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Initial experience with contrast-enhanced ultrasound in the first week after liver transplantation in children: a useful adjunct to Doppler ultrasound

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Abstract

Background

Doppler US is the primary screening for post-liver transplant vascular complications, but indeterminate findings require further imaging.

Objective

To evaluate whether contrast-enhanced US improves diagnostic assessment of vascular complications suspected by Doppler US.

Materials and methods

We retrospectively reviewed Doppler US and contrast-enhanced US studies obtained in the first week following liver transplant. Doppler US was performed twice daily for the first 5 postoperative days, and CEUS in the first postoperative day and when vascular complications were suspected. We correlated Doppler US and CEUS with surgical findings, and clinical and imaging follow-up. We evaluated Doppler US and CEUS quality in demonstrating the main hepatic artery (HA) at the porta hepatis as follows: Grade 0 = not seen, Grade 1 = only segments, Grade 2 = entire main HA, and Grade 3 = entire main HA to the intrahepatic branching. We used a Wilcoxon signed rank test to test the difference between Doppler US and CEUS methods.

Results

Twenty-nine children (15 girls, 14 boys) were identified, with median age 2.2 years (range 0.5–17.6 years). The most common transplant indication was biliary atresia (n=13). There was significantly (P<0.0001) improved main HA visualization with CEUS. In five children, CEUS was performed to evaluate suspected vascular complications; CEUS confirmed normal vascularity in two. CEUS demonstrated portal vein thrombosis (n=2) and main HA thrombosis (n=1), confirmed at surgery. In one child the main HA thrombosis was missed; marked HA narrowing was seen retrospectively on CEUS.

Conclusion

Immediately following liver transplantation, CEUS improves main HA visualization and diagnostic assessment of vascular complications.

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Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Room 1053, Indianapolis, IN, 46202, USA

    Boaz Karmazyn & S. Gregory Jennings

  2. Department of Radiology, Malatya Education and Research Hospital, Malatya, Turkey

    Dilek Sağlam

  3. Division of Pediatric Gastroenterology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA

    Giresh S. Rao

  4. Department of Transplant Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Richard S. Mangus

Authors
  1. Boaz Karmazyn
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  2. Dilek Sağlam
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  3. Giresh S. Rao
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  4. S. Gregory Jennings
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  5. Richard S. Mangus
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Correspondence to Boaz Karmazyn.

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ESM 1

A 2.5-year-old girl with a history of biliary atresia (same girl as in Fig. 2). Cine shows normal enhancement of the main and intrahepatic arteries followed by normal enhancement of the intrahepatic and main portal veins (MP4 3,215 kb)

ESM 2

A 1-year-old girl with a history of biliary atresia who had hepatic artery thrombosis 3 days following whole liver transplant (same girl as in Fig. 3). Cine shows no enhancing intrahepatic arteries, normal portal vein and cutoff of the main hepatic artery (MP4 17,032 kb)

ESM 3

A 6-month-old boy with a history of biliary atresia who had portal vein and hepatic artery thrombosis in the first postoperative day following whole liver transplant (same boy as in Fig. 4). Cine shows stenosis of the main hepatic artery (dashed arrow) at the bifurcation and no flow in the main portal vein (solid arrow) (MP4 3,889 kb)

ESM 4

An 8-month-old boy with a history of biliary atresia who had portal vein thrombosis on the first postoperative day following whole liver transplant (same boy as in Fig. 5). Cine shows normal main hepatic artery enhancement, enhancement of the intrahepatic portal veins, and no flow in the main portal vein (MP4 1,206 kb)

ESM 5

A 16-year-old girl with ornithine transcarbamylase deficiency after whole liver transplant (same girl as in Fig. 6). Cine shows normal enhancement of the hepatic veins (MP4 3,551 kb)

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Karmazyn, B., Sağlam, D., Rao, G.S. et al. Initial experience with contrast-enhanced ultrasound in the first week after liver transplantation in children: a useful adjunct to Doppler ultrasound. Pediatr Radiol 51, 248–256 (2021). https://doi.org/10.1007/s00247-020-04811-0

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  • DOI: https://doi.org/10.1007/s00247-020-04811-0

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