Common ultrasound and contrast-enhanced ultrasonography in the diagnosis of hepatic artery pseudoaneurysm after liver transplantation

Abstract

The diagnostic value of common ultrasound and contrast-enhanced ultrasonography (CEUS) in hepatic artery pseudoaneurysm (HAP) after liver transplantation was investigated. From January 2005 to November 2015, information was collected on 2,085 cases of orthotopic liver transplantation. The cases included 1,617 men and 468 women. Common ultrasound and CEUS were used to monitor arterial blood flow following surgery, and the complications were assessed. Instruments used included Acuson Sequoia 512 and Mylab Twice, and the contrast agent was SonoVue. The standard of common ultrasound in the diagnosis of HAP was follicular structure, which had arterial blood flow signal present beside the hepatic artery. The diagnostic criteria of HAP using CEUS were abnormal and round contrast enhancement zone and perfusion of the contrast agent in the zone near the hepatic artery. The diagnostic standard of HAP was computed tomographic angiography (CTA) and emergency operation. Eight cases of HAP were diagnosed in 2,085 patients after liver transplantation (0.38%). Three cases of HAP were diagnosed successfully by common ultrasound while 5 cases were missed. Sensitivity, specificity and diagnostic accuracy for common ultrasound was 37.5, 100 and 99.76%, respectively. Six cases of HAP were diagnosed by CEUS and 2 cases were missed. Sensitivity, specificity and diagnostic accuracy for CEUS was 75, 100 and 99.9%, respectively. Collectively, CEUS is a convenient and effective diagnostic method for HAP following liver transplantation, the diagnostic sensitivity was obviously higher than that of the common ultrasound, and it was more convenient than CTA. Nevertheless, the diagnosis of pseudoaneurysm with deep location, and unsatisfactory grayscale images were easily missed.

Comments and illustrations of the WFUMB CEUS liver guidelines: Rare vascular pathology, part II

“…Typical characteristics of hepatic infarction in CEUS is non-enhancement in the arterial, portal venous and late vascular phases. The borders are smooth and unlike, for example, abscesses, there is no increased enhancement at the periphery [9,66] (fig 2). Anechoic lesions without enhancement in all vascular phases may also be seen with abscesses and liquefying hematomas.…”

“…Hepatic artery pseudoaneurysm can develop following liver transplantation [8], but may occur with a frequency between 0.06% and 0.6% also after (laparoscopic) cholecystectomy [9][10][11][12]. Non-surgical reasons include blunt abdominal trauma [13], acute pancreatitis [14,15], and very rare infectious disease of the liver such as amoebic abscess [16][17][18].…”

“…This is to exclude perfusion abnormalities in the liver. In addition, fluid accumulation and collections can be detected and evaluated [9]. In the updated WFUMB and EFSUMB Guidelines 2020, this recommendation was not specifically formulated [4,5].…”

“…We also refer to the history of ultrasound in Europe and the first guidelines on CEUS [68,69]. CEUS can also be used to delineate more accurately vascular thromboses and confirm stenoses when duplex examination is inconclusive [8,9]. In most publications, the diagnosis of hepatic infarcts was made with contrastenhanced CT (CE-CT).…”

Meta-analysis of the diagnostic value of contrast-enhanced ultrasound for the detection of vascular complications after liver transplantation

“…Relevant data extracted from all 13 studies are summarized in table 1 (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Only two studies involved more than 100 cases for CEUS evaluation.…”