Marie A. Vasher MD, Presenter: Nothing to Disclose

Danny Rafik Lababidi MD, Abstract Co-Author: Nothing to Disclose

Kamal Massis MD, Abstract Co-Author: Nothing to Disclose

Bruce R. Zwiebel MD, Abstract Co-Author: Nothing to Disclose

Dana Marie Poletto MD, Abstract Co-Author: Nothing to Disclose

Haydy Rojas RN, Abstract Co-Author: Nothing to Disclose

Yougui Wu PhD, Abstract Co-Author: Nothing to Disclose

We sought to compare Doppler ultrasound findings to transhepatic catheter portal venogram findings of hepatic transplant main portal vein stenoses, and to determine which Doppler ultrasound criteria are often the best non-invasive measures for diagnosing portal vein stenosis.

32 post-hepatic transplant transhepatic catheter portal venograms following initial Doppler ultrasound were performed at our institution on 30 patients from November 1, 2004 to May 31, 2012 due to clinical, biochemical, Doppler ultrasound, CT and/or MRI abnormalities. Doppler ultrasounds and catheter portal venograms were retrospectively reviewed. Doppler ultrasound criteria of main portal vein peak velocity, velocity step-up ratio, and change in velocity across the anastomosis were correlated with catheter portal venogram. Narrowing of the main portal vein of at least 50% on portal venogram was considered stenotic. 54 randomly chosen patients without suspicion of hepatic transplant portal anastomotic stenoses were assigned to our control group. Patients who underwent catheter portal venogram without findings of portal vein stenosis were also assigned to our control group.

Portal vein stenosis (≥50%) was identified during 25 catheter portal venograms involving 24 patients. Upon comparing patients with portal vein stenosis to those in our control group, we found that Doppler ultrasound detection of ≥50% portal vein stenosis was achieved using the following criteria: velocity step-up ratio threshold of 2.4 (yielding a sensitivity of 95% and specificity of 92%); a threshold for change in velocity across the anastomosis of 69 cm/sec (yielding a sensitivity of 95% and specificity of 72%); and a threshold for peak velocity of 220 cm/sec (yielding a sensitivity of 60% and specificity of 95%).

Doppler ultrasound criteria, namely velocity step-up ratio and change in velocity across the anastomosis, are reliable indicators of ≥50% main portal vein anastomotic stenosis on catheter portal venogram. Using our threshold values, accurate detection of main portal vein anastomotic stenosis can be achieved prior to a patient undergoing transhepatic catheter portal venogram.

Applying the Doppler ultrasound criteria yielded in our study will result in selecting the most appropriate hepatic transplant patients with main portal vein stenosis for catheter portal venogram.

Vasher, M, Lababidi, D, Massis, K, Zwiebel, B, Poletto, D, Rojas, H, Wu, Y, Non-invasive Prediction of Hepatic Transplant Portal Vein Stenosis - Experience at a Single High Volume Transplant Center.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13044147.html