Visibility of the graft hepatic artery using superb microvascular imaging in liver transplantation recipients: initial experience

Abstract

Background

Hepatic artery (HA) obstruction is one of the most threatening complications following liver transplantation (LT); however, conventional color Doppler imaging (CDI) suffers from technical limitations regarding the visualization of fine vessels and low-velocity blood flow.

Purpose

To test the visibility of HA in postoperative evaluation of LT using a superb microvascular imaging (SMI).

Material and Methods

This retrospective study was approved by our institutional review board. Fifty-five consecutive patients (58 grafts; mean age = 56 years) who underwent LT with Doppler ultrasonography (US) on postoperative day 1 were included. We compared the subjective visibility of HA and objective measurements of HA caliber, visible HA length on CDI, monochrome SMI (mSMI), contrast-enhanced mSMI (CE-mSMI), and contrast harmonic imaging (CHI). Reproducibility of HA caliber measurements on SMI techniques were also evaluated by using intraclass correlation coefficients (ICCs).

Results

The subjective image quality for visibility of HA tended to be graded higher with mSMI than CDI, and with CE-mSMI than mSMI (P < 0.001). The overall reproducibility of HA caliber measurements was good to excellent for both mSMI and CE-mSMI (ICC = 0.674–0.855). HA caliber measurements on mSMI and CE-mSMI strongly correlated with CHI (R = 0.785, 0.798, P < 0.001), while mean HA length on mSMI was significantly longer than on CDI (1.88 ± 0.83 vs. 1.42 ± 1.01cm, P = 0.004), and even longer on CE-mSMI (vs. 3.28 ± 1.11 cm, P < 0.001).

Conclusion

The mSMI technique shows good reproducibility and correlates well with currently used methods for postoperative evaluation of HA in LT recipients. It is further improved by administration of an US contrast agent.

Keywords

Superb microvascular imaging Doppler ultrasound imaging liver transplantation transplant recipients hepatic artery

Get full access to this article

View all access options for this article.

References

Kim

et al.

Multidetector row CT of various hepatic artery complications after living donor liver transplantation. Abdom Imaging 2007; 32: 635–643.

Abbasoglu

Levy

Vodapally

et al.

Hepatic artery stenosis after liver transplantation–incidence, presentation, treatment, and long term outcome. Transplantation 1997; 63: 250–255.

Rajakannu

Awad

Ciacio

et al.

Intention-to-treat analysis of percutaneous endovascular treatment of hepatic artery stenosis after orthotopic liver transplantation. Liver Transpl 2016; 22: 923–933.

Mun

Kim

Song

et al.

Evaluation of the hepatic artery anastomosis by intraoperative sonography with high-frequency transducer in right-lobe graft living donor liver transplantation. J Clin Ultrasound 2010; 38: 10–16.

Choi

Lee

et al.

Routine intraoperative Doppler sonography in the evaluation of complications after living-related donor liver transplantation. J Clin Ultrasound 2007; 35: 483–490.

Hom

Shrestha

Palmer

et al.

Prospective evaluation of vascular complications after liver transplantation: comparison of conventional and microbubble contrast-enhanced US. Radiology 2006; 241: 267–274.

Sidhu

Shaw

Ellis

et al.

Microbubble ultrasound contrast in the assessment of hepatic artery patency following liver transplantation: role in reducing frequency of hepatic artery arteriography. Eur Radiol 2004; 14: 21–30.

Lee

Kim

et al.

Contrast-enhanced sonography for screening of vascular complication in recipients following living donor liver transplantation. J Clin Ultrasound 2013; 41: 305–312.

Hata J. Seeing the unseen new techniques in vascular imaging, Superb Micro-Vascular Imaging. Available at: https://mfl.ssl.cdn.sdlmedia.com/636364554487093572SO.pdf (accessed November 2014).

10.

Zhan

Diao

Jin

et al.

Superb Microvascular Imaging: A new vascular detecting ultrasonographic technique for avascular breast masses: A preliminary study. Eur J Radiol 2016; 85: 915–921.

11.

Lee

Kim

Han

et al.

Superb microvascular imaging for the detection of parenchymal perfusion in normal and undescended testes in young children. Eur J Radiol 2016; 85: 649–656.

12.

et al.

The diagnostic value of superb microvascular imaging (SMI) in detecting blood flow signals of breast lesions: a preliminary study comparing SMI to color Doppler flow imaging. Medicine (Baltimore) 2015; 94: e1502.

13.

Karaca

Oral

Kantarci

et al.

Comparison of the superb microvascular imaging technique and the color Doppler techniques for evaluating children's testicular blood flow. Eur Rev Med Pharmacol Sci 2016; 20: 1947–1953.

14.

Machado

Segal

Lyshchik

et al.

A novel microvascular flow technique: initial results in thyroids. Ultrasound Q 2016; 32: 67–74.

15.

Busing

Kilian

Schaible

et al.

Reliability and validity of MR image lung volume measurement in fetuses with congenital diaphragmatic hernia and in vitro lung models. Radiology 2008; 246: 553–561.

16.

Shrout

Fleiss

. Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979; 86: 420–428.