Reliability of an ultrasonographical scoring system for diagnosis of sinusoidal obstruction syndrome/veno-occlusive disease in patients with hematopoietic stem cell transplantation

Abstract

Purpose: Sinusoidal obstruction syndrome (SOS) / hepatic veno-occlusive disease (VOD) is a fatal complication after hematopoietic stem cell transplantation. We previously reported the usefulness of an ultrasonographical (US) scoring system, the Hokkaido US-based scoring system consisting of 10 parameters (HokUS-10): 1) hepatomegaly in the left lobe and 2) right lobe, 3) dilatation of the main portal vein (PV), 4) hepatofugal flow in the main PV, 5) decreased velocity of the PV, 6) dilatation of the para-umbilical vein (PUV), 7) appearance of blood flow signal in the PUV, 8) gallbladder (GB) wall thickening, 9) ascites, and 10) increased resistive index of the hepatic artery, for the diagnosis of SOS/VOD. However, the reliability of this system among operators remains elusive. Therefore, we prospectively evaluated the reliability of HokUS-10. Methods: Twenty-four healthy volunteers and 40 patients with liver dysfunction were enrolled. Inter-and intra-operator reliabilities were analyzed using three sonographers.Results: The median concordance rate of HokUS-10 among three sonographers and intra-operator in 24 volunteers was 92% (95% CI: 73-98%) and 98% (95% CI: 92-100%), respectively. In all 64 cases, in terms of the reliability between two sonographers for three representative US parameters (amount of ascites, GB wall thickening, and appearance of PUV blood flow signal), the median concordance rate was more than 98% (95% CI: 86-106%). Conclusion:The inter-and intra-reliabilities of HokUS-10 were excellent. Thus, US might be a reliable tool for SOS/VOD diagnosis.

Usefulness of ultrasonography and elastography in diagnosing oxaliplatin-induced sinusoidal obstruction syndrome

“…The results of this study allowed us to confirm the inter-examiner reproducibility of LSM evaluated by SWE. Although the inter-examiner reproducibility of HokUS-10 has already been shown [ 46 ], no previous reports investigated the reproducibility of LSM by SWE in patients with oxaliplatin-induced SOS.…”

Imaging of pediatric hematopoietic stem cell transplant recipients: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper

“…1. Grayscale and Doppler ultrasound are the first-line imaging screening studies for hepatic VOD and chronic GVHD involving the liver (Grade B; SOR 1.33, very strong recommendation) 49,[78][79][80][81][82] (Table 8). 84 6.…”

“… Grayscale and Doppler ultrasound are the first‐line imaging screening studies for hepatic VOD and chronic GVHD involving the liver (Grade B; SOR 1.33, very strong recommendation) 49,78–82 (Table 8). Abdominopelvic CT with intravenous contrast material and MR enterography are also recommended for imaging for chronic GVHD with suspected bowel involvement (Grade C; SOR 1.89, strong recommendation).…”

Low Plasma Levels of Hyaluronic Acid Might Rule Out Sinusoidal Obstruction Syndrome after Hematopoietic Stem Cell Transplantation

“…Nevertheless, it requires an expert sonographer and its role is still controversial because of nonuniformity of results [10,11]. Recently, novel simplified US scoring systems have been described (HokUS-10 and HokUS-6) [12][13][14][15] which show an excellent diagnostic value for SOS but still need to be validated in larger and prospective trials. Transjugular liver biopsy for histological evidence of SOS remains the gold standard but is invasive and difficult to perform and is therefore not mandatory for diagnosis [8,16,17].…”