Contrast-enhanced ultrasound in liver transplant: First results and potential for complications in the postoperative period

Clevert, D.‐A.; Stickel, M.; Minaifar, N.; Löhe, F.; Graeb, Christian; Jauch, Karl‐Walter; Reiser, Maximilian

doi:10.3233/ch-2009-1223

Cited by 33 publications

(16 citation statements)

References 20 publications

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“…Lack of visualization of the arterial tree, expected to be seen before portal enhancement, indicates complete arterial thrombosis with very high positive predictive values [10,32,99,131]. Identification of the arterial branches when conventional Doppler has failed [131], may allow subsequent targeted Doppler reassessment, which is needed to distinguish thrombosis from slow flow caused by vasoconstriction or splenic steal from postthrombotic/stenotic recanalization, tasks not achievable using CEUS alone.…”

Section: Image Interpretationmentioning

confidence: 99%

“…Before liver transplantation, CEUS is indicated to assess portal vein thrombosis and characterize focal liver lesions in cirrhosis. After liver transplantation, CEUS can be performed at the bedside or in the intensive care unit, avoiding most of the risks associated with CECT or angiography [10,32,63,100,154]. CEUS is indicated for:…”

Section: Indicationsmentioning

confidence: 99%

“…Quantitative analyses of the TIC can be performed to determine functional features that characterize the TIC with or without curve fitting. Several functional features can be studied [87]: ▶ Related to fractional blood volume: peak intensity (PI); area under the curve (AUC) [32]; area under the wash in (AUWI); under the wash out (AUWO). ▶ Related to blood flow: time to peak intensity (TPI); slope of the wash in (SWI).…”

Section: Administration Of Uca and Quantitative Analysis 731 Bolusmentioning

confidence: 99%

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Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver – Update 2012

et al. 2012

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Initially, a set of guidelines for the use of ultrasound contrast agents was published in 2004 dealing only with liver applications. A second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some non-liver applications. Time has moved on, and the need for international guidelines on the use of CEUS in the liver has become apparent. The present document describes the third iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS) using contrast specific imaging techniques. This joint WFUMB-EFSUMB initiative has implicated experts from major leading ultrasound societies worldwide. These liver CEUS guidelines are simultaneously published in the official journals of both organizing federations (i.e., Ultrasound in Medicine and Biology for WFUMB and Ultraschall in der Medizin/European Journal of Ultrasound for EFSUMB). These guidelines and recommendations provide general advice on the use of all currently clinically available ultrasound contrast agents (UCA). They are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis and improve the management of patients worldwide.

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Section: Image Interpretationmentioning

confidence: 99%

Section: Indicationsmentioning

confidence: 99%

Section: Administration Of Uca and Quantitative Analysis 731 Bolusmentioning

confidence: 99%

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Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver – Update 2012

et al. 2012

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“…This study also demonstrated the potential advantage of GLCM analyses to evaluate vascular damage in resource‐challenged settings where contrast enhancement may not be available. This study adds to the repertoire of some recent studies where vascular anatomy has been assessed after liver transplantation. Our study correlates the ultrasound imaging with the molecular changes during ex vivo storage of livers for the first time.…”

Section: Discussionmentioning

confidence: 94%

Evaluation of hepatic vascular endothelial injury during liver storage by molecular detection and targeted contrast‐enhanced ultrasound imaging

et al. 2015

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We hypothesized that lack of the high-energy phosphates during liver storage may potentially cause persistent injury to the vascular endothelium. Biopsies were obtained from livers obtained from beating heart human donors, stored either in the standard storage solution, that is, University of Wisconsin solution (UWS) or Celsior, and examined for various markers related to progressive endothelial injury. The expression of P2Y1 receptor, the major signal transduction machinery for adenosine triphosphate/adenosine diphosphate, decreased in hepatic vascular endothelial cells over time. Despite unaltered endothelial nitric oxide synthase (eNOS) levels, serine1177-phosphorylated eNOS, the active form of eNOS, progressively decreased with time. The production of nitric oxide enzyme decreased with time when liver tissues were examined in vitro. This also coincided with decreased interaction of eNOS with actin nucleating proteins like myristoylated alanine-rich C kinase substrate and Rac1, which plays a role in modulating the cytoskeleton and helps position eNOS in a favorable cytosolic position for active enzymatic activity. Conversely, the interaction of eNOS with caveolin1 was significantly increased 6 H after ex vivo storage. Finally, we demonstrated by targeted contrast-enhanced ultrasound that membrane-bound vascular cell adhesion molecule-1 in the hepatic vascular endothelial cell increased after 6 H of ex vivo storage. Overall, the results of this study provide evidence of a progressive hepatic vascular endothelial injury during the ex vivo storage. This may be a causative factor for ischemic cholangiopathy and delayed graft function post liver transplantation. V C 2015 IUBMB Life, 68(1): [51][52][53][54][55][56][57] 2015

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“…Consequently, the morphological changes in the contrast‐enhanced blood signal beam are considered the critical factors for distinguishing stenosis from SASS 23. Recently, CEUS has been widely used to detect hepatic artery stenosis and thrombosis as well as complications of bile ducts 23, 24. To our knowledge, this is the first investigation devoted to the use of CEUS for the diagnosis of SASS.…”

Section: Discussionmentioning

confidence: 98%

Contrast-enhanced ultrasound diagnosis of splenic artery steal syndrome after orthotopic liver transplantation

et al. 2012

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The aim of this study was to investigate the use of contrast-enhanced ultrasound (CEUS) for the detection of splenic artery steal syndrome (SASS) after orthotopic liver transplantation (OLT). Two hundred forty-seven patients underwent OLT. Blood tests and color Doppler flow imaging (CDFI) were performed at various time points after the operation. CEUS and celiac angiography were used for patients suspected of having SASS. If the diagnosis of SASS was confirmed, splenic artery embolization was performed to enhance hepatic artery flow. CEUS and angiography were performed for the assessment of postinterventional clinical outcomes. Three of the 247 patients died postoperatively, and 8 patients were suspected of having SASS because of elevated liver enzyme levels and slim or undetectable hepatic artery blood signals by CDFI at various points after the operation. In these 8 patients, CEUS showed a delayed and weak contrast-enhanced blood signal in the hepatic artery associated with a rapid and intense enhancement of the portal vein blood. No narrowing of the hyperintense signal was observed in the hepatic artery by CEUS. The 8 diagnoses of SASS were proven by celiac angiography, which showed delayed perfusion of the hepatic artery and rapid filling of the splenic artery. Immediately after the interventional procedure, CEUS demonstrated a significantly enlarged hyperintense blood signal in the hepatic artery. In conclusion, approximately 3.27% of SASS cases occur after OLT. SASS can be identified as a sluggish and weak hyperintense blood signal in the hepatic artery without the narrowing and interruption of the hypointense signal in CEUS imaging. CEUS is an effective imaging modality for the detection of SASS after OLT. Liver Transpl 18:966-971, 2012. V C 2012 AASLD.

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Contrast-enhanced ultrasound in liver transplant: First results and potential for complications in the postoperative period

Cited by 33 publications

References 20 publications

Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver – Update 2012

Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver – Update 2012

Evaluation of hepatic vascular endothelial injury during liver storage by molecular detection and targeted contrast‐enhanced ultrasound imaging

Contrast-enhanced ultrasound diagnosis of splenic artery steal syndrome after orthotopic liver transplantation

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