Application of contrast-enhanced ultrasound in diagnosis of hepatic artery thrombosis after liver transplantation
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摘要:
目的 评估超声造影在肝移植术后肝动脉血栓(HAT)诊断中的价值。 方法 2004年1月至 2012年8月在四川大学华西医院肝移植中心行肝移植手术的患者810例。患者术后均接受了彩色多普勒超声(彩超)检查,其中有58例怀疑HAT,从而继续接受超声造影检查。以肝动脉血管造影、手术结果和临床随访作为金标准,计算超声造影诊断HAT的敏感度、特异度、准确度、阳性预测值及阴性预测值。 结果 超声造影诊断16例HAT,正确诊断15例,误诊1例,无漏诊病例。超声造影诊断HAT的敏感度、特异度、准确度、阳性预测值及阴性预测值分别为1.0、0.977、0.983、0.938和1.0。本组患者HAT发生率和病死率分别为1.9%和53%。 结论 肝移植术后彩超检查怀疑HAT时应立即行超声造影检查,超声造影诊断肝动脉通畅的患者可避免肝动脉血管造影检查。 Abstract:Objective To assess the value of contrast-enhanced ultrasound (CEUS) in the diagnosis of hepatic artery thrombosis (HAT) after liver transplantation. Methods From January 2004 to August 2012, 810 patients who underwent liver transplantation in Liver Transplantation Center of West China Hospital of Sichuan University were enrolled in this study. All the recipients received Doppler ultrasound scanning after operation. CEUS examination was performed in 58 patients with suspected HAT. Based on the gold standards of hepatic artery angiography, surgical outcome and clinical follow-up, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CEUS in diagnosing HAT were calculated. Results Sixteen cases were diagnosed with HAT by CEUS, in which 15 were confirmed, one was misdiagnosed and no case was missed. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CEUS in diagnosing HAT were 1.0, 0.977, 0.983, 0.938 and 1.0 respectively. The incidence and mortality of HAT were 1.9%, 53% respectively in the study. Conclusions When suspected with HAT by Doppler ultrasound after liver transplantation, patients should immediately receive CEUS. Patients with unobstructed hepatic artery diagnosed by CEUS can avoid receiving hepatic artery angiography. -
Key words:
- Liver transplantation /
- Ultrasound /
- Contrast agent /
- Hepatic artery thrombosis /
- Diagnosis
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图 1 1例肝移植术后肝动脉血栓女性患者的影像学表现
注：患者43岁。A图为彩超在肝门部门静脉旁未探及肝动脉血流。B图为超声造影未显示肝动脉血流，可见肝右叶局灶性的无灌注区，提示梗死灶。C图动脉造影能显示肝总动脉(箭头所指)，但肝固有动脉及肝内动脉未见显示，证实了超声造影诊断HAT正确
Figure 1. Imaging findings of a female patient with hepatic artery thrombosis after liver transplantation
图 2 1例肝移植术后肝动脉血栓男性患者的影像学表现及术中情况
注：患者41岁。A图示超声造影动脉期在肝门部未见增强信号(空心箭头所示)，而右侧肾脏可见动脉灌注(实心箭头所示)。B图示手术证实HAT。C图示从肝动脉内取出的栓子。D图为术后的彩超检查显示恢复正常的肝动脉血流
Figure 2. Imaging findings and intraoperative situation of a male patient with hepatic artery thrombosis after liver transplantation
图 3 1例误诊为肝移植术后肝动脉血栓男性患者的影像学表现
注：患者32岁，术后第1日超声造影误诊为HAT。A图示超声造影动脉期在肝门部未见肝动脉显示(箭头所示)，门静脉清晰可见。B图示超声造影时肝实质灌注均匀，在门静脉旁可见1条可疑肝动脉的血管。C图为彩超探查上述可疑血管，流速频谱提示血流低，无搏动性。D图为肝动脉造影显示肝动脉通畅(箭头所示)，但流速低、染色淡
Figure 3. Imaging findings of a male patient who was misdiagnosed with hepatic artery thrombosis after liver transplantation
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