Preferred Imaging Modality Research Articles

Dementia imaging in clinical practice: a European-wide survey of 193 centres and conclusions by the ESNR working group

PurposeThrough a European-wide survey, we assessed the current clinical practice of imaging in the primary evaluation of dementia, with respect to standardised imaging, evaluation and reporting.MethodsAn online questionnaire was emailed to all European Society of Neuroradiology (ESNR) members (n = 1662) and non-members who had expressed their interest in ESNR activities in the past (n = 6400). The questionnaire featured 42 individual items, divided into multiple choice, single best choice and free text answers. Information was gathered on the context of the practices, available and preferred imaging modalities, applied imaging protocols and standards for interpretation, reporting and communication.ResultsA total of 193 unique (non-duplicate) entries from the European academic and non-academic institutions were received from a total of 28 countries. Of these, 75% were neuroradiologists, 12% general radiologists and 11% (neuro) radiologists in training. Of responding centres, 38% performed more than five scans/week for suspected dementia. MRI was primarily used in 72% of centres. Over 90% of centres acquired a combination of T2w, FLAIR, T1w, DWI and T2*w sequences. Visual rating scales were used in 75% of centres, most often the Fazekas and medial temporal atrophy scale; 32% of respondents lacked full confidence in their use. Only 23% of centres performed volumetric analysis. A minority of centres (28%) used structured reports.ConclusionsCurrent practice in dementia imaging is fairly homogeneous across Europe, in terms of image acquisition and image interpretation. Hurdles identified include training on the use of visual rating scales, implementation of volumetric assessment and structured reporting.

MRI Findings in Pott’s Spine with its Histopathological Correlation

Background: MRI is now the preferred imaging modality and preferred technique to define the activity and extent of infection for patients with suspected spinal tuberculosis. The objective of the study was to describe diagnostic accuracy, sensitivity and specificity of MRI in diagnosis of spinal tuberculosis and various radiological features of spinal tuberculosis (TB) on magnetic resonance imaging (MRI). Subjects and Methods: Out of total 45 cases of suspected tuberculosis in our study we given 38 case as spinal spondylo-discitis out of which 36 cases accurately diagnosed by MRI proved by histopathology or culture reports.  And 7 cases of given non tubercular out of which 1 case came to be tubercular spondylodiscitis on histopathology.  MRI case records of these 37 patients with proven tuberculosis retrospectively analysed. Results: The majority of the patients were males 60% (22/37) and most common age group is 31 to 50 years age group (45%). The most common clinical presentation was backache 81% (n=30) followed by fever 22/37 cases (59.45%). The Thoraco-lumbar spine was the commonest site of the disease (38.64%) followed by the lumbar region (31.82%). An intervertebral disc involvement, pre and paravertebral collections, subligamental extension of the abscess were commonly seen, with an epidural collection occurring in more than 75 % of the cases. In addition few cases also showed single vertebral involvement (n-3) and few cases shows skip lesions. Conclusion: The MRI scan is highly sensitive in the detection of various pathological processes of spinal tuberculosis and their pattern of occurrence. The extent of soft tissue involvement disease is best assessed by MRI which help in guiding the surgical treatment as well as to monitor the response to treatment during follow up.

Technical note: utilization of 3D-rendering for CT evaluation of extremitas sternalis claviculae within medical age assessment practice.

According to the acknowledged recommendations of the multidisciplinary "Study Group on Forensic Age Diagnostics," the indicator "medial clavicular ossification" carries the potential of delivering decisive evidence to proof age majority "beyond reasonable doubt" regarding age-disputed individuals within legal procedures. Yet, sternoclavicular thin-slice computed tomography, representing its preferred imaging modality, not rarely exhibits peculiar morphologies of the site, sometimes difficult to understand from the usually obtained, axial sections together with coronal reformations. Because of that, we utilized 3D-rendering of acquired CT data in 224 cases with the purpose to gain additional visualization of certain questionable appearances. Concerning reliable classification of medial clavicular ossification in line with the typologies of Schmeling et al. and Kellinghaus et al., it is concluded that such means of illustration contribute to recognition of polygonal or irregular, epiphyseal formations including the not-assessable shape variant "multiple, medial, secondary ossification centres" and of calcification of the articular capsule.

Recommendations for the Diagnostic Testing and Therapy of Atlas Fractures.

