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Verhagen MV, van der Doef HPJ, Kwee TC, de Haas RJ. No need for fasting prior to doppler ultrasound of pediatric liver transplants: A self-controlled study. Pediatr Transplant 2024; 28:e14622. [PMID: 37815016 DOI: 10.1111/petr.14622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Children frequently undergo routine Doppler-ultrasound (DUS) after liver transplantation (LT) for which they are fasted, but this may cause hunger and discomfort. OBJECTIVE To determine if DUS measurements, with focus on the portal vein (PV), are affected by prandial changes, and if this affects distress and feasibility of the DUS. MATERIALS AND METHODS Children were prospectively included to undergo a pre- and postprandial DUS on the same day at 6 months after LT. Pre- and anastomotic PV peak systolic velocity (PSV), and hepatic artery and hepatic vein DUS measurements were obtained. Pre- and postprandial measurements, and relative postprandial change of PV velocity ratio (VR) compared to PV anastomotic PSV, were compared using paired-sample t-tests and intraclass correlation coefficients (ICC). Obscuration by bowel gas, difficulty of DUS, and impact of fasting were assessed using 5-point rating scales. RESULTS Twenty-eight children (median age 3.5 years, IQR 1.6-10.8) were included; four were subsequently excluded because they were not fasted (N = 2) or withdrew consent for the second DUS (N = 2). Measurements between pre- and postprandial DUS, and relative postprandial change of VR compared to PV anastomotic PSV, were not significantly different (p > .05). Test consistency was good (ICC = 0.69, 95% CI = 0.29-0.67) for PV anastomotic PSV, and excellent (95% CI = 0.61-0.93) for PV VR. Obscuration by bowel gas or ease of DUS did not change after eating (p > .05). The majority (16/28, 57.2%) found fasting difficult, and several (13/28, 46.4%) got upset when fasted. CONCLUSION Children with an LT do not need to be fasted for routine DUS, which may decrease the burden of the examination.
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Affiliation(s)
- Martijn V Verhagen
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hubert P J van der Doef
- Department of Pediatric Gastroenterology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thomas C Kwee
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robbert J de Haas
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Sanchez-Garcia J, Lopez-Verdugo F, Shorti R, Krong J, Kastenberg ZJ, Walters S, Gagnon A, Paci P, Zendejas I, Alonso D, Fujita S, Contreras AG, Botha J, Esquivel CO, Rodriguez-Davalos MI. Three-dimensional Liver Model Application for Liver Transplantation. Transplantation 2024; 108:464-472. [PMID: 38259179 DOI: 10.1097/tp.0000000000004730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Children are removed from the liver transplant waitlist because of death or progressive illness. Size mismatch accounts for 30% of organ refusal. This study aimed to demonstrate that 3-dimensional (3D) technology is a feasible and accurate adjunct to organ allocation and living donor selection process. METHODS This prospective multicenter study included pediatric liver transplant candidates and living donors from January 2020 to February 2023. Patient-specific, 3D-printed liver models were used for anatomic planning, real-time evaluation during organ procurement, and surgical navigation. The primary outcome was to determine model accuracy. The secondary outcome was to determine the impact of outcomes in living donor hepatectomy. Study groups were analyzed using propensity score matching with a retrospective cohort. RESULTS Twenty-eight recipients were included. The median percentage error was -0.6% for 3D models and had the highest correlation to the actual liver explant (Pearson's R = 0.96, P < 0.001) compared with other volume calculation methods. Patient and graft survival were comparable. From 41 living donors, the median percentage error of the allograft was 12.4%. The donor-matched study group had lower central line utilization (21.4% versus 75%, P = 0.045), shorter length of stay (4 versus 7 d, P = 0.003), and lower mean comprehensive complication index (3 versus 21, P = 0.014). CONCLUSIONS Three-dimensional volume is highly correlated with actual liver explant volume and may vary across different allografts for living donation. The addition of 3D-printed liver models during the transplant evaluation and organ procurement process is a feasible and safe adjunct to the perioperative decision-making process.
