Guillermo Gallardo, Presenter: Nothing to Disclose

Manuel Parron Pajares MD, Abstract Co-Author: Nothing to Disclose

Consuelo Prieto MD, Abstract Co-Author: Nothing to Disclose

Ignacio Pastor MD, Abstract Co-Author: Nothing to Disclose

Ramón Rodríguez-Lemos, Abstract Co-Author: Nothing to Disclose

Manuel López Santamaría MD, Abstract Co-Author: Nothing to Disclose

To compare accuracy of Doppler ultrasonography (US) and 64-slices multidetector CT (64MDCT) in the diagnosis of vascular complications after pediatric liver transplantation (PLT).

Sixty-two PLT were performed during the last 24 months. Twenty-five patients with findings of vascular complications (involving stenosis or thrombosis of hepatic artery –HA, portal vein –PV- or inferior vena cava –IVC-) in previous US underwent a 64MDCT scan. The protocol included arterial and portal phases with automatic bolus triggering (adding a systemic venous phase if IVC pathology was presumed). Automatic radiation exposure adjustment was also used. MPR, MIP and VR reformations were extensively used. Depending on MDCT findings, surgical or therapeutic angiography approach or clinical and US follow-up were assessed.

Of the 25 patients, 76% (n=19) showed agreement with previous US diagnosis, without additional or different findings of complications involving HA, PV or IVC. However, 24% (n=6) showed discrepancies. • No complications on MDCT: Two patients (n=2), one with US suspicion of PV thrombosis and one with US suspicion of HA stenosis showed no real abnormalities. • Different findings between US and MDCT: Two patients (n=3) both with US suspicion of HA thrombosis actually showed HA stenosis. PV stenosis was depicted in other patient (n=1) with normal US findings. • MDCT additional findings: One patient (n=1) showed a double HA, with thrombosis of one of them. In those patients where no alterations were detected clinical follow-up confirmed a good evolution. Patients who underwent surgery or therapeutic angiography confirmed the 64MDCT findings in all cases.

Following our data, 64MDCT presents a higher accuracy than US in diagnosis of vascular complications following PLT (up to 24%). In 8% (n=2) the 64MDCT depicted no real abnormalities, whereas in 16% (n=4) the findings were more severe or additional features were depicted. The main discrepancies arose in evaluation of HA (n=4), demonstrating the 64MDCT a better accuracy for differentiating between thrombosis and stenosis, which is crucial due to the completely different treatment.

64MDCT is an invaluable tool to asses vascular complications in PLT. Its almost immediate and robust imaging findings allow confident decisions (ie. retransplantation) with reasonable radiation doses.

Gallardo, G, Parron Pajares, M, Prieto, C, Pastor, I, Rodríguez-Lemos, R, López Santamaría, M, Vascular Complications after Pediatric Liver Transplantation: Doppler Ultrasonography versus 64-slices Multidetector CT.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6012627.html