Spleen stiffness measurements by acoustic radiation force impulse imaging after living donor liver transplantation in children: a potential quantitative index for venous complications
Spleen stiffness measurements by acoustic radiation force impulse imaging after living donor liver transplantation in children: a potential quantitative index for venous complications
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DOI：
10.1007/s00247-014-3215-6
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发表时间：
2015-04-01
影响因子：
2.3
通讯作者：
Kuroda, Tatsuo
中科院分区：
文献类型：
--
作者：
Tomita, Hirofumi;Fuchimoto, Yasushi;Kuroda, Tatsuo
儿童活体肝移植常引起静脉并发症，导致门静脉高压症。脾脏硬度测量最近被提出作为门静脉高压症患者的一个新的，非侵入性的参数。为了评价声辐射力脉冲（ARFI）成像测量脾脏硬度在诊断小儿活体肝移植术后静脉并发症中的诊断价值，我们前瞻性地纳入了69例采用左侧同种异体肝进行小儿活体肝移植术后的患者。在方案肝活检检查时，通过脾实质中心的左侧肋间隙进行ARFI成像测量脾脏硬度，并重复五次。对脾脏硬度测量前后的影像学检查进行回顾性分析。关于静脉并发症，门静脉和肝静脉明显狭窄定义为多相CT显示狭窄> 50%。门静脉和肝静脉狭窄，分别确定在三个和两个病人。无和有静脉并发症的患者中位脾脏硬度值分别为2.70和4.00 m/s（P < 0.001）。脾硬度测量显示出对静脉并发症的良好诊断能力，临界值确定为2.93 m/s，灵敏度为100%，特异性为78.9%。脾脏硬度测量值随着介入治疗后静脉狭窄的缓解而降低，ARFI成像测量脾脏硬度可为小儿活体肝移植术后静脉并发症提供一个有用的定量指标。
Living donor liver transplantation in children often results in venous complications, leading to portal hypertension. Spleen stiffness measurements have been recently proposed as a new, noninvasive parameter for portal hypertension in cirrhotic patients.To evaluate the diagnostic value of spleen stiffness measurements by acoustic radiation force impulse (ARFI) imaging in diagnosing venous complications after pediatric living donor liver transplantation.We prospectively enrolled 69 patients after pediatric living donor liver transplantation using a left-side liver allograft. Around the time of the protocol liver biopsy examination, spleen stiffness measurements by ARFI imaging were performed via the left intercostal space at the center of the spleen parenchyma and repeated five times. Imaging examinations around the time of the spleen stiffness measurements were retrospectively reviewed. Regarding venous complications, significant portal and hepatic venous stenosis was defined as > 50% stenosis on multiphasic computed tomography.After post hoc exclusion, 62 patients were studied. Portal and hepatic venous stenosis was identified in three and two patients, respectively. The median spleen stiffness values were 2.70 and 4.00 m/s in patients without and with venous complications, respectively (P < 0.001). Spleen stiffness measurements showed good diagnostic power for venous complications, and the cutoff value was determined as 2.93 m/s, with 100% sensitivity and 78.9% specificity. Spleen stiffness measurements decreased with the relief of venous stenosis resulting from an interventional radiology procedure.Spleen stiffness measurements by ARFI imaging might provide a useful quantitative index for venous complications after pediatric living donor liver transplantation.