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Affiliation(s)
- Jorge Sanchez-Garcia
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Fidel Lopez-Verdugo
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Rami Shorti
- Emerging Technologies, Intermountain Health, Murray, UT
| | - Jake Krong
- Transplant Research Department, Intermountain Medical Center, Murray, UT
| | - Zachary J Kastenberg
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Shannon Walters
- Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Andrew Gagnon
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Philippe Paci
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Ivan Zendejas
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Diane Alonso
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Shiro Fujita
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Alan G Contreras
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Jean Botha
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Abdominal Transplant Service, Intermountain Medical Center, Murray, UT
| | - Carlos O Esquivel
- Division of Abdominal Transplantation, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA
| | - Manuel I Rodriguez-Davalos
- Liver Center, Intermountain Primary Children's Hospital, Salt Lake City, UT
- Division of Transplant Surgery, University of Utah School of Medicine, Salt Lake City, UT
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Verhagen MV, de Kleine RH, Groen H, van der Doef HPJ, Kwee TC, de Haas RJ. Doppler-ultrasound reference values after pediatric liver transplantation: a consecutive cohort study. Eur Radiol 2023; 33:6404-6413. [PMID: 36930263 PMCID: PMC10415481 DOI: 10.1007/s00330-023-09522-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/22/2022] [Accepted: 02/03/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES Doppler ultrasound (DUS) is the main imaging modality to evaluate vascular complications of pediatric liver transplants (LT). The current study aimed to determine reference values and their change over time. METHODS A consecutive cohort of pediatric patients undergoing an LT were retrospectively included between 2015 and 2020. Timepoints for standardized DUS were intra-operative and postoperative (day 0), days 1-7, months 1 and 3, and years 1 and 2. DUS measurements of the hepatic artery (HA), portal vein (PV), and hepatic vein(s) (HV) were included if there were no complications during 2 years follow-up. Measurements consisted of: peak systolic velocity (PSV) and resistive index (RI) for the HA, PSV for the PV, and venous pulsatility index (VPI) for the HV. Generalized estimating equations were used to analyze change over time. RESULTS One hundred twelve pediatric patients with 123 LTs were included (median age 3.3 years, interquartile range 0.7-10.1). Ninety-five HAs, 100 PVs, and 115 HVs without complications were included. Reference values for HA PSV and RI, PV PSV, and HV VPI were obtained for all timepoints (4043 included data points in total) and presented using 5th-95th percentiles and threshold values. All reference values changed significantly over time (p = 0.032 to p < 0.001). CONCLUSIONS DUS reference values of hepatic vessels in children after LT are presented, reference values change over time with specific vessel-dependent patterns. Timepoint-specific reference values improve the interpretation of DUS values and may help to better weigh their clinical significance. KEY POINTS • Doppler ultrasound reference values of pediatric liver transplantations are not static but change over time. Applying the correct reference values for the specific timepoint may further improve the interpretation of the measurements. • The pattern of change over time of Doppler ultrasound measurements differs between the hepatic vessel and measurement; knowledge of these patterns may help radiologists to better understand normal postoperative hemodynamic changes.
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Affiliation(s)
- Martijn V Verhagen
- Department of Radiology, University of Groningen, University Medical Center Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands.
