Changes of Portosystemic Collaterals and Splenic Volume on CT After Liver Transplantation and Factors Influencing Those Changes
Se Hyung Kim1,
Jeong Min Lee1,2,
Jin Young Choi3,
Kyung-Suk Suh4,
Nam-Joon Yi4,
Joon Koo Han1,2 and
Byung Ihn Choi1,2
1 Department of Radiology, Seoul National University Hospital, 28, Yeongon-dong,
Jongno-gu, Seoul 110-744, Korea.
2 Institute of Radiation Medicine, Seoul National University Hospital, Seoul,
Korea.
3 Department of Radiology, Yonsei University Hospital, Seoul, Korea.
4 Department of Surgery, Seoul National University Hospital, Seoul, Korea.
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Fig. 1A —Schematic drawing of portosystemic collaterals and
corresponding CT images. Schematic drawing illustrates portosystemic
collateral vessels in portal hypertension. 1 = esophageal varices; 2 =
paraesophageal varices; 3 = gastrorenal shunt; 4 = splenorenal shunt; 5 =
inferior mesenteric, hemorrhoidal, and internal iliac veins; 6 = mesocaval
shunt; 7 = intrahepatic portosystemic shunt; 8 = Sappey's veins.
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Fig. 1B —Schematic drawing of portosystemic collaterals and
corresponding CT images. On portal venous phase CT scan, esophageal
(asterisk) and paraesophageal (arrows) varices appear as
dilated veins located within and outside wall of lower esophagus,
respectively. Patient is 57-year-old man who received partial transplant.
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Fig. 1C —Schematic drawing of portosystemic collaterals and
corresponding CT images. Gastric submucosal (asterisks) and
adventitial (arrows) varices are seen as dilated veins located within
submucosal layer of gastric wall and in adventitial layer at exterior border
of gastric wall, respectively. Patient is 51-year-old man who received partial
transplant.
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Fig. 1D —Schematic drawing of portosystemic collaterals and
corresponding CT images. Splenic varices (arrows) are seen as
tortuous veins in region of splenic hila. Patient is 50-year-old woman who
received partial transplant.
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Fig. 1E —Schematic drawing of portosystemic collaterals and
corresponding CT images. Dilated or tortuous branches of superior or inferior
mesenteric vein within mesenteric fat are classified as mesenteric varices
(arrows). Patient is 47-yearold man who received total
transplant.
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Fig. 1F —Schematic drawing of portosystemic collaterals and
corresponding CT images. Retroperitoneal (arrows) varices appear as
tortuous retroperitoneal tributaries of superior or inferior mesenteric vein
located in retroperitoneum. Patient is 53-year-old woman who received partial
transplant.
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Fig. 3 —Graph shows evolution of varices and spleen volume over time
after liver transplantation (LT). First CT scan was obtained within 2 weeks
after transplantation, second CT at approximately 2 months, third CT at 6
months, and fourth CT at 1 year after transplantation. Numbers on main
y-axis indicate mean value of variceal grade and numbers on second
y-axis indicate spleen volume on each CT. Solid lines indicate that
difference of mean values of variceal grade or spleen volume between each CT
and just-prior CT are statistically significant, whereas dotted lines indicate
difference is not significant. All varices except splenic and retroperitoneal
varices significantly decreased in diameter on CT performed within 2 weeks
after transplantation (p < 0.05). All varices except esophageal
varices became stable approximately 2 months after transplantation. On the
contrary, esophageal varices continuously and significantly decreased in size
even more than 1 year after liver transplantation. Spleen volume decreased
significantly within 2 weeks after transplantation and became stable after
that time.
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Fig. 4A —45-year-old woman with grade 4 esophageal and paraesophageal
varices before undergoing liver transplantation. Preoperative CT scan obtained
at level of lower esophagus during portal venous phase shows tortuous enhanced
esophageal (asterisk) and paraesophageal (arrows) varices.
Largest diameters of esophageal and paraesophageal varices are 8.9 and 8 mm,
respectively, and number of both varices on transverse image is more than
four. Therefore, final variceal grade recorded by two radiologists was 4 for
both varices.
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Fig. 4B —45-year-old woman with grade 4 esophageal and paraesophageal
varices before undergoing liver transplantation. Transverse CT image obtained
11 days after deceased donor liver transplantation shows no varices within or
around esophagus. CT scans obtained at 190 days and 400 days after
transplantation (not shown) revealed no varices.
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Fig. 5A —43-year-old man with grade 4 gastric submucosal and
adventitial varices before undergoing liver transplantation. Preoperative CT
scan obtained at level of gastroesophageal junction during portal venous phase
shows multiple tortuous enhanced gastric submucosal (arrows) and
adventitial (arrowheads) varices. Largest diameters of gastric
submucosal and adventitial varices are 8.5 and 10.6 mm, respectively, and
number of both varices on transverse image is more than four. Therefore, final
grade of both varices was recorded as 4.
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Fig. 5B —43-year-old man with grade 4 gastric submucosal and
adventitial varices before undergoing liver transplantation. CT image obtained
11 days after living donor liver transplantation shows decrease in size of
largest diameter of gastric submucosal (arrows) and adventitial
(arrowheads) varices to 4 and 2.9 mm, respectively, and number of
varices is not changed. Consequently, grades of varices decreased from 4 to 3
and 2, respectively.
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Fig. 5C —43-year-old man with grade 4 gastric submucosal and
adventitial varices before undergoing liver transplantation. On CT image
obtained 1 year after transplantation, gastric submucosal (arrows)
and adventitial (arrowheads) varices are still seen.
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Fig. 6A —52-year-old man with retroperitoneal varices shown even 1
year after living donor liver transplantation using left lateral segment.
Preoperative CT scan shows conglomerated and enhanced varices
(arrows) at left retroperitoneal space. These varices were recorded
as grade 4 by radiologists.
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Fig. 6B —52-year-old man with retroperitoneal varices shown even 1
year after living donor liver transplantation using left lateral segment. CT
image obtained 1 year after transplantation shows persistent grade 4
retroperitoneal varices (arrows).
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Fig. 7A —6-year-old boy who underwent living donor liver
transplantation due to fulminant hepatic failure. Preoperative CT image
obtained during portal venous phase shows splenomegaly. Spleen (S) volume was
measured as 139.6 cm3.
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Fig. 7B —6-year-old boy who underwent living donor liver
transplantation due to fulminant hepatic failure. CT image obtained 10 days
after transplantation shows marked decrease of splenomegaly. Spleen (S) volume
at that time was measured as 92 cm3. On CT image obtained 14 months
after transplantation (not shown), spleen size had not decreased further and
spleen volume was measured as 93.5 cm3.
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Copyright © 2008 by the American Roentgen Ray Society.
