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Hepatic Outflow Obstruction at Middle Hepatic Vein Tributaries or Inferior Right Hepatic Veins After Living Donor Liver Transplantation with Modified Right Lobe Graft: Comparison of CT and Doppler Ultrasound

¹ Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap 2-dong, Songpa-ku, Seoul 138-736, Korea.
² Department of Radiology, Hanyang University Guri Hospital, Gyomun Dong, Guri, South Korea
³ Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea.
⁴ Department of Liver Transplantation Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-ku, Seoul, Korea.

OBJECTIVE. The objective of our study was to compare CT and Doppler ultrasound in the diagnosis of hepatic outflow obstruction at the middle hepatic vein (MHV) tributaries and inferior right hepatic veins (RHVs) after living donor liver transplantation (LDLT) with modified right lobe grafts.

MATERIALS AND METHODS. Thirty-seven venographies were performed in 36 patients after LDLT with modified right lobe grafts, evaluating 51 MHV tributaries and 25 inferior RHVs. They were classified as obstructed or nonobstructed. On Doppler ultrasound or CT, flow patterns of the MHV tributaries and inferior RHVs or the relative parenchymal attenuation, enhancement, and opacification of these veins were evaluated for the diagnosis of hepatic outflow obstruction. McNemar tests were performed to compare the diagnostic values of Doppler ultrasound and CT.

RESULTS. On the basis of hepatic venography, 33 MHV tributaries were categorized as obstructed and 18 as nonobstructed, and 16 inferior RHVs were categorized as obstructed and nine as nonobstructed. For the diagnosis of MHV tributary obstruction, Doppler ultrasound was more sensitive and accurate, although less specific, than CT (97% vs 39%, respectively, p < 0.001; 86% vs 61%, p = 0.0209; 67% vs 100%, p = 0.0412). Similarly, Doppler ultrasound was more sensitive (94% vs 31%, respectively) and accurate (84% vs 56%) than CT, although less specific (67% vs 100%), for the diagnosis of inferior RHV obstruction, with a statistical significance only for sensitivity (p = 0.002, 0.092, and 0.248, respectively).

CONCLUSION. Doppler ultrasound is more sensitive and accurate than CT for the detection of obstruction at the MHV tributaries and inferior RHVs in patients after LDLT using modified right lobe grafts. Although current CT criteria produce high specificity and may reduce unnecessary invasive venographies, optimal CT criteria with acceptable sensitivity should be reestablished.

Keywords: CT • Doppler ultrasound • hemodynamics • hepatic outflow obstruction • liver transplantation • living donor related liver transplantation

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