| | - Ruben H de Kleine
- Department of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hubert P J van der Doef
- Department of Pediatric Gastroenterology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thomas C Kwee
- Department of Radiology, University of Groningen, University Medical Center Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
| | - Robbert J de Haas
- Department of Radiology, University of Groningen, University Medical Center Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
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Chen LJ, Xin Y, Yuan MX, Ji CY, Peng YM, Yin Q. CircFOXN2 alleviates glucocorticoid- and tacrolimus-induced dyslipidemia by reducing FASN mRNA stability by binding to PTBP1 during liver transplantation. Am J Physiol Cell Physiol 2023; 325:C796-C806. [PMID: 37575056 DOI: 10.1152/ajpcell.00462.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 07/20/2023] [Accepted: 08/07/2023] [Indexed: 08/15/2023]
Abstract
We aimed to examine impacts and functional mechanism of circular RNA forkhead box N2 (FOXN2) in tacrolimus (TAC)- and dexamethasone (Dex)-induced lipid metabolism disorders. RNA level and protein contents in TAC, Dex, or combined TAC- plus Dex-treated patients and Huh-7 cells were measured utilizing quantitative real-time (qRT)-PCR and western blotting assays measured the formation of lipid droplet. Total cholesterol (TC) and triglyceride (TG) levels were determined using corresponding commercial kits and Oil red O staining. RNA immunoprecipitation and RNA pull-down verified the binding relationship among circFOXN2, polypyrimidine tract binding protein 1 (PTBP1) and fatty acid synthase (FASN). Male C57BL/6 mice were used to establish a dyslipidemia mouse model to validate the discoveries at the cellular level. Dex treatment significantly promoted TAC-mediated increase of TC and TG in serum samples and Huh-7 cells. Moreover, circFOXN2 was reduced but FASN was elevated in TAC-treated Huh-7 cells, and these expression trends were markedly enhanced by Dex cotreatment. Overexpression of circFOXN2 could reverse the accumulation of TC and TG and the upregulation of FASN and sterol regulatory element binding transcription factor 2 (SREBP2) mediated by Dex and TAC cotreatment. Mechanistically, circFOXN2 reduced FASN mRNA stability by recruiting PTBP1. The protective roles of circFOXN2 overexpression on lipid metabolism disorders were weakened by FASN overexpression. In vivo finding also disclosed that circFOXN2 greatly alleviated the dysregulation of lipid metabolism triggered by TAC plus Dex. CircFOXN2 alleviated the dysregulation of lipid metabolism induced by the combination of TAC and Dex by modulating the PTBP1/FASN axis.NEW & NOTEWORTHY Collectively, our experiments revealed for the first time that circFOXN2 alleviated the Dex- and TAC-induced dysregulation of lipid metabolism by regulating the PTBP1/FASN axis. These findings suggested that circFOXN2 and FASN might be candidate targets for the treatment of Dex- and TAC-induced metabolic disorders.
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Affiliation(s)
- Li-Jian Chen
- Department of General Surgery, Hunan Children's Hospital, Changsha, People's Republic of China
| | - Yang Xin
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Miao-Xian Yuan
- Department of General Surgery, Hunan Children's Hospital, Changsha, People's Republic of China
| | - Chun-Yi Ji
- Department of General Surgery, Hunan Children's Hospital, Changsha, People's Republic of China
| | - Yu-Ming Peng
- Department of General Surgery, Hunan Children's Hospital, Changsha, People's Republic of China
| | - Qiang Yin
- Department of General Surgery, Hunan Children's Hospital, Changsha, People's Republic of China
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Verhagen MV, Kwee TC, de Haas RJ. Hepatic artery and portal vein Doppler ultrasound reference values in children aged 0-17 years old. ULTRASOUND (LEEDS, ENGLAND) 2023; 31:112-118. [PMID: 37144228 PMCID: PMC10152319 DOI: 10.1177/1742271x221114050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/05/2022] [Indexed: 05/06/2023]
Abstract
