肝移植术后早期及晚期肝动脉血栓的超声造影鉴别诊断

目的探讨超声造影对肝移植术后早期及晚期肝动脉血栓(HAT)的鉴别诊断价值。方法选取中山大学附属第三医院2004年10月至2011年12月彩色多普勒超声检查或临床疑诊HAT的肝移植术后患者64例,入院后经临床观察、数字减影血管造影(digital subtraction angiography,DSA)和(或)计算机断层摄影术血管成像(CTangiography,CTA),予超声随访并且具备完整的超声造影资料。64例疑诊HAT患者分为早期组(<30d,18例)和晚期组(≥30d,46例)两组。以临床表现、DSA和(或)CTA、超声随访等作为确诊HAT的参考标准,早期HAT组和晚期HAT组患者的HAT诊断时间、超声造影与参考标准所用检查的时间差用全距(中位数)表示,分别计算超声造影诊断早期HAT和晚期HAT的敏感度、特异度、准确度(总符合率)。结果早期组HAT的诊断时间为术后5～23d(中位数13d);晚期组HAT的诊断时间为术后30～1800d(中位数156d)。超声造影与参考标准所用检查的时间差为0～129d(中位数6.5d),10例超过30d。早期HAT的超声造影表现为动脉期、静脉期早期肝内动脉均未见显示。超声造影诊断早期HAT的敏感度、特异度、准确度分别为100%(8/8)、100%(10/10)、100%(18/18)。晚期HAT的超声造影表现为肝外肝动脉显示不正常,肝门部细小迂曲的侧枝动脉形成,肝内动脉均可见显示。超声造影诊断晚期HAT的敏感度、特异度、准确度分别为100%(9/9)、97%(36/37)、98%(45/46)。晚期组1例肝动脉狭窄误诊为HAT,此例肝门部有丰富的侧枝动脉。结论超声造影可以清晰显示肝动脉,对早期HAT诊断明确,对晚期HAT的诊断价值稍逊于早期HAT,侧枝动脉丰富是影响诊断晚期HAT准确性的因素之一。

Differential diagnosis of early and later hepatic artery thrombosis after liver transplantation by contrast-enhanced ultrasonography

Objective To investigate the value of contrast-enhanced ultrasonography(CEUS) in the differential diagnosis of early and late hepatic artery thrombosis(HAT) after liver transplantation. Methods Sixty-four patients were selected from October 2004 to December 2011 in the Third Affiliated Hospital of Sun Yat-sen University, who were doubtfully diagnosed as HAT by color Doppler ultrasound or clinical features after liver transplantation. Ultrasound follow-up and CEUS data were completed after clinical observation, digital subtraction angiography (DSA) and(or) CT angiography(CTA). Sixty-four patients doubtfully diagnosed as HAT were divided into early group(<30 d,n=18) and late group(≥30 d,n=46). Clinical feature, DSA and(or) CTA and ultrasound follow up were used to confirm the diagnosis of HAT. The diagnosis time of HAT, time difference between CEUS and diagnosis confirmation were expressed by full range(median)in patients of early and late HAT groups. Sensitivity, specificity and accuracy (total coincidence) of CEUS in diagnosis of early and late HAT were calculated. Results The diagnosis time in early and late group was 5-23 d(median was 13 d)and 30-1 800 d(median was 156 d), respectively. The difference time between CEUS and diagnosis confirmation was 0-129 d(median was 6.5 d),which was more than 30 days in 10 cases. CEUS in early HAT showed no intrahepatic artery appearance in artery phase and early portal vein phase. The sensitivity, specificity and accuracy of CEUS in diagnosi early HAT were 100%(8/8),100%(10/10)and 100%(18/18)respectively. CEUS in late HAT showed abnormal appearance of extra hepatic artery, with appearance of small and circuitous collateral arteries developeol in hepatic portal, and appearance ofintrahepatic arteries. The sensitivity, specificity and accuracy of CEUS in diagnosing late HAT were 100%(9/9),97%(36/37)and 98%(45/46)respectively. One case with late hepatic artery stenosis was misdiagnosed as HAT because of rich collateral arteries in hepatic portal. Conclusions CEUS can show hepatic artery clearly with high diagnosis value for early HAT, but diagnosis value of late HAT is slightly lower than that of early HAT. Development of rich collateral arteries is one of the influence factors in diagnosis of late HAT.