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CEUS Liver: Transplant Evaluation
Gibran Timothy Yusuf, BSc (Hons), MBBS, FRCR; Maria Cristina Chammas, MD, PhD; Dirk Clevert, MD
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KEY FACTS

  • Imaging Anatomy

    • Posttransplant Complications

      TERMINOLOGY

      • Definitions

        • Orthotopic liver transplant (OLT): Most common type of liver transplant, which involves removal of pathological liver and replacement by donor liver (typically whole liver) in anatomical position
        • Auxiliary liver transplant: Partial donor liver is transplanted in addition to existing liver in order to provide temporary functional support in period of liver dysfunction
        • Split lobe transplant: Solitary lobe transplant (as opposed to whole liver); performed more frequently in pediatric liver transplantation

      IMAGING ANATOMY

      • General Anatomic Considerations

        • Critical Anatomic Structures

          ANATOMY IMAGING ISSUES

          • Imaging Approaches

            • Imaging Pitfalls

              Posttransplant Complications

              • Hepatic Artery Thrombosis

                • Hepatic Artery Stenosis

                  • Hepatic Artery Pseudoaneurysm

                    • Arterial Steal Syndrome

                      • Portal Vein Stenosis or Thrombosis

                        • Inferior Vena Cava and Hepatic Veins

                          • Nonvascular Complications

                            Selected References

                            1. Rafailidis V et al: Contrast-enhanced ultrasound (CEUS) of the abdominal vasculature. Abdom Radiol (NY). 43(4):934-947, 2018
                            2. Sidhu PS et al: The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: update 2017 (short version). Ultraschall Med. 39(2):154-180, 2018
                            3. Yusuf GT et al: Endocavitary contrast enhanced ultrasound (CEUS): a novel problem solving technique. Insights Imaging. 9(3):303-311, 2018
                            4. Huang DY et al: Contrast-enhanced US-guided interventions: improving success rate and avoiding complications using us contrast agents. Radiographics. 37(2):652-664, 2017
                            5. Ma L et al: Vascular complications after adult living donor liver transplantation: evaluation with ultrasonography. World J Gastroenterol. 22(4):1617-26, 2016
                            6. Ren X et al: Common ultrasound and contrast-enhanced ultrasonography in the diagnosis of hepatic artery pseudoaneurysm after liver transplantation. Exp Ther Med. 12(2):1029-1033, 2016
                            7. Rübenthaler J et al: Vascular complications in liver transplantation: beneficial role of contrast-enhanced ultrasound (CEUS) in the postoperative phase. Clin Hemorheol Microcirc. 64(3):475-482, 2016
                            8. García-Criado A et al: Impact of contrast-enhanced ultrasound in the study of hepatic artery hypoperfusion shortly after liver transplantation: contribution to the diagnosis of artery steal syndrome. Eur Radiol. 25(1):196-202, 2015
                            9. Claudon M et al: Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver - update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol. 39(2):187-210, 2013
                            10. Chopra SS et al: Contrast enhanced ultrasound cholangiography via T-tube following liver transplantation. Ann Transplant. 17(4):108-12, 2012
                            11. Sanyal R et al: Orthotopic liver transplantation: reversible Doppler US findings in the immediate postoperative period. Radiographics. 32(1):199-211, 2012
                            12. Singh AK et al: Postoperative imaging in liver transplantation: what radiologists should know. Radiographics. 30(2):339-51, 2010
                            13. Luo Y et al: CEUS: a new imaging approach for postoperative vascular complications after right-lobe LDLT. World J Gastroenterol. 15(29):3670-5, 2009
                            14. Bonini G et al: Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients. J Ultrasound. 10(2):99-106, 2007
                            15. Caiado AH et al: Complications of liver transplantation: multimodality imaging approach. Radiographics. 27(5):1401-17, 2007
                            16. Berry JD et al: Microbubble contrast-enhanced ultrasound in liver transplantation. Eur Radiol. 14 Suppl 8:P96-103, 2004
                            17. Sidhu PS et al: Microbubble ultrasound contrast in the assessment of hepatic artery patency following liver transplantation: role in reducing frequency of hepatic artery arteriography. Eur Radiol. 14(1):21-30, 2004
                            18. Crossin JD et al: US of liver transplants: normal and abnormal. Radiographics. 23(5):1093-114, 2003
                            19. Marshall MM et al: Assessment of portal venous system patency in the liver transplant candidate: a prospective study comparing ultrasound, microbubble-enhanced colour Doppler ultrasound, with arteriography and surgery. Clin Radiol. 57(5):377-83, 2002
                            20. Sidhu PS et al: Hepatic artery stenosis following liver transplantation: significance of the tardus parvus waveform and the role of microbubble contrast media in the detection of a focal stenosis. Clin Radiol. 57(9):789-99, 2002
                            21. Marshall MM et al: Hepatic artery pseudoaneurysms following liver transplantation: incidence, presenting features and management. Clin Radiol. 56(7):579-87, 2001
                            22. Sidhu PS et al: Clinical use of Levovist, an ultrasound contrast agent, in the imaging of liver transplantation: assessment of the pre- and post-transplant patient. Eur Radiol. 10(7):1114-26, 2000
                            Related Anatomy
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Imaging Anatomy