Introduction Doppler ultrasound of the portal vein peak systolic velocity and hepatic artery peak systolic velocity and resistive index in children is often performed during abdominal ultrasound for the assessment of liver and other abdominal pathology. However, evidence-based reference values are not available. We aimed to determine these reference values and to investigate whether they are age-dependent. Methods Children who underwent abdominal ultrasound between 2020 and 2021 were retrospectively identified. Patients without hepatic or cardiac abnormalities at the time of ultrasound or during at least 3 months follow-up were eligible for the study. Ultrasound without hepatic hilum portal vein peak systolic velocity and/or hepatic artery peak systolic velocity and resistive index measurements were excluded. Age-dependent changes were analyzed using linear regression. Normal range reference values were described using percentiles for all ages, and for age subgroups. Results One-hundred ultrasound examinations performed in 100 healthy children aged 0-17.9 years (median 7.8 years, interquartile range 1.1-14.1 years) were included. Ninety-nine portal vein peak systolic velocity and 80 hepatic artery peak systolic velocity and resistive index measurements were obtained. There was no significant association between portal vein peak systolic velocity and age (β = -0.056, p = 0.68). There were significant associations between age and hepatic artery peak systolic velocity, and between age and hepatic artery resistive index (β = -0.873, p = 0.04 and β = -0.004, p < 0.001, respectively). Detailed reference values were provided for all ages, and for age subgroups. Conclusion Reference values for the hepatic hilum portal vein peak systolic velocity, hepatic artery peak systolic velocity, and hepatic artery resistive index in children were established. Portal vein peak systolic velocity is not age-dependent, whereas hepatic artery peak systolic velocity and hepatic artery resistive index decrease when children get older.
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Affiliation(s)
- Martijn V Verhagen
- Department of Radiology, University Medical Center
Groningen, University of Groningen, Groningen, The Netherlands
| | - Thomas C Kwee
- Department of Radiology, University Medical Center
Groningen, University of Groningen, Groningen, The Netherlands
| | - Robbert J de Haas
- Department of Radiology, University Medical Center
Groningen, University of Groningen, Groningen, The Netherlands
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Verhagen MV, de Kleine RH, van der Doef HP, Kwee TC, de Haas RJ. Doppler Ultrasound of Vascular Complications After Pediatric Liver
Transplantation: Incidence, Time of Detection, and Positive Predictive
Value. Ultrasound Int Open 2022; 8:E36-E42. [PMID: 36408371 PMCID: PMC9668490 DOI: 10.1055/a-1961-9100] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/13/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose
Doppler ultrasound (DUS) is widely used to detect vascular
complications after pediatric liver transplantation (LT). This study aimed to
assess the moment of first detection of vascular complications with DUS, and to
determine the positive predictive value (PPV) of DUS.
Materials and Methods
Patients aged 0–18 years who underwent LT
between 2015 and 2019 were retrospectively included. 92 LTs in 83 patients were
included (median age: 3.9 years, interquartile range: 0.7–10.5).
Patients underwent perioperative (intra-operative and immediately postoperative)
and daily DUS surveillance during the first postoperative week, and at 1, 3, and
12 months. Vascular complications were categorized for the hepatic artery,
portal vein, and hepatic veins. DUS findings were compared to surgical or
radiological findings during the 1-year follow-up.
Results
52 vascular complications were diagnosed by DUS in 35/92
LTs (38%). 15 out of 52 (28.8%) were diagnosed perioperatively,
29/52 (55.8%) were diagnosed on postoperative days 1–7,
and 8/52 (15.4%) after day 7. The PPV for all vascular
complications diagnosed with DUS was 92.3%. During the 1-year follow-up,
18/19 (94.7%) hepatic artery complications, 19/26
(73.1%) portal vein complications, and 7/7 (100%)
hepatic vein complications were diagnosed perioperatively or during the first
week.
Conclusion
The majority of vascular complications during the first year
after pediatric LT were diagnosed by DUS perioperatively or during the first
week, with a high PPV. Our findings provide important information regarding when
to expect different types of vascular complications on DUS, which might improve
DUS post-LT surveillance protocols.
