Chaolun Li, Presenter: Nothing to Disclose

Weiping Wang MD, Abstract Co-Author: Nothing to Disclose

Eunice Kim Moon MD, Abstract Co-Author: Nothing to Disclose

John Fung, Abstract Co-Author: Nothing to Disclose

Koji Hashimoto MD, Abstract Co-Author: Nothing to Disclose

The purpose of this retrospective study is to compare the most commonly used Doppler parameters between splenic steal syndrome (SSS) patients after orthotopic liver transplantation and the control group to investigate the findings and the value of Doppler ultrasound in the diagnosis of SSS and follow-up after treatment.

A total of 51 patients with angiographic confirmed SSS (40 men, 11 women, average age of 57.7±9.9 years, age range 27-76 years) were enrolled in this study. The control group consisted of 50 liver transplant patients (40 men, 10 women, average age of 55.8±10.4 years, age range 8-75 years) with normal liver enzyme levels from the same period. The clinical data and ultrasound examination records were reviewed. All the patients were treated with proximal splenic artery embolizaion after the diagnosis of SSS was established. All the patients with SSS underwent Doppler ultrasound examination before and after the treatment. The following parameters were documented and analyzed in both groups: portal venous velocity (PVV), peak systolic velocity (PSV) of hepatic artery, resistance index (RI) of hepatic artery, and the size of spleen.

RI of the SSS group (0.94±0.08) was significantly higher than those of the control group (0.80±0.10) (P< 0.0001). RI>0.91 is the optimal threshold for the diagnosis of SSS with sensitivity of 72.0%, specificity of 80.8%, PPV of 78.9%, and NPV of 74.3% (AUC=0.81, P<0.0001). Moreover, RI tends to remain a high level in SSS patients, while it will normalize in the control group. Therefore, it may be more helpful for the diagnosis to observe the change of RI dynamically over time. There was no significant difference of PVV and PSV of hepatic artery between the two groups. After the SAE, RI significantly decreased from 0.94±0.08 to 0.77±0.11 (P< 0.0001), and PVV decreased from 87.9±25.2 cm/s to 43.1±17.7 cm/s (P< 0.0001). PSV of hepatic artery increased from 68.0±37.7 cm/s before SAE to 72.1±41.6 with no statistically significant difference (P=0.14).

A persistent high resistance hepatic arterial waveform should lead to the suspicion of SSS. RI and portal vein velocity are better indicators than hepatic arterial PSV for successful treatment of SSS.

Doppler ultrasound imaging is a useful screening method for both the diagnosis of SSS and the follow-up after treatment. 

Li, C, Wang, W, Moon, E, Fung, J, Hashimoto, K, Doppler Sonographic Findings of Splenic Steal Syndrome after Liver Transplantation.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014857.html