                              • Posttransplant Complications

                                TERMINOLOGY

                                • Definitions

                                  • Orthotopic liver transplant (OLT): Most common type of liver transplant, which involves removal of pathological liver and replacement by donor liver (typically whole liver) in anatomical position
                                  • Auxiliary liver transplant: Partial donor liver is transplanted in addition to existing liver in order to provide temporary functional support in period of liver dysfunction
                                  • Split lobe transplant: Solitary lobe transplant (as opposed to whole liver); performed more frequently in pediatric liver transplantation

                                IMAGING ANATOMY

                                • General Anatomic Considerations

                                  • Critical Anatomic Structures

                                    ANATOMY IMAGING ISSUES

                                    • Imaging Approaches

                                      • Imaging Pitfalls

                                        Posttransplant Complications

                                        • Hepatic Artery Thrombosis

                                          • Hepatic Artery Stenosis

                                            • Hepatic Artery Pseudoaneurysm

                                              • Arterial Steal Syndrome

                                                • Portal Vein Stenosis or Thrombosis

                                                  • Inferior Vena Cava and Hepatic Veins

                                                    • Nonvascular Complications

                                                      Selected References

                                                      1. Rafailidis V et al: Contrast-enhanced ultrasound (CEUS) of the abdominal vasculature. Abdom Radiol (NY). 43(4):934-947, 2018
                                                      2. Sidhu PS et al: The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: update 2017 (short version). Ultraschall Med. 39(2):154-180, 2018
                                                      3. Yusuf GT et al: Endocavitary contrast enhanced ultrasound (CEUS): a novel problem solving technique. Insights Imaging. 9(3):303-311, 2018
                                                      4. Huang DY et al: Contrast-enhanced US-guided interventions: improving success rate and avoiding complications using us contrast agents. Radiographics. 37(2):652-664, 2017
                                                      5. Ma L et al: Vascular complications after adult living donor liver transplantation: evaluation with ultrasonography. World J Gastroenterol. 22(4):1617-26, 2016
                                                      6. Ren X et al: Common ultrasound and contrast-enhanced ultrasonography in the diagnosis of hepatic artery pseudoaneurysm after liver transplantation. Exp Ther Med. 12(2):1029-1033, 2016
                                                      7. Rübenthaler J et al: Vascular complications in liver transplantation: beneficial role of contrast-enhanced ultrasound (CEUS) in the postoperative phase. Clin Hemorheol Microcirc. 64(3):475-482, 2016
                                                      8. García-Criado A et al: Impact of contrast-enhanced ultrasound in the study of hepatic artery hypoperfusion shortly after liver transplantation: contribution to the diagnosis of artery steal syndrome. Eur Radiol. 25(1):196-202, 2015
                                                      9. Claudon M et al: Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver - update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol. 39(2):187-210, 2013
                                                      10. Chopra SS et al: Contrast enhanced ultrasound cholangiography via T-tube following liver transplantation. Ann Transplant. 17(4):108-12, 2012
                                                      11. Sanyal R et al: Orthotopic liver transplantation: reversible Doppler US findings in the immediate postoperative period. Radiographics. 32(1):199-211, 2012
                                                      12. Singh AK et al: Postoperative imaging in liver transplantation: what radiologists should know. Radiographics. 30(2):339-51, 2010
                                                      13. Luo Y et al: CEUS: a new imaging approach for postoperative vascular complications after right-lobe LDLT. World J Gastroenterol. 15(29):3670-5, 2009
                                                      14. Bonini G et al: Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients. J Ultrasound. 10(2):99-106, 2007
                                                      15. Caiado AH et al: Complications of liver transplantation: multimodality imaging approach. Radiographics. 27(5):1401-17, 2007
                                                      16. Berry JD et al: Microbubble contrast-enhanced ultrasound in liver transplantation. Eur Radiol. 14 Suppl 8:P96-103, 2004
                                                      17. Sidhu PS et al: Microbubble ultrasound contrast in the assessment of hepatic artery patency following liver transplantation: role in reducing frequency of hepatic artery arteriography. Eur Radiol. 14(1):21-30, 2004
                                                      18. Crossin JD et al: US of liver transplants: normal and abnormal. Radiographics. 23(5):1093-114, 2003
                                                      19. Marshall MM et al: Assessment of portal venous system patency in the liver transplant candidate: a prospective study comparing ultrasound, microbubble-enhanced colour Doppler ultrasound, with arteriography and surgery. Clin Radiol. 57(5):377-83, 2002
                                                      20. Sidhu PS et al: Hepatic artery stenosis following liver transplantation: significance of the tardus parvus waveform and the role of microbubble contrast media in the detection of a focal stenosis. Clin Radiol. 57(9):789-99, 2002
                                                      21. Marshall MM et al: Hepatic artery pseudoaneurysms following liver transplantation: incidence, presenting features and management. Clin Radiol. 56(7):579-87, 2001
                                                      22. Sidhu PS et al: Clinical use of Levovist, an ultrasound contrast agent, in the imaging of liver transplantation: assessment of the pre- and post-transplant patient. Eur Radiol. 10(7):1114-26, 2000