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Affiliation(s)
- Martijn V. Verhagen
- Department of Radiology, UMCG, Groningen, Netherlands,Correspondence Dr. Martijn V. Verhagen UMCGDepartment of RadiologyHanzeplein 19700RB GroningenNetherlands31(0)625649708
| | - Ruben H.J. de Kleine
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and
Liver Transplantation, University of Groningen, University Medical Centre
Groningen, Groningen, Netherlands
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Hyodo R, Takehara Y, Naganawa S. 4D Flow MRI in the portal venous system: imaging and analysis methods, and clinical applications. Radiol Med 2022; 127:1181-1198. [PMID: 36123520 PMCID: PMC9587937 DOI: 10.1007/s11547-022-01553-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/29/2022] [Indexed: 02/07/2023]
Abstract
Thus far, ultrasound, CT, and 2D cine phase-contrast MRI has been adopted to evaluate blood flow and vascular morphology in the portal venous system; however, all these techniques have some shortcomings, such as limited field of view and difficulty in accurately evaluating blood flow. A new imaging technique, namely 3D cine phase-contrast (4D Flow) MRI, can acquire blood flow data of the entire abdomen at once and in a time-resolved manner, allowing visual, quantitative, and comprehensive assessment of blood flow in the portal venous system. In addition, a retrospective blood flow analysis, i.e., "retrospective flowmetry," is possible. Although the development of 4D Flow MRI for the portal system has been delayed compared to that for the arterial system owing to the lower flow velocity of the portal venous system and the presence of respiratory artifacts, several useful reports have recently been published as the technology has advanced. In the first part of this narrative review article, technical considerations of image acquisition and analysis methods of 4D Flow MRI for the portal venous system and the validations of their results are described. In the second part, the current clinical application of 4D Flow MRI for the portal venous system is reviewed.
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Affiliation(s)
- Ryota Hyodo
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Yasuo Takehara
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Hojreh A, Ba-Ssalamah A, Lang C, Poetter-Lang S, Huber WD, Tamandl D. Influence of age on gadoxetic acid disodium-induced transient respiratory motion artifacts in pediatric liver MRI. PLoS One 2022; 17:e0264069. [PMID: 35235594 PMCID: PMC8890729 DOI: 10.1371/journal.pone.0264069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 02/02/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Gd-EOB-DTPA-enhanced liver MRI is frequently compromised by transient severe motion artifacts (TSM) in the arterial phase, which limits image interpretation for the detection and differentiation of focal liver lesions and for the recognition of the arterial vasculature before and after liver transplantation. The purpose of this study was to investigate which patient factors affect TSM in children who undergo Gd-EOB-DTPA-enhanced liver MRI and whether younger children are affected as much as adolescents. METHODS One hundred and forty-eight patients (65 female, 83 male, 0.1-18.9 years old), who underwent 226 Gd-EOB-DTPA-enhanced MRIs were included retrospectively in this single-center study. The occurrence of TSM was assessed by three readers using a four-point Likert scale. The relation to age, gender, body mass index, indication for MRI, requirement for sedation, and MR repetition was investigated using uni- and multivariate logistic regression analysis. RESULTS In Gd-EOB-DTPA-enhanced MRIs, TSM occurred in 24 examinations (10.6%). Patients with TSM were significantly older than patients without TSM (median 14.3 years; range 10.1-18.1 vs. 12.4 years; range 0.1-18.9, p<0.001). TSM never appeared under sedation. Thirty of 50 scans in patients younger than 10 years were without sedation. TSM were not observed in non-sedated patients younger than 10 years of age (p = 0.028). In a logistic regression analysis, age remained the only cofactor independently associated with the occurrence of TSM (hazard ratio 9.152, p = 0.049). CONCLUSION TSM in Gd-EOB-DTPA-enhanced liver MRI do not appear in children under the age of 10 years.
