Abstract
PurposeConsidering the high false-positive diagnosis of the tardus parvus waveform (TPW) in Doppler ultrasonography (DUS) for hepatic artery stenosis (HAS) after liver transplantation (LT), this study aimed to determine clinical features and new cut-off values to help guide treatment.Materials and methodsThis retrospective study was approved by an Institutional Review Board. A total of 171 LT recipients were included and underwent DUS and either computed tomography angiography or digital subtraction angiography with an interval < 4 weeks at least 1 month post-LT. The DUS of 69 patients exhibited TPW [defined as resistive index (RI) < 0.5 and systolic acceleration time (SAT) > 0.08 s]. A multilevel likelihood ratio (LR) analysis was used to explore new cut-off values for DUS. In addition, abnormal liver function was considered additional evidence (defined as any liver enzyme > 3-fold of the upper limit of normal level or 2-fold increased). The results were stratified into three categories, category 1 (subjects with traditional TPW), category 2 (subjects with traditional TPW and abnormal liver function), and category 3 (subjects with traditional TPW and abnormal liver function, or with new cut-off values), and the diagnostic performance of each category was analyzed.ResultsThe LR analysis revealed new cut-off values of RI < 0.4 (LR = 10.58) or SAT > 0.12 s (LR = 16.46). The false-positive rates for categories 2 and 3 were significantly lower (7.6% vs. 18.1%, P = 0.038; 1.9% vs. 18.1%, P < 0.001, respectively) than those for category 1, while the sensitivity for category 2 was significantly lower (41.8% vs. 74.6%, P < 0.001; 41.8% vs. 61.2%, P = 0.038, respectively) than that for categories 1 and 3.ConclusionUsing either (1) RI < 0.4 or SAT > 0.12 s, or (2) traditional TPW (RI < 0.5 and SAT > 0.08 s) in the presence of abnormal liver functions as the DUS criteria for HAS will significantly decrease the false-positive rate compared to traditional TPW without a significant increase in the false-negative rate.
Highlights
Considering the high false-positive diagnosis of the tardus parvus waveform (TPW) in Doppler ultrasonography (DUS) for hepatic artery stenosis (HAS) after liver transplantation (LT), this study aimed to determine clinical features and new cut-off values to help guide treatment
Patients were included in the study if they underwent DUS and a follow-up computed tomography angiography (CTA) or digital subtraction angiography (DSA) within a 4-week interval at least 1 month after the LT for a targeted evaluation of the hepatic arteries based on the present diagnostic procedure at our institution, as mentioned above (Fig. 1)
The likelihood ratios (LRs) analysis revealed that the new cut-off values of resistive index (RI) < 0.4 (LR = 10.58) or systolic acceleration time (SAT) > 0.12 s (LR = 16.46) were adequate for including
Summary
Considering the high false-positive diagnosis of the tardus parvus waveform (TPW) in Doppler ultrasonography (DUS) for hepatic artery stenosis (HAS) after liver transplantation (LT), this study aimed to determine clinical features and new cut-off values to help guide treatment. The DUS diagnostic criteria for significant HAS after LT has withstood the test of time since Dodd III et al [10] evaluated quantitative parameters derived from the main hepatic artery Their criteria consist of a tardus parvus waveform [TPW, with resistive index (RI) < 0.5, systolic acceleration time (SAT) > 0.08 s] and peak systolic velocity (PSV) > 2 m/s. The purpose of this study is to determine clinical features and new Doppler cut-off values to provide strong evidence to diagnose HAS to help guide treatment with immediate angiography or follow-up
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