In a consensus process with four sessions in 2017, the working group on "the upper cervical spine" of the German Society for Orthopaedic and Trauma Surgery (DGOU) formulated "Therapeutic Recommendations for the Diagnosis and Treatment of Fractures to the Upper Cervical Spine", incorporating their own experience and current literature. The following article describes the recommendations for the atlas vertebra. About 10% of all cervical spine injuries include the axis vertebra. The diagnostic process primarily aims to detect the injury and to determine joint incongruency and integrity of the atlas ring. For classification purposes, the Gehweiler classification and the Dickman classification are suitable. The Canadian c-spine rule is recommended for clinical screening for c-spine injuries. CT is the preferred imaging modality; MRI is needed to determine the integrity of the Lig. transversum atlantis in complete atlas ring fractures. Conservative treatment is appropriate in very many atlas fractures. Surgical treatment is recommended in existing or potential joint incongruity or instability, which are frequently seen in Gehweiler IIIB or Gehweiler IV fractures. Posterior atlanto-axial stabilisation and fusion using transarticular screws or an internal fixator are regarded as a gold standard in the majority of surgical cases. Especially in young patients, the possibility of isolated atlas osteosynthesis should be checked. A possible option for Gehweiler IV fractures is halo-fixation with mild distraction for ligamentotaxis. Secondary dislocation should be checked for frequently. Involvement of the occipito-atlantal joint complex requires stabilisation of the occiput as well.

Radiologist’s views on anatomical knowledge amongst junior doctors and the teaching of anatomy in medical curricula

Reduced teaching resources, increasing student numbers and congested medical curricula have led to reports of inadequate anatomical knowledge among newly qualified doctors, placing scrutiny on pre-clinical education. We wished to gauge the opinions of practicing radiologists on undergraduate anatomy education. Members of the Irish Faculty of Radiologists were invited to complete a questionnaire based on anatomy teaching practices, its relevance and the standards of anatomical knowledge at graduation. Out of 67 respondents, 69% were of senior grade, with the majority working in diagnostic radiology. Respondents universally agreed that anatomy is central to radiology; however, decade of graduation significantly influenced radiologist’s level of satisfaction with their anatomical knowledge at the start of their training. Fifty percent believed that the cadaver should remain the cornerstone of anatomy education. The vast majority of radiologists agreed that radiology and anatomy should be taught in tandem during pre-clinical training to better prepare students for clinical practice. Practicing radiologists believed they were best positioned to deliver radiology-based anatomy teaching. CT and MRI respectively were proposed as the preferred imaging modalities for teaching anatomy, although free comments showed varied opinion on how radiology and cadaveric anatomy should be integrated. Radiologists were also concerned with the anatomical knowledge of the junior doctor. This study may add to the debate concerning the vertical integration of anatomy in medical education and may help inform the delivery of radiology in the anatomy curriculum.

Assessment of deep venous thrombosis in the lower extremity in Behçet's syndrome: MR venography versus Doppler ultrasonography.

Lower extremity venous thrombosis (DVT) is the most common vascular manifestation of Behçet's syndrome (BS). Currently, Doppler ultrasonography (USG) is the most commonly preferred imaging modality in the diagnosis and follow-up of patients with acute and chronic DVT. Magnetic resonance (MR) venography, a quick and a non-invasive imaging modality, is successfully used to detect DVT in various settings. We had been unaware of studies with MR venography in BS. The aim of this study is to compare the diagnostic value of true fast imaging with steady-state precession magnetic resonance (True-FISP MR) venography and Doppler USG in the assessment of chronic DVT among patients with BS. 28 BS patients with chronic lower extremity DVT were studied. Common femoral (CFV) and femoral vein (FV) on both right and left sides were examined for the presence of thrombosis, recanalisation, collaterals and reflux. There are findings of chronic DVT in all Doppler USG images of 28 patients (45 of 56 FV and 35 of 56 CFV), while MR venography detects chronic thrombotic changes in 26/28 (93%) patients (43 of 52 FV and 28 of 52 CFV). Collateral veins are detected in 19 patients (19/28) with MR venography, whereas they are present in only 7 (7/28) with USG (P = 0.003). Furthermore, patients with severe post-thrombotic syndrome are more likely to have collateral formation on the MR compared to those without (12/14 vs 7/14; P = 0.043). Among patients with BS, MR venography might be an alternative or additional method to detect chronic thrombosis in the lower extremities.

Protocol for a prospective, longitudinal cohort study on the effect of arterial disease level on the outcomes of supervised exercise in intermittent claudication: the ELECT Registry

IntroductionDespite guideline recommendations advocating conservative management before invasive treatment in intermittent claudication, early revascularisation remains widespread in patients with favourable anatomy. The aim of the Effect of Disease Level on...

