Doppler evaluation of arterial complications of adult orthotopic liver transplantation

PURPOSE: The aim of this study was to analyze the role of the resistance index (RI), systolic acceleration time (SAT), and spectral waveform's morphologic characteristics in the sonographic evaluation of the hepatic artery for early detection of stenosis or thrombosis after orthotopic liver transplantation. METHODS: Arterial Doppler sonograms of 174 transplanted livers in 150 patients were analyzed for presence or absence of blood flow, RI, SAT, and peak systolic velocity. A qualitative evaluation of the spectral waveform morphologic characteristics was also made. In patients who had had abnormal findings on sonography, we compared those results with results obtained on multislice helical CT or angiography. RESULTS: At least 1 of the Doppler criteria for hepatic artery stenosis or thrombosis was identified in 25 of the transplants. The findings on multislice helical CT, angiography, or both confirmed the diagnosis of stenosis or thrombosis in 20 of the 25 cases: in 9 of 10 cases of absent hepatic arterial blood flow, 5 of 9 with an RI lower than 0.5, 6 of 7 cases with an SAT longer than 0.08 second, 10 of 11 cases of changes to a tardus-parvus-like spectral waveform, and in the 1 case of a peak systolic velocity greater than 2 m/second. CONCLUSIONS: The most accurate indicator of hepatic arterial stenosis or thrombosis was a change in the spectral waveform to a tardus-parvus pattern, with 91% sensitivity and 99.1% specificity. Among the other parameters, an increase of the SAT value (> 0.08 second), when associated with the morphologic modification of the systolic peak, is a more reliable parameter than the RI for early detection of artery stenosis, especially when the type of anastomosis is unknown.     

成人肝移植术后血管、胆道并发症的介入治疗

目的评价介入治疗成人肝移植术后血管、胆道并发症的有效性和安全性。方法 2007年12月至2011年12月,肝移植后出现血管、胆道并发症的患者12例行介入治疗。观察临床症状、并发症及患者存活情况。结果患者术后临床症状缓解,无手术相关严重并发症。中位随访期12个月(4～48个月)内,除1例患者死亡外,余所有患者存活。结论介入治疗肝移植术后血管、胆道并发症是有效和安全的。     

肝移植术后肝动脉并发症多普勒超声误诊原因分析

目的分析肝移植术后多普勒超声误诊肝动脉并发症的原因，并探讨超声造影纠正多普勒超声误诊病例的临床价值。方法采用多普勒超声检查肝移植术后患者1745人次，发现肝动脉血流动力学指标异常（符合以下条件之一：肝内动脉阻力指数〈0．5、肝内动脉加速度时间〉0．08s、肝固有动脉最大流速〉100cm／s或持续明显降低、肝门部或左肝、右肝动脉血流信号消失）并自愿行超声造影检查者68例。以数字减影血管造影或临床追踪为诊断标准，分析多普勒超声误诊病例的特点。结果68例患者中出现9例多普勒超声假阳性诊断，超声造影全部予以纠正。移植肝水肿、肝动脉痉挛、急性排斥反应、肝动脉与门静脉完全重叠、仪器敏感性较低、操作者经验不足等可导致多普勒超声检查时动脉血流信号不显示；肝动脉迂曲扭转、肝内动静脉瘘等可引起动脉血流动力学参数异常，出现假阳性结果。结论在诊断肝移植术后肝动脉并发症时，多普勒超声受多种因素影响可出现假阳性诊断；超声造影可及时、有效地予以纠正，减少临床等待时间及不必要的有创性检查。     

原位肝移植术后并发症的彩色多普勒超声诊断

目的探讨彩色多普勒超声在原位肝移植术后并发症中的诊断价值。方法回顾分析彩色多普勒超声对32例原位肝移植患者术后并发症的诊断结果。结果彩色多普勒超声诊断原位肝移植术后并发症主要有胸腹腔积液、肝动脉血栓、肝癌复发、肝周及腹腔占位、胆管炎及移植肝排异等。结论彩色多普勒超声在肝移植术后并发症诊断中具有重要的实用价值。     

