Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Improving the Specificity of CT Angiography for the Diagnosis of Hepatic Artery Occlusion after Liver Transplantation in Suspected Patients with Doppler Ultrasound Abnormalities

  • Jin Sil Kim (Department of Radiology and Medical Research Institute, School of Medicine, Ewha Womans University) ;
  • Dong Wook Kim (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kyoung Won Kim (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Gi Won Song (Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sung Gyu Lee (Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2021.04.01
  • Accepted : 2021.08.07
  • Published : 2022.01.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: To investigate whether the diagnostic performance of CT angiography (CTA) could be improved by modifying the conventional criterion (anastomosis site abnormality) to diagnose hepatic artery occlusion (HAO) after liver transplantation (LT) in suspected patients with Doppler ultrasound (US) abnormalities. Materials and Methods: One hundred thirty-four adult LT recipients (88 males and 46 females; mean age, 52.7 years) with suspected HAO on Doppler US (40 HAO and 94 non-HAO according to the reference standards) were included. We evaluated 1) abnormalities in the HA anastomosis, categorized as a cutoff, ≥ 50% stenosis at the anastomotic site, or diffuse stenosis at both graft and recipient sides around the anastomosis, and 2) abnormalities in the distal run-off, including invisibility or irregular, faint, and discontinuous enhancement. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the conventional (considering anastomosis site abnormalities alone) and modified CTA criteria (abnormalities in both the anastomosis site and distal run-off) for the diagnosis of HAO were calculated and compared using the McNemar test. Results: By using the conventional criterion to diagnose HAO, the sensitivity, specificity, PPV, NPV, and accuracy were 100% (40/40), 74.5% (70/94), 62.5% (40/64), 100% (70/70), and 82.1% (110/134), respectively. The modified criterion for diagnosing HAO showed significantly increased specificity (93.6%, 88/94) and accuracy (93.3%, 125/134) compared to that with the conventional criterion (p = 0.001 and 0.002, respectively), although the sensitivity (92.5%, 37/40) decreased slightly without statistical significance (p = 0.250). Conclusion: The modified criterion considering abnormalities in both the anastomosis site and distal run-off improved the diagnostic performance of CTA for HAO in suspected patients with Doppler US abnormalities, particularly by increasing the specificity.

Keywords

Acknowledgement

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (No. 2017R1E1A1A03070961).

References

  1. Kim JS, Kim KW, Lee J, Kwon HJ, Kwon JH, Song GW, et al. Diagnostic performance for hepatic artery occlusion after liver transplantation: computed tomography angiography versus contrast-enhanced ultrasound. Liver Transpl 2019;25:1651-1660
  2. Astarcioglu I, Egeli T, Gulcu A, Ozbilgin M, Agalar C, Cesmeli EB, et al. Vascular complications after liver transplantation. Exp Clin Transplant. 2019 Mar [Epub]. https://doi.org/10.6002/ect.2018.0240
  3. Steinbruck K, Enne M, Fernandes R, Martinho JM, Balbi E, Agoglia L, et al. Vascular complications after living donor liver transplantation: a Brazilian, single-center experience. Transplant Proc 2011;43:196-198
  4. Khalaf H. Vascular complications after deceased and living donor liver transplantation: a single-center experience. Transplant Proc 2010;42:865-870
  5. Park YS, Kim KW, Lee SJ, Lee J, Jung DH, Song GW, et al. Hepatic arterial stenosis assessed with doppler US after liver transplantation: frequent false-positive diagnoses with tardus parvus waveform and value of adding optimal peak systolic velocity cutoff. Radiology 2011;260:884-891
  6. Brancatelli G, Katyal S, Federle MP, Fontes P. Three-dimensional multislice helical computed tomography with the volume rendering technique in the detection of vascular complications after liver transplantation. Transplantation 2002;73:237-242
  7. Piolanti M, Fabbro E, Pascali E, Rossi C, Caputo M, Varotti G, et al. CT angiography for the evaluation of adult orthotopic liver transplantation arterial complications. Radiol Med 2001;102:348-356
  8. Kayahan Ulu EM, Coskun M, Ozbek O, Tutar NU, Ozturk A, Aytekin C, et al. Accuracy of multidetector computed tomographic angiography for detecting hepatic artery complications after liver transplantation. Transplant Proc 2007;39:3239-3244
  9. Garcia-Criado A, Gilabert R, Berzigotti A, Bru C. Doppler ultrasound findings in the hepatic artery shortly after liver transplantation. AJR Am J Roentgenol 2009;193:128-135
  10. Dodd GD 3rd, Memel DS, Zajko AB, Baron RL, Santaguida LA. Hepatic artery stenosis and thrombosis in transplant recipients: Doppler diagnosis with resistive index and systolic acceleration time. Radiology 1994;192:657-661
  11. Bekker J, Ploem S, de Jong KP. Early hepatic artery thrombosis after liver transplantation: a systematic review of the incidence, outcome and risk factors. Am J Transplant 2009;9:746-757
  12. Vignali C, Bargellini I, Cioni R, Petruzzi P, Cicorelli A, Lazzereschi M, et al. Diagnosis and treatment of hepatic artery stenosis after orthotopic liver transplantation. Transplant Proc 2004;36:2771-2773
  13. Katyal S, Oliver JH 3rd, Buck DG, Federle MP. Detection of vascular complications after liver transplantation: early experience in multislice CT angiography with volume rendering. AJR Am J Roentgenol 2000;175:1735-1739
  14. Legmann P, Costes V, Tudoret L, Girardot C, Hazebroucq V, Uzan E, et al. Hepatic artery thrombosis after liver transplantation: diagnosis with spiral CT. AJR Am J Roentgenol 1995;164:97-101
  15. Hom BK, Shrestha R, Palmer SL, Katz MD, Selby RR, Asatryan Z, et al. Prospective evaluation of vascular complications after liver transplantation: comparison of conventional and microbubble contrast-enhanced US. Radiology 2006;241:267-274