors.forename: Akihiro
authors.initials: A
authors.lastname: Fujino
authors.forename: Mototoshi
authors.initials: M
authors.lastname: Kato
authors.forename: Takumi
authors.initials: T
authors.lastname: Fujimura
authors.forename: Hideo
authors.initials: H
authors.lastname: Ishihama
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Takahashi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tanami
authors.forename: Seishi
authors.initials: S
authors.lastname: Nakatsuka
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Ebinuma
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Saito
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shinoda
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kuroda
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013154:Spleen / Q000000981:diagnostic imaging* / Q000473:pathology