床旁彩色及脉冲多普勒(双功能)超声评估原位肝移植术后并发症

目的 观察床旁彩色及脉冲多普勒(双功能)超声评估原位肝移植(OLT)术后并发症的价值。方法 回顾性分析65例接受OLT患者术后第1、3、7天床旁腹部双功能超声检查资料,评估肝脏实质回声及肝固有动脉及门静脉等血流束,测量门静脉峰值流速(PVPV)、肝动脉主干收缩期血流峰值流速(PSV)及血流阻力指数(RI)。根据腹部CT增强、CT血管成 像(CTA)、超声造影(CEUS)、临床干预(包括增强免疫抑制剂和二次移植手术)或病理结果,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估以OLT后第7天内超声所测PSV(PSV_第7天)及RI(RI_第7天)判断有无并发症的效能。结果 65例OLT后第1、3及7天,PVPV分别为71.00(45.50,96.50)、57.50(42.00,71.00)及50.00(33.00,66.00)cm/s,RI分别为0.68±0.16、0.69±0.17、0.66±0.13,各时间点间PVPV及RI差异均无统计学意义(H=5.475、P=0.065,F=0.964、P=0.501);PSV分别为63.00(44.50,89.00)、47.00(31.50,64.50)及50.00(38.25,64.75)cm/s,各时间点差异有统计学意义(H=7.313,P=0.026)。65例中,PSV正常46例、偏低(PSV＜25 cm/s) 1例、偏高(PSV＞100 cm/s)18例;RI正常18例、偏低(RI＜0.5)11例、偏高(RI＞0.7)36例。36例出现OLT后并发症。以PSV_第7天诊断OLT后并发症的AUC为0.561,RI_第7天为0.699,PSV_第7天联合RI_第7天为0.732,与单独RI_第7天差异无统计学意义(Z=0.290,P＞0.05)。结论 利用床旁双功能超声监测移植肝动脉主干血流信号及RI可有效评估OLT后并发症。     

彩色多普勒超声检查在诊断原位肝移植术后胆道并发症中的作用——与胆道造影术对比性研究60例分析

目的：探讨彩色多普勒超声检查（彩超）在肝移植术后胆道并发症诊断中的作用。方法：分析行肝移植的312例患者发生胆道并发症的情况,以胆道造影术为金标准评价彩超在诊断这些患者胆道并发症诊断中的作用。结果：共60例患者行胆道造影术明确胆道并发症的诊断,在胆道造影检查前2周内所行的胆道彩超结果示,彩超诊断胆道梗阻、胆漏、胆泥、胆结石敏感度分别为82％、80％、40％、100％;特异度分别为100％、100％、84％、96％。结论：彩超在诊断胆道并发症中敏感度、特异度较高,对诊断胆道并发症具有一定的意义。     

MRI诊断56例肝移植术后移植肝实质并发症

目的 探讨MRI对肝移植术后移植肝实质并发症的诊断价值。方法 56例肝移植术后患者均接受MR常规序列扫描(Fiesta、Dual-Echo、FSPGR、FS FSE RT、DWI)及LAVA薄层动态增强检查,分析各序列影像表现。结果 肝实质动脉期异常灌注15例;肝内肿瘤复发9例,伴下腔静脉、门静脉及肝静脉癌栓3例;肝局灶性缺血、坏死2例,胆源性肝脓肿2例,肝脏周围炎2例,灶性肝出血2例,局灶性脂肪肝2例,弥漫性脂肪肝1例,肝淤血1例,肝嗜酸性肉芽肿1例,未分化肉瘤1例。结论 MRI可准确反映移植肝实质各种并发症,在其临床诊断及治疗方案的制定中具有重要价值。     

Routine intraoperative Doppler sonography in the evaluation of complications after living-related donor liver transplantation

PURPOSE: To determine whether quantitative and qualitative analysis of intraoperative Doppler sonography data are predictive of vascular complications after living-related donor liver transplantation. METHODS: Intraoperative sonograms of 81 transplanted livers (right lobe in 61 patients, left lobe in 20 patients) were analyzed for the presence of blood flow, resistance index, systolic acceleration time (SAT), peak systolic velocity, and morphologic characteristics of spectral waveform of the hepatic artery. Peak velocity and spectral waveforms of portal and hepatic veins were also analyzed. Intraoperative sonography results were compared with information obtained with multidetector-row CT (MDCT) angiography or conventional angiography. The time interval between operation and angiography ranged from 1 to 23 days (mean, 8.5 days). RESULTS: Hepatic artery stenosis (HAS) was identified in 20 patients via MDCT angiography, conventional angiography, or both. The Doppler parameters found helpful for predicting HAS were tardus-parvus pattern and delayed SAT. The sensitivity, specificity, and negative predictive value (NPV) were 60.0%, 73.7%, and 84.9%, respectively, for tardus-parvus pattern and 40.0%, 83.6%, and 80.9%, respectively, for delayed SAT. Peak velocities of the portal and hepatic veins were not reliable indicators of vascular complication. Loss of triphasity of the hepatic vein had a 98.4% NPV for venous obstruction. CONCLUSIONS: Delayed SAT of the hepatic artery and loss of triphasity of the hepatic vein had a >80% for specificity for predicting vascular complications. Tardus-parvus pattern, delayed SAT of the hepatic artery, and loss of triphasity of the hepatic vein showed an acceptable NPV for identifying vascular complications.     