600.29 Portable versus Mounted Fluoroscopic Imaging during Transcatheter Aortic Valve Replacement

To compare outcomes of portable angiography system (PAS) versus mounted angiography system (MAS) in high-risk patients with severe symptomatic aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). MAS is the preferred imaging modality for TAVR procedures. The role and

Femoroacetabular impingement - Update 2019

Since the first description of the femoroacetabular impingement (FAI) concept diagnostic imaging of FAI has continuously been developed. The biomechanical concept is explained and an update on diagnostic imaging of FAI is presented. Based on a literature search this review article presents the current state of knowledge about FAI mechanisms and gives an overview on state of the art radiological diagnostics. A perspective on new imaging methods is also given. The FAI is adynamic phenomenon with amechanical conflict between the femoral head and/or neck and the acetabulum. It is usually suspected clinically; however, imaging plays an essential role in establishing the diagnosis by detecting and defining the underlying deformities of the proximal femur (cam deformity) and the acetabulum (pincer deformity) and by evaluating associated lesions of the articular cartilage and labrum. Basic imaging diagnostics consist of anteroposterior and lateral radiographs. Magnetic resonance imaging (MRI) and MR arthrography are the preferred imaging modalities for detailed analysis of deformities, for the detection and graduation of lesions of articular cartilage (sensitivity 58-91%) and labral lesions (sensitivity 50-92%). Simultaneously, these methods can exclude other hip diseases. Current standards and new developments in FAI imaging are presented. For the diagnosis of FAI typical clinical and imaging findings are required. Radiological diagnostics are an indispensable component in establishing the diagnosis of FAI, in the differentiation of the underlying deformities and in the assessment of treatment-relevant joint damage.

Survey of Current Management Practices for Carotid Webs.

Background: Carotid webs are thick, fibrous intimal bands that appear as intraluminal shelf-like defects at the carotid bifurcation on vascular imaging. These lesions are a potential underrecognized cause of cryptogenic ischemic stroke. Although the recognition of carotid webs has increased, no evidence-based treatment guidelines are available. We surveyed subspecialists across multiple neurologic disciplines to assess the state of current clinical practice.Methods: An 8-question multiple-choice style survey of neurologists and radiologists assessed familiarity with this disease entity, preferred imaging modalities, and management strategies for asymptomatic and symptomatic (producing stroke) carotid webs. Responses were collected through SurveyMonkey software via anonymous responses to a posted survey link on the Society of Neurointerventional Surgery website in addition to invitation emails sent to colleagues in corresponding fields.Results: Of the 74 total respondents, 64% identified as neurointerventionalists. Respondents identified computed tomography angiography as the most commonly used imaging modality to place carotid webs in the differential diagnosis (57% of respondents’ preference), while conventional digital subtraction angiogram was the preferred modality to confirm a web (54% of respondents’ preference). Respondents preferred single and dual antiplatelet therapy to manage asymptomatic and acute stroke-producing carotid webs, while invasive treatment was most commonly sought for webs producing recurrent strokes.Conclusion: Familiarity with carotid webs varied across subspecialties. We found some consensus among respondents on the imaging modality preferred to identify webs, on asymptomatic carotid web management, and on recurrently symptomatic (multiple strokes) carotid web management. Less consistency was seen regarding preferences for confirmatory imaging and management of acutely symptomatic (initial stroke) carotid webs.

Endovascular stenting of spontaneous isolated dissection of superior mesenteric artery

Spontaneous isolated dissection of the superior mesenteric artery (SID-SMA) is a rare condition often presenting with vague signs and symptoms. Although the disease entity is rare, the potential for morbidity and mortality is high. Computed tomographic angiography is the preferred imaging modality for identification of SID-SMA. It may be managed by conservative, surgical, or endovascular treatment based on clinical presentation, but there is no general consensus regarding the treatment strategy. Here, we describe a case of SID of SMA treated successfully with percutaneous endovascular stent placement.

Segmentation-Based Blood Flow Parameter Refinement in Cerebrovascular Structures Using 4-D Arterial Spin Labeling MRA.

