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DOI:10.2214/AJR.06.1366
AJR 2007; 189:101-108
© American Roentgen Ray Society

Original Research

Value of CT and Doppler Sonography in the Evaluation of Hepatic Vein Stenosis After Dual-Graft Living Donor Liver Transplantation

Seung Soo Lee1, Kyoung Won Kim1, Seong Ho Park1, Yong Moon Shin1, Pyo Nyun Kim1, Sung Gyu Lee2 and Moon-Gyu Lee1

1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap-2 dong, Songpa-ku, Seoul 138-736, Korea.
2 Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea.

OBJECTIVE. The purpose of this study was to evaluate the imaging findings and role of CT and Doppler sonography in the diagnosis of hepatic vein (HV) stenosis after dual-graft living donor liver transplantation (LDLT).

MATERIALS AND METHODS. Using hepatic venography as the reference standard, 73 grafts with venographic evaluation in 43 dual-graft LDLT recipients were classified into either a stenosis (n = 39) or a nonstenosis (n = 34) group. CT scans were evaluated for relative attenuation, enhancement pattern, and HV abnormality for each graft. Doppler sonography evaluation of the flow pattern of HVs for each graft was performed. CT and Doppler sonography findings were compared in the stenosis and nonstenosis groups using the independent sample Student's t test and Fisher's exact test. Multifactorial logistic regression analysis was performed to determine the best predictors of the diagnosis of HV stenosis.

RESULTS. Heterogeneous enhancement (p = 0.046), abnormal HV on CT (p = 0.025), and HV wave pattern on Doppler sonography (p = 0.005) were significant findings. The accuracy for the diagnosis of HV stenosis was 60.0% for heterogeneous enhancement, 61.5% for abnormal HV, and 66.2% for a monophasic flow pattern. Heterogeneous enhancement and HV wave pattern were significant independent findings on multifactorial logistic regression analysis. The overall accuracy of the logistic model in the diagnosis of HV stenosis was 71.7%

CONCLUSION. Although CT and Doppler sonography can be helpful in diagnosing HV stenosis, given the low accuracy of individual imaging findings, the diagnosis of HV stenosis should be made cautiously, with both CT and Doppler sonography regarded as complementary examinations.

Keywords: CT • Doppler sonography • hepatic vein stenosis • liver transplantation


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