彩色多普勒超声在肝移植血管并发症中的应用价值

目的 确定彩色多普勒超声成像(CDFI)技术在肝移植血管并发症中应用价值。方法 应用彩色多普勒及频谱多普勒技术对26例肝移植病例(7例小儿部分肝移植及19例成人肝移植)进行术前评价，术中指导及术后监测，重点观察受体术后至少180d内肝血流动力学各项参数及肝脏动、静脉及门静脉血流频谱形态变化，及时发现血管狭窄及血栓等严重并发症。结果 26例肝移植病例，术后CDFI及时发现肝动脉狭窄(HAS)1例及肝动脉血栓(HAT)1例，经过血管造影证实。发现门静脉血栓1例，肝静脉狭窄2例，经过再次手术取栓及狭窄处球囊扩张后，血流灌注恢复正常。结论 应用CDFI监测各项血流指标，对于术后早期发现肝脏血管狭窄及血栓等严重并发症具有较高的敏感性和特异性，提高了手术的成功率和患者的生存率。     

彩色多普勒超声对肝移植术后并发症的诊断价值

目的评价彩色多普勒超声对肝移植术后并发症的诊断价值。方法回顾性分析和总结26例肝移植术后并发症的彩色多普勒超声检查资料,检测指标包括肝动脉及左右分支的峰值速度（HAPV）、阻力指数（RI）、加速度及加速时间,门静脉平均流速,肝实质及胆管回声。结果6例经手术或造影证实为血管并发症（肝动脉血栓形成1例,肝动脉狭窄2例,肝动脉痉挛1例,门静脉狭窄2例）,彩色多普勒超声表现有肝动脉狭窄处的高速高阻血流并伴有湍流,而狭窄远端峰值速度〈40cm／s,RI〈0．5,加速时间〉0．08s,加速度〈300cm／s^2,1例肝动脉血栓形成肝门部无动脉血流信号;6例急性排斥反应,3例胆管结石并扩张。结论彩色多普勒超声对肝移植术后血管并发症的诊断具有重要的指导意义。     

彩色多普勒超声在肝移植中的应用

目的探讨彩色多普勒超声在肝移植中的应用价值.方法运用彩色多普勒超声观察9例肝移植患者术前、术后声像图特征,测定肝门部肝动脉收缩期峰值速度（SPV）、舒张末期流速（EDV）、阻力指数（RI）、搏动指数（PI）、血流速度积分（FVI）,门静脉主干、肝静脉血流速度（PVV、HVV）等血流动力学指标.结果9例肝移植病例术前超声明确了原发病因及可移植性.术后彩色多普勒超声准确判断移植肝排异反应3例、肝周血肿2例、普遍存在胸腔、腹腔积液.肝动脉有较高的显示率（89%）.3例采用自动弹射肝组织活检术.结论彩色多普勒超声对评定移植肝脏正常与否及并发症的检出具有重要的应用价值,超声引导穿刺术有助于诊断、治疗.     

Vascular and nonvascular complications of renal transplants: sonographic evaluation and correlation with other imaging modalities, surgery, and pathology

Cadaveric or living donor renal transplantation is commonly performed in individuals with end-stage renal disease. In recent years, gray-scale sonography, coupled with color Doppler sonography (CDUS), power Doppler sonography (PDUS), or spectral Doppler sonography, has become the primary imaging modality for these patients. Postoperative serial sonography is performed to detect complications and aid in posttransplant management. In addition, sonography is used to guide percutaneous aspiration of fluid or biopsy to diagnose rejection or renal and perirenal masses.In this article we discuss the spectrum of sonographic findings, both vascular and nonvascular, of renal transplant complications, including but not limited to renal arterial and venous stenosis and thrombosis, peritransplant collections (lymphoceles, hematomas, urinomas, and seromas), posttransplant lymphoproliferative disorder, and postbiopsy complications (hematomas, pseudoaneurysms, and arteriovenous fistulas). We correlate sonographic findings with those from other imaging modalities (such as angiography, CT, and MRI) and findings at surgery and pathology when possible.     