Cerebrovascular diseases are one of the main global causes of death and disability in the adult population. The preferred imaging modality for the diagnostic routine is digital subtraction angiography, an invasive modality. Time-resolved three-dimensional arterial spin labeling magnetic resonance angiography (4D ASL MRA) is an alternative non-invasive modality, which captures morphological and blood flow data of the cerebrovascular system, with high spatial and temporal resolution. This work proposes advanced medical image processing methods that extract the anatomical and hemodynamic information contained in 4D ASL MRA datasets. A previously published segmentation method, which uses blood flow data to improve its accuracy, is extended to estimate blood flow parameters by fitting a mathematical model to the measured vascular signal. The estimated values are then refined using regression techniques within the cerebrovascular segmentation. The proposed method was evaluated using fifteen 4D ASL MRA phantoms, with ground-truth morphological and hemodynamic data, fifteen 4D ASL MRA datasets acquired from healthy volunteers, and two 4D ASL MRA datasets from patients with a stenosis. The proposed method reached an average Dice similarity coefficient of 0.957 and 0.938in the phantom and real dataset segmentation evaluations, respectively. The estimated blood flow parameter values are more similar to the ground-truth values after the refinement step, when using phantoms. A qualitative analysis showed that the refined blood flow estimation is more realistic compared to the raw hemodynamic parameters. The proposed method can provide accurate segmentations and blood flow parameter estimations in the cerebrovascular system using 4D ASL MRA datasets. The information obtained with the proposed method can help clinicians and researchers to study the cerebrovascular system non-invasively.

Patient-specific 3D printed pulmonary artery model with simulation of peripheral pulmonary embolism for developing optimal computed tomography pulmonary angiography protocols.

Computed tomography pulmonary angiography (CTPA) is the preferred imaging modality for diagnosis of patients with suspected pulmonary embolism (PE). Radiation dose associated with CTPA has been significantly reduced due to the use of dose-reduction strategies, however, investigation of low-dose CTPA with use of different kVp and pitch values has not been systematically studied. The aim of this study was to utilize a 3D printed pulmonary model with simulation of small thrombus in the pulmonary arteries for development of optimal CTPA protocols. Animal blood clots were inserted into the pulmonary arteries to simulate peripheral embolism based on a realistic 3D printed pulmonary artery model. The 3D printed model was scanned with 192-slice 3rd generation dual-source CT with 1 mm slice thickness and 0.5 mm reconstruction interval. All images were reconstructed with advanced modelled iterative reconstruction (IR) at a strength level of 3. CTPA scanning parameters were as follows: 70, 80, 100 and 120 kVp, 0.9, 2.2 and 3.2 pitch values. Quantitative assessment of image quality was determined by measuring signal-to-noise ratio (SNR) in both main pulmonary arteries, while qualitative analysis of images was scored by two experienced radiologists (score of 1 indicates poor visualization of thrombus with no confidence, and score of 5 excellent visualization of thrombus with high confidence) to determine the image quality in relation to different scanning protocols for detection of thrombus in the pulmonary arteries. No significant differences were found in SNR measurements among all CTPA protocols (P>0.05), regardless of kVp or pitch values used, although SNR was higher with 120 kVp and 0.9 and 2.2 pitch protocols than that in other protocols. The thrombi were detected in all images, with 70 kVp and 3.2 pitch protocol scored the lowest with a score of 3 by two observers, and images with other protocols were scored 4 or 5. Lowering kVp from 120 to 70 with use of high-pitch 2.2 or 3.2 protocol resulted in up to 80% dose reduction without significantly affecting image quality. Low-dose CT pulmonary angiography protocols comprising 70 kVp and high pitch 2.2 or 3.2 allow for detection of peripheral PE with significant reduction in radiation dose while images are still considered diagnostic.

Automatic lung segmentation in low-dose chest CT scans using convolutional deep and wide network (CDWN)

Computed tomography (CT) imaging is the preferred imaging modality for diagnosing lung-related complaints. Automatic lung segmentation is the most common prerequisite to develop a computerized diagnosis system for analyzing chest CT images. In this paper, a convolutional deep and wide network (CDWN) is proposed to segment lung region from the chest CT scan for further medical diagnosis. Earlier lung segmentation techniques depend on handcrafted features, and their performance relies on the features considered for segmentation. The proposed model automatically segments the lung from complete CT scan in two laps: (1) learning the required filters to extract hierarchical feature representations at convolutional layers, (2) dense prediction with spatial features through learnable deconvolutional layers. The model has been trained and evaluated with low-dose chest CT scan images on LIDC-IDRI database. The proposed CDWN reaches the average Dice coefficient of 0.95 and accuracy of 98% in segmenting the lung regions from 20 test images and maintains consistent results for all test images. The experimental results confirm that the proposed approach achieves a superior performance compared to other state-of-the-art methods for lung segmentation.

Accuracy of Commonly-Used Imaging Modalities in Assessing Left Atrial Appendage for Interventional Closure: Review Article.

