超声造影在肝移植术后肝动脉血栓诊断中的应用

Application of contrast-enhanced ultrasound in diagnosis of hepatic artery thrombosis after liver transplantation

目的评估超声造影在肝移植术后肝动脉血栓(HAT)诊断中的价值。方法 2004年1月至2012年8月在四川大学华西医院肝移植中心行肝移植手术的患者810例。患者术后均接受了彩色多普勒超声(彩超)检查,其中有58例怀疑HAT,从而继续接受超声造影检查。以肝动脉血管造影、手术结果和临床随访作为金标准,计算超声造影诊断HAT的敏感度、特异度、准确度、阳性预测值及阴性预测值。结果超声造影诊断16例HAT,正确诊断15例,误诊1例,无漏诊病例。超声造影诊断HAT的敏感度、特异度、准确度、阳性预测值及阴性预测值分别为1.0、0.977、0.983、0.938和1.0。本组患者HAT发生率和病死率分别为1.9%和53%。结论肝移植术后彩超检查怀疑HAT时应立即行超声造影检查,超声造影诊断肝动脉通畅的患者可避免肝动脉血管造影检查。

Objective To assess the value of contrast-enhanced ultrasound （CEUS） in the diagnosis of hepatic artery thrombosis （HAT） after liver transplantation. Methods From January 2004 to August 2012, 810 patients who underwent liver transplantation in Liver Transplantation Center of West China Hospital of Sichuan University were enrolled in this study. All the recipients received Doppler ultrasound scanning after operation. CEUS examination was performed in 58 patients with suspected HAT. Based on the gold standards of hepatic artery angiography, surgical outcome and clinical follow-up, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CEUS in diagnosing HAT were calculated. Results Sixteen cases were diagnosed with HAT by CEUS, in which 15 were confirmed, one was misdiagnosed and no case was missed. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CEUS in diagnosing HAT were 1.0, 0. 977, 0. 983, O. 958 and 1.0 respectively. The incidence and mortality of HAT were 1.9%, 53% respectively in the study. Conclusions When suspected with HAT by Doppler ultrasound after liver transplantation, patients should immediately receive CEUS. Patients with unobstructed hepatic artery diagnosed by CEUS can avoid receiving hepatic artery angiography.