复方氯己定含漱液预防肝移植术后口腔并发症的疗效观察

目的 探讨复方氯己定含漱液进行口腔护理预防肝移植术后口腔并发症的疗效.方法 将84例肝移植术后患者随机分为对照组(42例)和观察组(42例),对照组按常规采用生理盐水进行口腔护理,观察组采用复方氯己定含漱液进行口腔护理,观察比较两组患者术后口腔感染的发生情况.结果 观察组口腔感染发生率显著低于对照组(P<0.01).结...     

彩色多普勒及超声造影在肝移植术后肝动脉血栓形成的应用研究

目的探讨彩色多普勒血流成像（CDFI）及超声造影在肝移植术后肝动脉血栓形成（HAT）诊断中的应用价值。方法对106例肝移植术后患者进行CDFI检查，并对其中9例肝动脉异常不能排除HAT的患者行超声造影检查。采用对比脉冲序列（CPS）成像技术，造影剂为SonoVue。结果106例肝移植术后患者中，98例肝动脉多普勒血流信号清晰显示，8例术后早期多切面扫查未显示肝门区及肝内门静脉周围肝动脉彩色血流信号，CDFI不能排除HAT。行超声造影后，6例肝动脉主干及分支清晰显示，走行正常，除外HAT，经随访证实；2例超声造影后肝动脉仍未显示者诊断为HAT，经数字减影血管造影（DSA）或对比CT血管成像（CTA）证实。1例患者于术后10个月CDFI检查发现肝动脉血流信号显示但频谱异常，收缩期峰值流速降低，阻力指数〈0．50，收缩期加速时间延长，超过0．08S，呈Tardus，Parvus改变；超声造影后见肝动脉密集细小且走行迂曲，诊断为HAT侧支循环形成，经CTA证实。结论CDFI结合超声造影检查可提高肝移植术后HAT的诊断准确性。     

肝移植后胆道并发症的超声诊断价值

背景：肝移植后胆道并发症可引起移植后肝失功,超声是移植肝胆道并发症的重要检查手段之一。目的：探讨超声对肝移植后胆道并发症的诊断价值。 方法：纳入92例肝移植患者,男81例,女11例,年龄21-67岁;其中同种异体原位肝移植90例,活体部分肝移植2例;胆道重建方式均为胆管-胆管端端吻合。回顾性分析肝移植后常规检查及彩色多普勒超声检查结果,着重分析患者有无胆漏、胆道狭窄、胆泥或胆石形成,部分患者于超声引导下穿刺引流。 结果与结论：92例患者中超声诊断肝移植后胆道并发症14例：胆漏5例;胆道狭窄4例,其中吻合口狭窄2例,非吻合口狭窄2例;4例胆泥形成;1例胆管结石。提示肝移植胆道并发症患者有特征性超声表现,超声对肝移植后胆道并发症的诊断有重要价值。     

彩色多普勒超声对门静脉广泛血栓肝移植患者围手术期监测的临床意义:附四例分析

目的探讨术前存在广泛门静脉血栓肝移植患者采用彩色多普勒超声(CDI)进行围手术期监测的临床作用。方法对4例术前存在广泛门静脉血栓肝移植患者于术前、术后进行CDI检查。术后首次CDI检查在移植术后24h内进行,术后第1周和第2周隔天1次,以后每周1～2次;主要监测指标包括门静脉主干最大内径、平均血流速(TAMX)、最大流速(Vmax)、血流频谱、侧支循环。结果 4例病例术前CDI检查发现门静脉主干血流缓慢、整段狭窄、完全堵塞、无血流及门静脉内膜严重病变等情况;并探测到多支侧支循环血流丰富、肠系膜上静脉扩张和无法找到满意的门静脉重建部位。这些情况在手术中证实,并指导了肝移植特殊类型手术中供肝门静脉灌注重建。术后2周隔天进行1次的CDI检查显示4例患者门静脉内径、血流方向及流速都呈现正常,取得较好重建效果和良好的肝功能恢复。结论 CDI对监测肝移植术后门静脉并发症具有较好效果,对术前门静脉系统广泛血栓患者,CDI对指导术者在术前思考手术可能遇到问题、设计和准备应变手术方式具有一定价值。     

