反向脉冲谐波实时超声造影诊断背驼式肝移植术后肝静脉及下腔静脉并发症

目的探讨实时超声造影检查在背驼式肝移植术后肝静脉及下腔静脉并发症诊断中的应用价值。方法对25例背驼式肝移植术后CDFI疑诊肝静脉及下腔静脉并发症的患者进行实时超声造影检查。采用造影剂声诺维（SonoVue）2.4ml肘部浅静脉团注,反向脉冲谐波低机械指数（MI0.15-0.19）实时超声造影。将超声造影结果与增强CT对照分析。结果超声造影诊断下腔静脉血栓3例;肝静脉血栓5例,其中2例继发肝组织淤血、坏死;超声造影诊断肝静脉狭窄6例,下腔静脉狭窄4例,其中最严重的1例肝上下腔静脉内径3.8mm。CDFI与增强CT的符合率为72%（18/25）,实时超声造影与增强CT的符合率为100%（18/18）。结论实时超声造影对背驼式肝移植术后肝静脉及下腔静脉并发症的诊断能力与增强CT相当,实时超声造影更加方便灵活,为背驼式肝移植术后静脉并发症的诊断提供了一种可靠的影像学新方法。

Real-time contrast enhanced ultrasonography in the diagnosis of hepatic vein and IVC complications after piggyback liver transplantation

Objective To study the value of real-time contrast enhanced ultrasonography in the diagnosis of hepatic vein and IVC complications after piggyback liver transplantation. Methods Twenty-five patients with abnormal CDFI in hepatic vein and IVC after piggyback liver transplantation were examined by real-time contrast enhanced ultrasonography after bolus injection of 2.4 ml contrast agents (SonoVue) under the reversing pulsed harmonic mode low mechanical index (MI 0.15-0.19).The results were compared with that of computerized tomographic angiography(CT). Results Three cases of IVC thrombosis and five cases of hepatic vein thrombosis were demonstrated by contrast enhanced ultrasonography. In the five cases of hepatic vein thrombosis, two were complicated with congestion and necrocytosis of draining live lobe. Six cases of hepatic vein stenoses and four cases of IVC stenoses were demonstrated by contrast enhanced ultrasonography, and the diameter of the most serious one was 3.8 mm. The results of CDFI were in concordance with CT in 72% (18/25) of the patients, and the results of contrast enhanced ultrasonography were in 100% (18/18) of the patients. Conclusion Real-time contrast enhanced ultrasonography is comparable to CT in the diagnosis of hepatic vein and IVC complications after piggyback liver transplantation,and it is more convenient and flexible. It can provide a new imaging modality for the diagnosis of venous complications after piggyback liver transplantation.