The Effectiveness of Noninvasive Transabdominal Ultrasound Evaluation in the Diagnosis of Sinusoidal Obstruction Syndrome after Hematopoietic Stem Cell Transplantation

Abstract

Sinusoidal obstruction syndrome (SOS) is one of the complications after hematopoietic stem cell transplantation (HSCT). The widely used clinical criteria can efficiently diagnose SOS, but cannot determine the severity or assess the treatment response. To address the issues, we propose a new transabdominal ultrasound (US) scoring system of SOS. From 2008 to 2013, 113 patients underwent HSCT were enrolled in the study. The patients were scored by three factors in US findings: gall bladder wall thickness, existence of ascites, and appearance of blood flow signal in paraumbilical vein. We further assessed the effectiveness of the addition of some liver function tests to the US scoring. Statistical analysis was performed by t-test (P<0.05). Ten patients were diagnosed as SOS (7.5%) by clinical criteria. The US SOS score (mean±SD) of SOS-group and non-SOS-group were 3.6±1.1 and 0.6±0.8, respectively (P<0.01). The most effective cut off value was 3 (area under the receiver operating characteristic curve: 0.95). When total bilirubin level (no less than 1.0 mg/dl) was included in the score, specificity, accuracy, and negative predictive value were improved. Furthermore, the US scores were elevated prior to diagnosis in some cases, which suggests the US scoring system is useful for diagnosis in early stage. Other parameters didn’t contribute to SOS diagnosis in combination with US scoring. More analysis is needed to demonstrate the correlation with severity and outcomes. Our US SOS scoring system is effective in making a diagnosis of SOS, especially in combination with bilirubin levels.