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Diagnostic Performance for Hepatic Artery Occlusion After Liver Transplantation: Computed Tomography Angiography Versus Contrast‐Enhanced Ultrasound
Author(s) -
Kim Jin Sil,
Kim Kyoung Won,
Lee Jeongjin,
Kwon HeonJu,
Kwon Jae Hyun,
Song Gi Won,
Lee Sung Gyu
Publication year - 2019
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.25588
Subject(s) - medicine , radiology , contrast enhanced ultrasound , liver transplantation , angiography , stenosis , ultrasound , anastomosis , mcnemar's test , computed tomography angiography , abnormality , occlusion , doppler ultrasound , receiver operating characteristic , transplantation , surgery , statistics , mathematics , psychiatry
The purpose of this study was to compare the diagnostic performance of computed tomography angiography (CTA) and contrast‐enhanced ultrasound (CEUS) when used to diagnose significant hepatic artery occlusion (HAO) in patients that was suspected on Doppler ultrasound (US). Among 3465 adult liver transplantations (LTs) performed between January 2010 and February 2018, 329 recipients were suspected of having HAO by Doppler US. In these patients, 139 recipients who had undergone both CTA and CEUS as second‐line studies were included. CTA and CEUS were retrospectively reviewed using the criteria for HAO used in previous studies (CTA, ≥50% stenosis at the anastomosis; CEUS, no HA enhancement or delayed and discontinuous enhancement). The diagnostic values of CTA and CEUS were compared using the McNemar test. CEUS showed statistically significant better accuracy and specificity than CTA in patients with Doppler US abnormality seen after LT (accuracy, 99.3% versus 89.2%, P < 0.001; specificity, 100% versus 83.1%, P < 0.001). CTA had 15 false‐positive diagnoses, and CEUS had 1 false‐negative diagnosis. In conclusion, CEUS showed higher specificity and positive predictive value than CTA for the diagnosis of HAO in selected patients with a Doppler US abnormality. However, even if there is no HAO diagnosed on CEUS, continuous monitoring and follow‐up imaging are required when HAO is strongly suspected in the clinical setting and on CTA.