Hepatic venous congestion after living donor liver transplantation with right lobe graft: two-phase CT findings.
Hepatic venous congestion after living donor liver transplantation with right lobe graft: two-phase CT findings.
复制标题
DOI：
10.1148/radiol.2321030482
复制
发表时间：
2004-07
期刊：
影响因子：
19.7
通讯作者：
B. Kim;T. Kim;Jung-Sun Kim;Moon‐gyu Lee;Jung Hoon Kim;K. Kim;K. Sung;P. Kim;H. Ha;Sung Gyu Lee;W. Kang
中科院分区：
文献类型：
--
作者：
B. Kim;T. Kim;Jung-Sun Kim;Moon‐gyu Lee;Jung Hoon Kim;K. Kim;K. Sung;P. Kim;H. Ha;Sung Gyu Lee;W. Kang
目的 描述和确定右叶活体肝移植 (LDLT) 后肝静脉充血两相计算机断层扫描 (CT) 结果的临床重要性。材料和方法 48 名患者在 LDLT 后 1、2 和 4 周接受了两期（肝动脉期和门静脉期 [PVP]）CT 检查。评估图像中肝静脉充血区域的肝脏衰减差异、这些区域的肝和外周门静脉混浊以及随访 CT 结果的变化。 CT检查结果与血清胆红素水平相关。采用Fisher精确检验和混合模型。从六名患者身上获取了组织病理学标本。结果 30例患者（62%）在初次CT扫描时右叶移植物V段和VIII段存在衰减差异。在 PVP 期间，分别在 17 个（63%）和 27 个（100%）高衰减充血区域中观察到肝或外周门静脉混浊，在 16 个低衰减区域中分别没有出现和 3 个（19%）出现肝静脉或外周门静脉混浊。在 4 周的 CT 随访中，PVP 期间出现低衰减的 16 名患者中有 11 名的衰减差值减小。 14例高衰减患者均未表现出音量变化，但衰减差异减小或消失。组织病理学标本显示所有六名患者均存在肝静脉充血的证据。在组织病理学检查中所有三名患有严重肝静脉淤血的患者中，PVP CT 均显示低衰减。 PVP 期间低衰减患者和高衰减患者之间以及低衰减患者和无衰减差异患者之间的血清胆红素水平存在显着差异 (P = 0.035)。结论 LDLT 后可能与肝静脉淤血相关的区域在 CT 上有不同的衰减； PVP 期间增强减弱与术后血清胆红素水平升高相关，这表明肝静脉淤血的严重程度。
PURPOSE To describe and determine clinical importance of two-phase computed tomographic (CT) findings of hepatic venous congestion after living donor liver transplantation (LDLT) with right lobe graft. MATERIALS AND METHODS Forty-eight patients underwent two-phase (hepatic arterial phase and portal venous phase [PVP]) CT at 1, 2, and 4 weeks after LDLT. Images were evaluated for hepatic attenuation difference in areas of hepatic venous congestion, opacification of hepatic and peripheral portal veins in those areas, and changes in findings at follow-up CT. CT findings were correlated with serum bilirubin level. Fisher exact test and mixed model were applied. Histopathologic specimens were obtained in six patients. RESULTS Thirty patients (62%) had attenuation difference in segments V and VIII of right lobe transplant at initial CT scanning. Opacification of hepatic or peripheral portal veins was seen in 17 (63%) and 27 (100%) hyperattenuating areas of congestion during PVP and in none and three (19%) of 16 hypoattenuating areas, respectively. At 4-week follow-up CT, attenuation difference decreased in volume in 11 of 16 patients with hypoattenuation during PVP. All 14 patients with hyperattenuation showed no change in volume, but attenuation difference had decreased or disappeared. Histopathologic specimens showed evidence of hepatic venous congestion in all six patients. Hypoattenuation was seen at PVP CT in all three patients with severe hepatic venous congestion at histopathologic examination. Serum bilirubin level was significantly different between patients with hypoattenuation and those with hyperattenuation during PVP (P =.035) and between patients with hypoattenuation and those without attenuation difference (P =.009). CONCLUSION Areas possibly related to hepatic venous congestion after LDLT have variable attenuation at CT; decreased enhancement during PVP correlates with increased postoperative serum bilirubin level, which indicates severity of hepatic venous congestion.