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Affiliation(s)
- Azadeh Hojreh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christian Lang
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Anaesthesia, Emergency Medicine and Intensive Care, General Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - Sarah Poetter-Lang
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Wolf-Dietrich Huber
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Dietmar Tamandl
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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Verhagen MV, Dikkers R, de Kleine RH, Kwee TC, van der Doef HPJ, de Haas RJ. Assessment of hepatic artery anatomy in pediatric liver transplant recipients: MR angiography versus CT angiography. Pediatr Transplant 2021; 25:e14002. [PMID: 33729659 DOI: 10.1111/petr.14002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/27/2021] [Accepted: 02/23/2021] [Indexed: 12/15/2022]
Abstract
During LT screening, children undergo CTA to determine hepatic artery anatomy. However, CTA imparts radiation, unlike MRA. The aim was to compare MRA to CTA in assessing hepatic artery anatomy in pediatric LT recipients. Twenty-one children (median age 8.9 years) who underwent both CTA and fl3D-ce MRA before LT were retrospectively included. Interreader variability between 2 radiologists, image quality, movement artifacts, and confidence scores, were used to compare MRA to CTA. Subgroup analyses for ages <6 years and ≥6 years were performed. Interreader variability for MRA and CTA in children <6 years was comparable (k = 0.839 and k = 0.757, respectively), while in children ≥6 years CTA was superior to MRA (k 1.000 and k 0.000, respectively). Overall image quality and confidence scores of CTA were significantly higher compared to MRA at all ages (2.8/3 vs. 2.3/3, p = .001; and 2.9/3 vs. 2.5/3, p = .003, respectively). Movement artifacts were significantly lower in CTA compared to MRA in children ≥6 years (1.0/3 vs. 1.7/3, p = .010, respectively). CTA is preferred over fl3D-ce MRA for the preoperative assessment of hepatic artery anatomy in children receiving LT, both at ages <6 years and ≥6 years.
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Affiliation(s)
- Martijn V Verhagen
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Riksta Dikkers
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ruben H de Kleine
- Department of Surgery, Section HPB Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thomas C Kwee
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hubert P J van der Doef
- Department of Pediatric Gastroenterology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robbert J de Haas
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Delgado-Moraleda JJ, Ballester-Vallés C, Marti-Bonmati L. Role of imaging in the evaluation of vascular complications after liver transplantation. Insights Imaging 2019; 10:78. [PMID: 31414188 PMCID: PMC6694376 DOI: 10.1186/s13244-019-0759-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/18/2019] [Indexed: 12/15/2022] Open
Abstract
Clinical manifestations of liver transplantation complications can be subtle and non-specific. Medical imaging, mainly Doppler ultrasound, plays an important role to detect and grade these. Colour Doppler ultrasound exams are routinely performed at 24–48 h, on the 7th day, the first and third month after transplantation. MDCT and MR images are acquired based on the Doppler ultrasound (DUS) findings, even in the absence of abnormal liver function. As vascular complications appear early after surgery, DUS should be performed by experience personnel. Diagnostic angiography is seldom performed. This pictorial review illustrates the key imaging findings of vascular complications in patients with liver transplantation: hepatic artery complications (such as thrombosis, stenosis of the anastomosis and pseudoaneurysms), portal vein abnormalities (such as occlusion and stenosis) and hepatic veins and/or inferior vena cava flow changes (Budd-Chiari syndrome).
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Affiliation(s)
- Juan-José Delgado-Moraleda
- Medical Imaging Department and Biomedical Imaging Research Group (GIBI230), La Fe Polytechnics and University Hospital and Health Research Institute, Valencia, Spain.
| | - Carmen Ballester-Vallés
- Medical Imaging Department and Biomedical Imaging Research Group (GIBI230), La Fe Polytechnics and University Hospital and Health Research Institute, Valencia, Spain
| | - Luis Marti-Bonmati
- Medical Imaging Department and Biomedical Imaging Research Group (GIBI230), La Fe Polytechnics and University Hospital and Health Research Institute, Valencia, Spain
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11
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Analysis of magnetic resonance imaging findings of children with neurologic complications after liver transplantation. Radiol Med 2017; 122:617-622. [DOI: 10.1007/s11547-017-0756-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/21/2017] [Indexed: 01/01/2023]
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