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Multi-slice spiral CT of living-related liver transplantation in children: pictorial essay.

Choi SH, Goo HW, Yoon CH - Korean J Radiol (2004 Jul-Sep)

Bottom Line: Multiplanar and three-dimensional imaging using multi-slice spiral CT can be used for preoperative vascular imaging, as well as for evaluating postoperative complications.In this essay, we describe the usefulness of multi-slice CT, combined with a variety of different reconstruction techniques, for the preoperative evaluation of transplant recipients.In addition, we demonstrate the multi-slice CT findings of postoperative complications, including vascular stenosis or thrombosis, bile duct leak or stricture, and extrahepatic fluid collection.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea.

ABSTRACT
In pediatric living-related liver transplantation, preoperative evaluation of the recipient is important for surgical planning, while the accurate diagnosis of postoperative complications is essential for graft salvage. Multiplanar and three-dimensional imaging using multi-slice spiral CT can be used for preoperative vascular imaging, as well as for evaluating postoperative complications. In this essay, we describe the usefulness of multi-slice CT, combined with a variety of different reconstruction techniques, for the preoperative evaluation of transplant recipients. In addition, we demonstrate the multi-slice CT findings of postoperative complications, including vascular stenosis or thrombosis, bile duct leak or stricture, and extrahepatic fluid collection.

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Hepatic artery stenosis in an 11-year-old girl, 18 days after living-related liver transplantation to treat fulminant hepatitis.
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Figure 13: Hepatic artery stenosis in an 11-year-old girl, 18 days after living-related liver transplantation to treat fulminant hepatitis.

Mentions: Hepatic artery thrombosis is the most common vascular complication, occurring in 9% to 42% of children receiving transplants (9). Hepatic artery thrombosis most often occurs within the first 2 months after transplantation and frequently results in graft failure, leading to increased morbidity and mortality. Recent technical advances, including microscopic surgery, the use of anticoagulants such as aspirin and low molecular weight heparin, and the use of intraoperative Doppler ultrasound (US), have reduced the incidence of hepatic arterial thrombosis (10). Doppler US is commonly used to detect hepatic artery stenosis or thrombosis through the detection of hemodynamic changes. However, Doppler US may not directly visualize the stenosed hepatic artery and, unlike CT, the accuracy of its findings may be dependent on the skill of the individual sonographer and on the patient's body habitus. In contrast, CT angiography using multi-slice CT can accurately depict the location and extent of stenosis and thrombosis of the hepatic artery with excellent spatial resolution (11) (Figs. 13A, 13B). In addition, CT may be able to better demonstrate any parenchymal abnormality of the transplanted liver. On CT, hepatic infarction is well delineated as an irregular and wedge-shaped low-attenuation lesion located at the periphery of the liver (Fig. 13C). However, the CT findings need to be carefully evaluated, because CT angiography tends to overestimate stenosis and is limited by poor visualization of the distal small branches. In addition, surgical clips at the anastomosis site of the hepatic artery can cause beam hardening artifacts, which may complicate the assessment of the patency of the arterial anastomosis site. Targeted reformatting with a thin slab thickness may mitigate such artifacts around the anastomosis site.


Multi-slice spiral CT of living-related liver transplantation in children: pictorial essay.

Choi SH, Goo HW, Yoon CH - Korean J Radiol (2004 Jul-Sep)

Hepatic artery stenosis in an 11-year-old girl, 18 days after living-related liver transplantation to treat fulminant hepatitis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698162&req=5

Figure 13: Hepatic artery stenosis in an 11-year-old girl, 18 days after living-related liver transplantation to treat fulminant hepatitis.
Mentions: Hepatic artery thrombosis is the most common vascular complication, occurring in 9% to 42% of children receiving transplants (9). Hepatic artery thrombosis most often occurs within the first 2 months after transplantation and frequently results in graft failure, leading to increased morbidity and mortality. Recent technical advances, including microscopic surgery, the use of anticoagulants such as aspirin and low molecular weight heparin, and the use of intraoperative Doppler ultrasound (US), have reduced the incidence of hepatic arterial thrombosis (10). Doppler US is commonly used to detect hepatic artery stenosis or thrombosis through the detection of hemodynamic changes. However, Doppler US may not directly visualize the stenosed hepatic artery and, unlike CT, the accuracy of its findings may be dependent on the skill of the individual sonographer and on the patient's body habitus. In contrast, CT angiography using multi-slice CT can accurately depict the location and extent of stenosis and thrombosis of the hepatic artery with excellent spatial resolution (11) (Figs. 13A, 13B). In addition, CT may be able to better demonstrate any parenchymal abnormality of the transplanted liver. On CT, hepatic infarction is well delineated as an irregular and wedge-shaped low-attenuation lesion located at the periphery of the liver (Fig. 13C). However, the CT findings need to be carefully evaluated, because CT angiography tends to overestimate stenosis and is limited by poor visualization of the distal small branches. In addition, surgical clips at the anastomosis site of the hepatic artery can cause beam hardening artifacts, which may complicate the assessment of the patency of the arterial anastomosis site. Targeted reformatting with a thin slab thickness may mitigate such artifacts around the anastomosis site.

Bottom Line: Multiplanar and three-dimensional imaging using multi-slice spiral CT can be used for preoperative vascular imaging, as well as for evaluating postoperative complications.In this essay, we describe the usefulness of multi-slice CT, combined with a variety of different reconstruction techniques, for the preoperative evaluation of transplant recipients.In addition, we demonstrate the multi-slice CT findings of postoperative complications, including vascular stenosis or thrombosis, bile duct leak or stricture, and extrahepatic fluid collection.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea.

ABSTRACT
In pediatric living-related liver transplantation, preoperative evaluation of the recipient is important for surgical planning, while the accurate diagnosis of postoperative complications is essential for graft salvage. Multiplanar and three-dimensional imaging using multi-slice spiral CT can be used for preoperative vascular imaging, as well as for evaluating postoperative complications. In this essay, we describe the usefulness of multi-slice CT, combined with a variety of different reconstruction techniques, for the preoperative evaluation of transplant recipients. In addition, we demonstrate the multi-slice CT findings of postoperative complications, including vascular stenosis or thrombosis, bile duct leak or stricture, and extrahepatic fluid collection.

Show MeSH
Related in: MedlinePlus