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Sonographic Evaluation of Venous Obstruction in Liver Transplants

Wui K. Chong1, Jason C. Beland1,2 and Susan M. Weeks1,3

1 Department of Radiology, CB 7510, University of North Carolina Hospitals, 101 Manning Dr., Chapel Hill, NC 27599-7510.
2 Present address: Department of Radiology, Saint Joseph's Hospital, Atlanta, GA.
3 Present address: Interventional Services, Wake Radiology Diagnostic Imaging, Inc., Cary, NC.


Figure 1
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  		Fig. 1 —56-year-old male liver transplant recipient. Measurement of venous pulsatility index on triphasic waveform from the middle hepatic vein (MHV). Venous pulsatility index is difference between maximum (A) and minimum (B) frequency shift divided by A. With triphasic waveform (above), this is A + B / A.

 

Figure 2
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  		Fig. 2 —Doppler sonogram of 52-year-old female liver transplant patient shows main portal vein (MPV) occlusion due to thrombus.

 

Figure 3
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  		Fig. 3A —Doppler sonograms in 46-year-old male liver transplant patient with main portal vein (MPV) stenosis. V = velocity, PRE = preanastomosis, ANA = anastomosis. Angle-corrected MPV preanastomotic velocity is 31.8 cm/s.

 

Figure 4
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  		Fig. 3B —Doppler sonograms in 46-year-old male liver transplant patient with main portal vein (MPV) stenosis. V = velocity, PRE = preanastomosis, ANA = anastomosis. Velocity at MPV anastomosis is 153 cm/s. Anastomotic-to-preanastomotic velocity ratio is 4.81.

 

Figure 5
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  		Fig. 3C —Doppler sonograms in 46-year-old male liver transplant patient with main portal vein (MPV) stenosis. V = velocity, PRE = preanastomosis, ANA = anastomosis. Corresponding angiogram shows anastomotic stenosis.

 

Figure 6
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  		Fig. 3D —Doppler sonograms in 46-year-old male liver transplant patient with main portal vein (MPV) stenosis. V = velocity, PRE = preanastomosis, ANA = anastomosis. Angiographic improvement after balloon dilatation.

 

Figure 7
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  		Fig. 4 —Receiver operating characteristic curve for evaluation of portal vein stenosis with portal vein velocity ratio (PVVR).

 

Figure 8
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  		Fig. 5 —Receiver operating characteristic curve for evaluation of portal vein stenosis with peak portal vein velocity (PPVV).

 

Figure 9
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  		Fig. 6 —Receiver operating characteristic curve for evaluation of hepatic vein/IVC stenosis with venous pulsatility index (VPI).

 

Figure 10
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  		Fig. 7A —52-year-old male liver transplant patient with outflow vein stenosis. LHV = left hepatic vein, V = velocity. Doppler spectrum from LHV shows weak biphasic waveform (venous pulsatility index = 0.22).

 

Figure 11
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  		Fig. 7B —52-year-old male liver transplant patient with outflow vein stenosis. LHV = left hepatic vein, V = velocity. Transjugular hepatic venogram shows anastomotic stenosis (arrow). Balloon dilatation was performed and stent was placed across stenosis.

 

Figure 12
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  		Fig. 7C —52-year-old male liver transplant patient with outflow vein stenosis. LHV = left hepatic vein, V = velocity. Posttreatment Doppler sonogram shows waveform that is still biphasic, but pulsatility is improved (venous pulsatility index = 0.45).

 

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