Abstract Archives of the RSNA, 2009
Gilbert Whang MD, Presenter: Nothing to Disclose
Suzanne Palmer MD, Abstract Co-Author: Nothing to Disclose
Yelena Desyatnikov, Abstract Co-Author: Nothing to Disclose
Banafsheh Peyvandi MD, Abstract Co-Author: Nothing to Disclose
Maria V. Stapfer MD, Abstract Co-Author: Nothing to Disclose
Edward Gary Grant MD, Abstract Co-Author: Nothing to Disclose
The purpose of our study was to determine the clinical and radiologic relevance of elevated portal vein velocities as identified by Doppler ultrasound using recently published threshold velocity.
Our study consisted of a retrospective review of all available Doppler sonographic studies of 290 adult transplant (cadaveric whole liver) patients performed at our institution between 2003 and 2008. Evaluations included detailed examination of gray-scale, color-flow and Doppler duplex images of the portal veins. Angle adjusted peak velocity measurements were obtained from the main, right and left portal veins (including the area of anastomosis). Based on a recent publication (Chong WK et al. AJR 2007), a peak portal vein velocity greater than 125 cm/sec was used to stratify those with suspected significant portal venous obstruction.
The average peak anastomotic velocity was 43 cm/sec with a standard deviation of 30 and median of 36. Velocities ranged between 9 and 221 cm/sec. 15 patients among 290 (5.2%) were identified as having main portal vein velocity greater than 125 cm/sec. The average peak anastomotic velocity in this group was 166 cm/sec. A review of these patients showed that elevated velocity was identified in 13 of 15 patients within the first 7 days after transplantation (average – 1.8 days). Follow-up ultrasounds were available in 12 of these patients and all showed a fall in velocity within the normal range without any intervention (range of 1-90 days; average – 22.6 days). All those patients who underwent follow-up ultrasounds within the 1st week showed normalization of velocity at that time. Only 2 patients out of 290 patients were found to have portal vein velocity greater than 125 cm/sec beyond the immediate postoperative period. MRI and CT examinations confirmed stenosis. In one case, a Whipple procedure preceded the identification of the elevated velocity.
When identified in the immediate postoperative period, elevated portal vein velocity appears to be a transient phenomenon. Surveillance ultrasounds are sufficient for follow-up and more invasive measures are unnecessary. True portal vein stenosis is extremely rare in our patient population.
Elevated portal vein velocity on Doppler studies may be a transient phenomenon and surveillance ultrasounds are sufficient for follow-up.
Significance of Elevated Portal Vein Velocity by Doppler in Cadaveric Liver Transplants. Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8012808.html