Yang Shin Park MD, Presenter: Nothing to Disclose

Kyoung Won Kim MD, Abstract Co-Author: Nothing to Disclose

Gi-Won Song, Abstract Co-Author: Nothing to Disclose

Shin Hwang MD, Abstract Co-Author: Nothing to Disclose

Sung Gyu Lee MD, Abstract Co-Author: Nothing to Disclose

To evaluate diagnostic values of conventional tardus parvus(TP) waveform of hepatic artery(HA) on Doppler sonography for significant HA stenosis(HAS) in recipients of liver transplantation(LT) and to determine if there is an additional value to combine optimal cutoff value for peak systolic velocity(PSV).

We searched LT database in our institution and found 252 patients (M:F=188:64; mean age±SD, 50.7±9.3yrs) who underwent LT from January to October 2009. They underwent 2180 Doppler sonography and 863 CT examinations before the discharge. First, we reviewed Doppler reports to find if conventional TP pattern of HA was noted, which was defined as waveform with resistive index <0.5 and systolic acceleration time >0.08 seconds, and CT scans nearest to the sonography were matched for review in these cases. When there was no episode of TP waveform on Doppler sonography, all the CT scans were included for review. On CT scans, we evaluated percentage stenosis of HA at anastomosis and, accordingly, patients were categorized into HAS(>50% stenosis) and non-HAS group. We evaluated the diagnostic values of conventional TP for HAS. In recipients with TP waveform of HA, we evaluated PSV as well and ROC analysis was performed to determine the optimal cutoff value for PSV to diagnose HAS. Diagnostic values were re-established with combination of conventional TP pattern and optimal cutoff for PSV.

Episode of conventional TP was noted in 42(16.7%) patients on Doppler sonography. On CT, 20 patients were categorized into HAS group and 232 belonged to non-HAS group. Sensitivity, specificity, positive predictive value(PPV), and negative predictive value of conventional TP were 60%, 87.1%, 28.6%, and 96.2%, respectively. False-positive rate was 71.4%. ROC analysis revealed optimal cutoff value for PSV of HA as <42 cm/sec with sensitivity of 91.7% and specificity of 86.7%. Combination of conventional TP pattern and PSV <42 cm/sec improved specificity to 98.3% and PPV to 71.4%.

Conventional TP waveform of HA produced relatively low specificity and poor PPV with high false-positive rate. Combination of conventional TP pattern and optimal cutoff for PSV greatly improves the specificity and PPV to diagnose HAS.

Acknowledgement of high false positive rate of TP waveform and combination of TP pattern and optimal cutoff for PSV could enhance accurate diagnosis of HAS on Doppler sonography.

Park, Y, Kim, K, Song, G, Hwang, S, Lee, S, Hepatic Artery Stenosis after Liver Transplantation: Frequent False Positive Diagnoses with Conventional Tardus Parvus Waveform and Additional Value to Combine Optimal Cutoff for Peak Systolic Velocity.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9007439.html