多模态超声造影诊断肝移植术后动脉并发症应用价值分析  

Application of multimodal contrast-enhanced ultrasound in diagnosing arterial complications in recipients of liver transplantation

作　　者：郭江红 杨晶[2] 王欢 Guo Jianghong;Yang Jing;Wang Huan(Department of Ultrasound,Gaoxin Hospital,Xi'an 710070,Shaanxi Province,China)

机构地区：[1]西安高新医院超声科,西安市710070 [2]西安医学院第一附属医院超声医学科

出　　处：《实用肝脏病杂志》2025年第2期294-297,共4页Journal of Practical Hepatology

基　　金：陕西省科技厅重点研发计划项目(编号:2019SF-008)。

摘　　要：目的探讨多模态超声造影诊断肝移植(LT)术后动脉并发症的应用价值。方法2019年5月~2024年5月我院进行LT治疗患者79例,以数字减影血管造影(DSA)为诊断动脉并发症的“金标准”,分别采用二维灰阶超声成像、彩色多普勒血流成像(CDFI)、脉冲波多普勒成像(PW)和超声造影成像技术(CEUS)检查,早期发现动脉并发症,应用受试者工作特征曲线(ROC)评估诊断效能。结果经DSA检查,发现本组患者LT术后动脉正常者39例(49.4%),发生动脉并发症者40例(50.6%),其中血栓形成16例,血管狭窄13例,脾动脉盗血综合征6例和动脉瘤5例;在35例原发病为肝硬化、20例为肝衰竭和24例为原发性肝癌患者,LT术后动脉并发症发生率无显著性差异(P>0.05);CEUS诊断的敏感度、特异度、准确性、阳性预测值和阴性预测值分别为90.0%、97.4%、93.7%、97.3%和90.5%,而常规超声检查诊断则分别为97.5%(P<0.05)、89.7%(P<0.05)、93.7%、90.7%和97.2%。结论采用CEUS检查可能较为准确地诊断LT术后动脉并发症的发生,但其敏感性稍差,应予以注意。Objective The aim of this study was to investigate the diagnostic efficacy of multimodal contrast-enhanced ultrasound(CEUS)in diagnosing arterial complications(AC)in recipients of liver transplantation(LT).Methods A cohort of 79 patients with end-stage liver diseases were encountered in our hospital between May 2019 and May 2024,and all patients underwent orthotopic liver transplantation(OLT).After the operation,digital subtraction angiography(DSA)as golden criteria,2D grey-scale ultrasonography,color Doppler imaging(CDI),spectral Doppler and pulsed wave Doppler imaging,and CEUS were conducted.Receiver operating characteristic curve(ROC)was applied to evaluate diagnostic performance.Results DSA showed normal hepatic arteries in 39 cases(49.4%),and ACs in 40 cases(50.6%)in our 79 recipients of LT,and of which were hepatic artery thrombosis(HAT)in 16 cases,hepatic artery stricture(HAS)in 13 cases,splenic arterial steal syndrome(ASS)in 6 cases and splenic artery aneurysm in 5 cases;there were no significant differences as respect to prevalence of ACs after OLT among patients with underlying liver cirrhosis in 35 cases,liver failure in 20 cases and primary liver cancers in 24 cases(P>0.05);the sensitivity,specificity,accuracy,positive predictive value and negative predictive value by CEUS in finding ACs were 90.0%,97.4%,93.7%,97.3% and 90.5%,while they were 97.5%(P<0.05),89.7%(P<0.05),93.7%,90.7%and 97.2%by conventional ultrasonography.Conclusions CEUS check-up for ACs could help clinicians make appropriate measures early and might improve the prognosis of recipients in this setting.

关 键 词：肝移植 动脉并发症 超声造影 诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学] R657.3[医药卫生—诊断学]