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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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Related in: MedlinePlus

Portal vein obstruction in a 7-year-old girl, 7 years after living-related liver transplantation to treat biliary atresia. Volume rendering image shows complete obstruction of the main portal vein (arrowheads). Multiple collateral vessels (*) arising from the superior mesenteric vein (SMV) reconstituted the intrahepatic portal veins (arrows). SV = splenic vein
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Figure 16: Portal vein obstruction in a 7-year-old girl, 7 years after living-related liver transplantation to treat biliary atresia. Volume rendering image shows complete obstruction of the main portal vein (arrowheads). Multiple collateral vessels (*) arising from the superior mesenteric vein (SMV) reconstituted the intrahepatic portal veins (arrows). SV = splenic vein

Mentions: Portal vein complications following liver transplantation are relatively uncommon, with an incidence of only 1% to 6% (12). They may result from the use of faulty surgical techniques, the excessive length of the interposed vascular graft, vessel misalignment, hypercoagulable states, previous portal vein surgery or previous portal vein thrombosis (9). Significant portal vein stenosis (Fig. 15) may be difficult to diagnose with CT or other noninvasive imaging techniques, because mild or insignificant narrowing of portal venous anastomosis is a common finding, which may result from discrepancies between the calibers of the donor and recipient portal veins or from a plication deformity. In the absence of portal hypertension, this finding has no clinical significance (13). Significant portal vein stenosis can be suspected, however, if the poststenotic dilatation of the portal vein is found to have progressed on a follow up CT scan. In addition, portal hypertension may be suspected when a follow up CT scan reveals increased spleen size, the development or increase of spontaneous collaterals, or an increase in the amount of ascites. Thus, initial CT angiography obtained during the early postoperative period should be used as the baseline for comparison with follow-up CT angiography. By comparing the initial and follow-up MPR images obtained in the same plane, subtle changes in the diameter of the portal vein can be detected. In addition, the effect of the growth of the transplanted liver should be considered when evaluating the portal vein, because the enlarged transplanted liver may compress the intrahepatic portion of the intact portal vein, thereby resulting in a false diagnosis of portal vein stenosis. On the other hand, portal vein thrombosis can be observed as a low-attenuation filling defect in the portal vein during contrast-enhanced CT. In some instances, the stenosed extrahepatic portal vein may be completely occluded (Fig. 16), and its early detection is important for successful interventional reopening of the occluded portal vein. Multi-slice CT with variable reconstruction techniques can provide excellent visualization of stenosis, thrombosis and obstruction of the portal vein (11).


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)

Portal vein obstruction in a 7-year-old girl, 7 years after living-related liver transplantation to treat biliary atresia. Volume rendering image shows complete obstruction of the main portal vein (arrowheads). Multiple collateral vessels (*) arising from the superior mesenteric vein (SMV) reconstituted the intrahepatic portal veins (arrows). SV = splenic vein
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 16: Portal vein obstruction in a 7-year-old girl, 7 years after living-related liver transplantation to treat biliary atresia. Volume rendering image shows complete obstruction of the main portal vein (arrowheads). Multiple collateral vessels (*) arising from the superior mesenteric vein (SMV) reconstituted the intrahepatic portal veins (arrows). SV = splenic vein
Mentions: Portal vein complications following liver transplantation are relatively uncommon, with an incidence of only 1% to 6% (12). They may result from the use of faulty surgical techniques, the excessive length of the interposed vascular graft, vessel misalignment, hypercoagulable states, previous portal vein surgery or previous portal vein thrombosis (9). Significant portal vein stenosis (Fig. 15) may be difficult to diagnose with CT or other noninvasive imaging techniques, because mild or insignificant narrowing of portal venous anastomosis is a common finding, which may result from discrepancies between the calibers of the donor and recipient portal veins or from a plication deformity. In the absence of portal hypertension, this finding has no clinical significance (13). Significant portal vein stenosis can be suspected, however, if the poststenotic dilatation of the portal vein is found to have progressed on a follow up CT scan. In addition, portal hypertension may be suspected when a follow up CT scan reveals increased spleen size, the development or increase of spontaneous collaterals, or an increase in the amount of ascites. Thus, initial CT angiography obtained during the early postoperative period should be used as the baseline for comparison with follow-up CT angiography. By comparing the initial and follow-up MPR images obtained in the same plane, subtle changes in the diameter of the portal vein can be detected. In addition, the effect of the growth of the transplanted liver should be considered when evaluating the portal vein, because the enlarged transplanted liver may compress the intrahepatic portion of the intact portal vein, thereby resulting in a false diagnosis of portal vein stenosis. On the other hand, portal vein thrombosis can be observed as a low-attenuation filling defect in the portal vein during contrast-enhanced CT. In some instances, the stenosed extrahepatic portal vein may be completely occluded (Fig. 16), and its early detection is important for successful interventional reopening of the occluded portal vein. Multi-slice CT with variable reconstruction techniques can provide excellent visualization of stenosis, thrombosis and obstruction of the portal vein (11).

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