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.
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Fig. 1A —41-year-old man with hepatic vein stenosis of left graft.
Axial portal venous phase CT scan obtained on second postoperative day shows
diffuse heterogeneous enhancement pattern of left graft (straight
arrows). In contrast to normally enhancing right-graft hepatic vein
(curved arrow), left-graft hepatic vein is unopacified.
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Fig. 1C —41-year-old man with hepatic vein stenosis of left graft.
Hepatic venogram obtained on fourth postoperative day shows anastomotic
stenosis of left-graft hepatic vein (arrows). Pressure gradient
across anastomotic site was 9 mm Hg.
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Fig. 2A —51-year-old man with hepatic vein stenosis of left graft.
Axial portal venous phase CT scans obtained on 71st postoperative day show
diffuse heterogeneous enhancement pattern of left graft (arrows,
A and B). In contrast to normally enhancing right-graft hepatic
vein (curved arrow, B), left-graft hepatic vein
(arrowheads, A) is not opacified by contrast material and
appears hypoattenuating to liver parenchyma. Hepatic venography (not shown)
was performed on 75th postoperative day and showed anastomotic stenosis of
left-graft hepatic vein and pressure gradient across anastomotic site of 20 mm
Hg.
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Fig. 2B —51-year-old man with hepatic vein stenosis of left graft.
Axial portal venous phase CT scans obtained on 71st postoperative day show
diffuse heterogeneous enhancement pattern of left graft (arrows,
A and B). In contrast to normally enhancing right-graft hepatic
vein (curved arrow, B), left-graft hepatic vein
(arrowheads, A) is not opacified by contrast material and
appears hypoattenuating to liver parenchyma. Hepatic venography (not shown)
was performed on 75th postoperative day and showed anastomotic stenosis of
left-graft hepatic vein and pressure gradient across anastomotic site of 20 mm
Hg.
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Fig. 2C —51-year-old man with hepatic vein stenosis of left graft.
Axial portal venous phase image of follow-up CT obtained 5 days after hepatic
venography shows stent in left-graft hepatic vein (arrowheads).
Enhancement pattern of left graft has become homogeneous.
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Fig. 3A —57-year-old man with hepatic vein stenosis of right graft.
Axial portal venous phase CT scan obtained on 84th postoperative day shows
diffuse heterogeneous enhancement pattern of right graft
(arrows).
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Fig. 3B —57-year-old man with hepatic vein stenosis of right graft.
Oblique coronal maximum-intensity-projection image shows short segmental focal
narrowing at anastomotic site of right-graft hepatic vein
(arrowheads) with mild prestenotic dilatation.
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Fig. 3D —57-year-old man with hepatic vein stenosis of right graft.
Hepatic venogram obtained on 90th postoperative day shows anastomotic stenosis
of right-graft hepatic vein (arrows). Pressure gradient across
anastomotic site was 7 mm Hg.
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Fig. 4A —41-year-old man with hepatic vein stenosis of right graft.
Axial portal venous phase CT scan obtained on 9th postoperative day shows
homogeneous enhancement pattern of both grafts. In contrast to
normal-appearing anastomotic site of left-graft hepatic vein (curved
arrow), there is short segmental slit like narrowing at anastomotic site
of right-graft hepatic vein (arrows) with prestenotic dilatation.
Ratio of diameter of preanastomotic segment to that of anastomotic segment is
greater than 2.0. Therefore, focal narrowing of right graft hepatic vein is
determined to be present.
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Fig. 4B —41-year-old man with hepatic vein stenosis of right graft.
Doppler sonogram obtained on 7th postoperative day. Spectral Doppler waveform
of right-graft hepatic vein shows monophasic flow pattern.
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Fig. 4C —41-year-old man with hepatic vein stenosis of right graft.
Hepatic venogram obtained on 9th postoperative day shows anastomotic stenosis
of right-graft hepatic vein (arrows). Pressure gradient across
anastomotic site was 10 mm Hg.
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Copyright © 2007 by the American Roentgen Ray Society.
