Contrast-Enhanced Ultrasonography in Pancreas Transplantation

Abstract

CEUS yields useful information after pancreas transplantation and has been proven a sensitive tool in the surveillance of pancreas grafts. Further studies will be needed to differentiate rejection from other posttransplantation complications using CEUS.

Dynamic Contrast‐Enhanced Ultrasound for Quantification of Tissue Perfusion

“…Human dynamic contrast‐enhanced US studies with other clinical applications apart from tumor perfusion were successfully conducted: (1) in quantifying the hepatic transit time for detecting occult liver metastases 62 ; (2) in diabetic kidneys as an instrument for detecting the severity of microvascular perfusion deficits 84 ; (3) in transplant grafts (kidney and pancreas) for predicting graft rejection 85 , 86 ; and (4) in Crohn disease for predicting therapy responses 87 , 88 …”

“…To predict early graft rejection with dynamic contrast‐enhanced US, time‐intensity curves were calculated in 14 pancreas transplant recipients, and the data were compared between normal pancreas transplants, grafts undergoing rejection, and grafts after successful treatment of the rejection episode by Kersting et al 86 The time‐intensity curves showed a significantly slower ascent and diminished maximum intensity in pancreas grafts during rejection, with a significantly reduced maximum intensity and time to peak intensity. After successful treatment of rejection, these measurements were almost restored to initial values.…”

“…Human dynamic contrast-enhanced US studies with other clinical applications apart from tumor perfusion were successfully conducted: (1) in quantifying the hepatic transit time for detecting occult liver metastases 62 ; (2) in diabetic kidneys as an instrument for detecting the severity of microvascular perfusion deficits 84 ; (3) in transplant grafts (kidney and pancreas) for predicting graft rejection 85,86 ; and (4) in Crohn disease for predicting therapy responses. 87,88 Summary and Conclusions This review concludes that dynamic contrast-enhanced US imaging is, at the moment, the most sensitive cross-sectional realtime method for measuring the perfusion of parenchymatous organs noninvasively.…”

The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version)

“…CEUS can image the microcirculation to allow evaluation of viability and may provide prognostic information [171 -173]. Early quantitative functional data shows promise in the diagnosis and management of rejection and represents a research field in transplant assessment [146,174].…”

Role of Contrast-Enhanced Ultrasound (CEUS) in Paediatric Practice: An EFSUMB Position Statement

“…Background Possible indications for the application of CEUS in children with transplantations (renal, liver, pancreas and renal combined), are likely similar to adult indications, and the application of CEUS to the imaging assessment is likely to be of substantial clinical relevance. Most adult investigations have focused on the liver [51, 85 -88] pancreas [89]and kidney [90 -95]. Assessment of a number of potential areas in the transplanted child include differentiation of incidental focal liver lesions [96], suspected post-transplant-lymphoproliferative disease (PTLD), paediatric tumour characterization before and after transplantation, depiction of vascularity, vascular patency before and after solid organ transplantation (liver [97], kidney, pancreas, bowel) or skin flaps [98], ischemic alterations such as infarction, active bleeding, graft vs. host disease (GVHD) [99] of the bowel and infectious complications after transplantation.…”