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Prospective Evaluation of Vascular Complications after Liver Transplantation: Comparison of Conventional and Microbubble Contrast-enhanced US¹

¹ From the Departments of Radiology (B.K.H., R.S., S.L.P., M.D.K., Z.A., J.K.W., E.G.G.) and Surgery (R.R.S.), University of Southern California, Keck School of Medicine, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033. From the 2004 RSNA Annual Meeting. Received April 14, 2005; revision requested June 13; revision received July 25; accepted September 1; final version accepted February 1, 2006. Supported by a grant from GE Healthcare. Address correspondence to E.G.G. (e-mail: edgrant{at}usc.edu).

View larger version (18K): [in this window] [in a new window] [Download PPT slide]   Figure 1: Chart shows the cause of liver disease in patients who underwent liver transplantation and were enrolled in our study. Data are numbers of patients and percentages.

View larger version (73K): [in this window] [in a new window] [Download PPT slide]   Figure 2a: Longitudinal oblique contrast-enhanced US scans obtained with contrast pulse sequencing in the mixed mode. With this technique, echoes arising from contrast material are displayed in a shade of gold overlaid on a background of gray-scale tissue echoes. (a) Image obtained 11.6 seconds after contrast material injection demonstrates a normal proper HA (arrow) and central branches. The PV (P) is devoid of echoes and displayed in black. (b) Image obtained through the same region 19.5 seconds after contrast material injection demonstrates intense enhancement of the HA (arrow); contrast material filled the PV (P). (c) Image obtained 45 seconds after contrast material injection demonstrates homogeneous parenchymal enhancement, with common bile duct (arrow).

View larger version (90K): [in this window] [in a new window] [Download PPT slide]   Figure 2b: Longitudinal oblique contrast-enhanced US scans obtained with contrast pulse sequencing in the mixed mode. With this technique, echoes arising from contrast material are displayed in a shade of gold overlaid on a background of gray-scale tissue echoes. (a) Image obtained 11.6 seconds after contrast material injection demonstrates a normal proper HA (arrow) and central branches. The PV (P) is devoid of echoes and displayed in black. (b) Image obtained through the same region 19.5 seconds after contrast material injection demonstrates intense enhancement of the HA (arrow); contrast material filled the PV (P). (c) Image obtained 45 seconds after contrast material injection demonstrates homogeneous parenchymal enhancement, with common bile duct (arrow).

View larger version (79K): [in this window] [in a new window] [Download PPT slide]   Figure 2c: Longitudinal oblique contrast-enhanced US scans obtained with contrast pulse sequencing in the mixed mode. With this technique, echoes arising from contrast material are displayed in a shade of gold overlaid on a background of gray-scale tissue echoes. (a) Image obtained 11.6 seconds after contrast material injection demonstrates a normal proper HA (arrow) and central branches. The PV (P) is devoid of echoes and displayed in black. (b) Image obtained through the same region 19.5 seconds after contrast material injection demonstrates intense enhancement of the HA (arrow); contrast material filled the PV (P). (c) Image obtained 45 seconds after contrast material injection demonstrates homogeneous parenchymal enhancement, with common bile duct (arrow).

View larger version (47K): [in this window] [in a new window] [Download PPT slide]   Figure 3a: HA thrombosis in 34-year-old woman who had undergone living related liver donor transplantation. (a) Longitudinal oblique conventional Doppler US scan obtained 2 days after transplantation fails to show HA flow beyond the level of the porta hepatis. Only a small stump of the patent artery (PHA) is shown on this image. Visualization of the PV and its intrahepatic branches is normal. (b) Longitudinal oblique contrast-enhanced US scan obtained 4 hours after conventional Doppler US. The HA was not visualized. Normal filling of the PV (P) was demonstrated. This parenchymal phase image shows almost a complete lack of perfusion in the anterior right lobe. (c) Posteroanterior selective angiogram obtained after celiac artery injection confirms complete thrombosis of right HA at the level of the anastomosis (white arrow). The arterial anatomy is unusual. The left HA (black arrow) was ligated at surgery and arises from the common HA, which continues into the gastroduodenal artery. The patient underwent repeat transplantation 2 days later.

View larger version (60K): [in this window] [in a new window] [Download PPT slide]   Figure 3b: HA thrombosis in 34-year-old woman who had undergone living related liver donor transplantation. (a) Longitudinal oblique conventional Doppler US scan obtained 2 days after transplantation fails to show HA flow beyond the level of the porta hepatis. Only a small stump of the patent artery (PHA) is shown on this image. Visualization of the PV and its intrahepatic branches is normal. (b) Longitudinal oblique contrast-enhanced US scan obtained 4 hours after conventional Doppler US. The HA was not visualized. Normal filling of the PV (P) was demonstrated. This parenchymal phase image shows almost a complete lack of perfusion in the anterior right lobe. (c) Posteroanterior selective angiogram obtained after celiac artery injection confirms complete thrombosis of right HA at the level of the anastomosis (white arrow). The arterial anatomy is unusual. The left HA (black arrow) was ligated at surgery and arises from the common HA, which continues into the gastroduodenal artery. The patient underwent repeat transplantation 2 days later.

View larger version (127K): [in this window] [in a new window] [Download PPT slide]   Figure 3c: HA thrombosis in 34-year-old woman who had undergone living related liver donor transplantation. (a) Longitudinal oblique conventional Doppler US scan obtained 2 days after transplantation fails to show HA flow beyond the level of the porta hepatis. Only a small stump of the patent artery (PHA) is shown on this image. Visualization of the PV and its intrahepatic branches is normal. (b) Longitudinal oblique contrast-enhanced US scan obtained 4 hours after conventional Doppler US. The HA was not visualized. Normal filling of the PV (P) was demonstrated. This parenchymal phase image shows almost a complete lack of perfusion in the anterior right lobe. (c) Posteroanterior selective angiogram obtained after celiac artery injection confirms complete thrombosis of right HA at the level of the anastomosis (white arrow). The arterial anatomy is unusual. The left HA (black arrow) was ligated at surgery and arises from the common HA, which continues into the gastroduodenal artery. The patient underwent repeat transplantation 2 days later.

View larger version (44K): [in this window] [in a new window] [Download PPT slide]   Figure 4a: HA thrombosis with subsequent collateral vessel formation. (a) Longitudinal oblique contrast-enhanced US scan obtained in the contrast-only mode (with absence of gray-scale background) demonstrates multiple small vessels in the region of the porta hepatis (arrow) anterior to the PV (P). The image was obtained in the arterial phase, and the vein had not yet filled with contrast material. Scans obtained in the cephalad direction (not shown) demonstrated patency of the right and left HA branches. (b) Right anterior oblique selective angiogram failed to demonstrate a normally patent proper HA. The proper HA is replaced by a series of tiny collateral vessels. Note the reconstitution of the intrahepatic branches of the HA from collateral vessels.

View larger version (145K): [in this window] [in a new window] [Download PPT slide]   Figure 4b: HA thrombosis with subsequent collateral vessel formation. (a) Longitudinal oblique contrast-enhanced US scan obtained in the contrast-only mode (with absence of gray-scale background) demonstrates multiple small vessels in the region of the porta hepatis (arrow) anterior to the PV (P). The image was obtained in the arterial phase, and the vein had not yet filled with contrast material. Scans obtained in the cephalad direction (not shown) demonstrated patency of the right and left HA branches. (b) Right anterior oblique selective angiogram failed to demonstrate a normally patent proper HA. The proper HA is replaced by a series of tiny collateral vessels. Note the reconstitution of the intrahepatic branches of the HA from collateral vessels.