超声造影在肝移植术后肝动脉并发症中的应用价值

The application value of contrast-enhanced ultrasound in the diagnosis of hepatic artery complications after liver transplantation

目的探讨超声造影(CEUS)在肝移植术后肝动脉并发症中的应用价值。方法回顾性分析2015年8月至2022年12月在青岛大学附属医院器官移植中心行肝移植手术的858例成人受者临床资料。肝移植术后定期行常规超声检查,对彩色多普勒血流显像(CDFI)结果提示可疑肝动脉病变的29例受者进一步行CEUS检查。依据数字减影血管造影(DSA)、计算机体层血管成像(CTA)或手术结果判断CEUS诊断肝动脉并发症的准确性。正态分布计量资料组间比较采用配对t检验,计量资料组间比较采用Fisher确切概率法。P<0.05为差异具有统计学意义。结果29例CDFI检查提示可疑肝动脉病变的受者中,怀疑肝动脉血栓(HAT)15例、肝动脉狭窄(HAS)1例和脾动脉盗血综合征(SASS)13例。进一步行CEUS检查,诊断为HAT 9例、HAS1例、SASS 9例。经DSA、CTA或手术结果证实,共17例存在肝动脉并发症,分别为HAT 8例(其中1例为肝动脉夹层合并HAT)、HAS1例和SASS 8例。CDFI和CEUS检测肝动脉并发症的准确率分别为58.6%(17/29)、89.5%(17/19),差异有统计学意义(P=0.026)。CUES诊断肝动脉并发症的敏感度、特异度和一致率分别为100%(16/16)、76.9%(10/13)和89.7%(26/29)。HAT的CEUS表现为肝动脉在动脉期乃至门脉期在门静脉周围未见显影。SASS的CEUS表现为门静脉内增强信号明显,肝动脉晚于脾动脉和或门静脉显影,肝内动脉显影暗淡。HAS的CEUS表现为肝门区肝动脉血流纤细,吻合口处狭窄。结论CEUS在肝移植术后肝动脉并发症的诊断中具有重要的作用。当常规超声怀疑肝动脉异常时,应立即行CEUS检查,有利于早期发现肝动脉并发症。

Objective To investigate the diagnostic value of contrast-enhanced ultrasound(CEUS)in hepatic artery complications after liver transplantation.Methods The clinical data of 858 patients who underwent liver transplantation in the Organ Transplant Center of the Affiliated Hospital of Qingdao University from August 2015 to December 2022 were retrospectively analyzed.Regular ultrasound examination was performed after liver transplantation,and CEUS examination was performed in 29 patients with suspicious hepatic artery lesions indicated by color Doppler flow imaging(CDFI).Digital subtraction angiography(DSA),computerized tomography angiography(CTA)or surgical results were used to determine the accuracy of CEUS in diagnosing hepatic arterial complications.The paired t test was used for comparison between normal distribution data groups,and Fisher exact probability method was used for comparison between data groups.P<0.05 was considered statistically significant.Results Further CEUS examination was performed on 29 patients with suspected hepatic artery disease indicated by CDFI examination,and 9 cases were diagnosed as hepatic artery thrombosis(HAT),1 case as hepatic artery stenosis(HAS),and 9 cases as splenic artery stealing blood syndrome(SASS).According to DSA,CTA or surgical results,a total of 17 cases of hepatic arterial complications were confirmed,including 8 cases of HAT(including 1 case of hepatic artery dissection with HAT),1 case of HAS and 8 cases of SASS.The accuracy of CDFI and CEUS in detecting hepatic artery complications was 58.6%(17/29)and 89.5%(17/19),respectively,with statistical significance(P=0.026).The sensitivity,specificity and consistency rates of CUES in diagnosing hepatic artery complications were 100%(16/16),76.9%(10/13)and 89.7%(26/29),respectively.The CEUS of HAT showed that the hepatic artery did not develop around the portal vein in the arterial stage or even in the portal vein stage.The CEUS of SASS showed obvious enhancement signal in portal vein,hepatic artery was developed later than splenic artery and/or portal vein,and intrahepatic artery was dim.The CEUS of HAS showed thin hepatic artery flow and anastomotic stenosis in the hepatic portal area.Conclusions CEUS plays an important role in the diagnosis of hepatic arterial complications after liver transplantation.When hepatic artery abnormalities are suspected by routine ultrasound,CEUS examination should be performed immediately,which is conducive to early detection of hepatic artery complications.