超声在小儿肝移植后血管并发症中的应用进展

目前肝移植已成为慢性肝病终末期唯一有效的治疗方法，但术后血管并发症往往是移植失败的主要原因。儿童由于移植物体积和血管管径较小，术后血管并发症较成人更易发生。CDFI是临床评估肝移植后血流动力学和血管通畅性的首选影像学检查方法，但在准确诊断某些血管并发症方面仍有一定局限性。近年来，CEUS应用于小儿肝移植的监测。本文就超声检查在小儿肝移植后血流动力学变化和血管并发症中的应用进行概述。     

超声造影在肝移植术后血管源性并发症中的应用

目的探讨超声造影在检测肝移植术后血管源性并发症中的应用价值。方法对肝移植术后经彩色多普勒血流显像检查疑肝血管血流异常患者行超声造影检查，观察肝动脉、门静脉、下腔静脉及肝实质的血流灌注，对其中29例经数字减影血管造影（DSA）或CT血管造影（CTA）／MR血管造影（MRA）证实的病例进行分析。结果术后血管源性并发症患者28例，其中肝动脉狭窄22例，肝动脉血栓闭塞3例（肝动脉血栓闭塞合并肝梗死2例），门静脉狭窄2例，下腔静脉狭窄1例，另1例为肝门部血肿并肝动脉、门静脉受压狭窄。超声造影可明确诊断肝动脉血栓闭塞，显示肝动脉、门静脉及下腔静脉狭窄，与DSA或CTA／MRA结果符合率分别为100％（3／3）、90．9％（20／22）、100％（2／2）及100％（1／1）。结论超声造影对肝移植术后血管源性并发症的诊断具有较高的准确率，对指导临床诊断及治疗具有重要的临床应用价值。     

Renal transplantation parenchymal complications: what Doppler ultrasound can and cannot do

Kidney transplantation is the treatment of choice in end-stage renal disease, given the better quality of life of transplanted patients when compared with patients on maintenance dialysis. In spite of surgical improvements and new immunosuppressive regimens, parts of transplanted grafts still develop chronic dysfunction. Ultrasonography, both in B-mode and with Doppler ultrasound, is an important diagnostic tool in case of clinical conditions which might impair kidney function. Even though ultrasonography is considered fundamental in the diagnosis of vascular and surgical complications of the transplanted kidney, its role is not fully understood in case of parenchymal complications of the graft. The specificity of Doppler is low both in case of acute complications, such as acute tubular necrosis, drugs toxicity and acute rejection, and in case of chronic conditions, such as chronic allograft nephropathy. Single determinations of resistance indices present low diagnostic accuracy, which is higher in case of successive measurements performed during the follow-up of the graft. Modern techniques such as tissue pulsatility index, maximal fractional area and contrast-enhanced ultrasound increase ultrasonography diagnostic power in case of parenchymal complications of the transplanted kidney.

Electronic supplementary material

The online version of this article (doi:10.1007/s40477-014-0118-1) contains supplementary material, which is available to authorized users.     

彩色多普勒超声研究肝移植后门静脉血流动力学变化

目的探讨肝移植术后的门静脉血流动力学变化规律。方法应用灰阶和彩色多普勒超声检测了15例正常人和22例原位肝移植患者术后的肝脏。总结14例无明显并发症原位肝移植患者的门静脉时间平均血流速度（TAV）变化规律和5例肝动脉血栓形成患者及3例门静脉并发症患者的门静脉血流动力学变化。结果①肝移植术后无并发症的患者早期门静脉TAV显著高于对照组，但呈下降趋势，至手术3个月后与对照组差异无显著性意义。②5例肝动脉血栓形成患者的门静脉TAV高于肝移植后同期无并发症的患者。③3例门静脉并发症患者的门静脉血流紊乱。结论肝移植后门静脉TAV逐渐下降，至手术3个月后恢复正常；门静脉血流动力学变化对肝移植后并发症的协助诊断有重要意义。