Periprocedural imaging assessment for percutaneous Left Atrial Appendage (LAA) transcatheter occlusion can be obtained by utilizing different imaging modalities including fluoroscopy, magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound imaging. Given the complex and variable morphology of the left atrial appendage, it is crucial to obtain the most accurate LAA dimensions to prevent intra-procedural device changes, recapture maneuvers, and prolonged procedure time. We therefore sought to examine the accuracy of the most commonly utilized imaging modalities in LAA occlusion. Institutional Review Board (IRB) approval was waived as we only reviewed published data. By utilizing PUBMED which is an integrated online website to list the published literature based on its relevance, we retrieved thirty-two articles on the accuracy of most commonly used imaging modalities for pre-procedural assessment of the left atrial appendage morphology, namely, two-dimensional transesophageal echocardiography, three-dimensional transesophageal echocardiography, computed tomography, and three-dimensional printing. There is strong evidence that real-time three-dimensional transesophageal echocardiography is more accurate than two-dimensional transesophageal echocardiography. Three-dimensional computed tomography has recently emerged as an imaging modality and it showed exceptional accuracy when merged with three-dimensional printing technology. However, real time three-dimensional transesophageal echocardiography may be considered the preferred imaging modality as it can provide accurate measurements without requiring radiation exposure or contrast administration. We will present the most common imaging modality used for LAA assessment and will provide an algorithmic approach including preprocedural, periprocedural, intraprocedural, and postprocedural.

Sonographic Spectrum of Testicular Adrenal Rest Tumors

Testicular adrenal rest tumors (TARTs) are benign testicular masses but can lead to infertility without medical attention. It is important to identify TARTs in childhood, as early diagnosis has been shown to have good success in preserving fertility. It is also important to differentiate TARTs from other testicular masses to avoid unnecessary orchiectomy. Ultrasound is the preferred imaging modality for the evaluation of TARTs; however, sonographic differentiation from testicular neoplasms can sometimes be very difficult. In this article, we review the spectrum of sonographic features of TARTs and propose a decision tree that relies on these features, with the goal of increasing clinician’s confidence in diagnosing TARTs.

Incidental Finding of a Colonic Gastrointestinal Stromal Tumor (GIST) in Screening Colonoscopy: A Case Report and Review of Literature

Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the gut. GISTs arise due to mutation in the c-kit tyrosine kinase of the interstitial cells of cajal (ICCs) that leads to continuously activated state of tyrosine kinase and thus results in formation of GISTs. GISTs are most common in stomach (75%) and small intestine (25%). Less than 5 % of GISTs occur in colon and rectum. We present a 50 year old male who underwent a routine screening colonoscopy and was otherwise asymptomatic. Physical examination was unremarkable. Past medical history was significant for developmental delay and chronic constipation. Colonoscopy revealed a submucosal appearing lesion with an overlying ulcer at the hepatic flexure. Histopathology revealed spindle cells are arranged in a storiform-type pattern with chronic inflammatory cell infiltrate including several eosinophils, reactive epithelial cell changes and focal ulceration without any adenomatous change is observed. Immunohistochemical stains were positive for DOG -1 and CD117. CT scan of the abdomen with contrast did not reveal any evidence of metastatic lesions. GISTs account for less than 1% of gastrointestinal (GI) malignancies and only make up to 0.1% of colorectal tumors. A few other cases of colonic GIST have been reported in literature, however, they are still rare and account for less than 2% of all GISTs. Median age of presentation is 60 years with a slight male predominance. The most common clinical presentation is abdominal pain followed by gastrointestinal bleeding, obstruction and perforation. CD117 is the most important diagnostic marker and is positive in more than 95% of cases and CD34 is positive in 70% of cases. The most common cellular morphology noted in histopathology is spindle cell type followed by epithelioid and mixed cellular types. Approximately 30% of GISTs have malignant potential. Prognosis depends on the size of the tumor, histology, mitotic potential and local invasion. CT scan with contrast is the preferred imaging modality of choice for initial staging. Treatment is surgical resection and adjuvant therapy with Imatinib (tyrosine kinase inhibitor). Close surveillance is recommended in the first 3 to 5 years after treatment due to maximum risk of recurrence within that time frame. A screening colonoscopy prevented adverse outcomes in this patient who could not report symptoms due to intellectual disability.1533_A Figure 1. GIST CD117 Positive1533_B Figure 2. GIST - Spindle cell histopathology1533_C Figure 3. Hepatic flexure lesion with a central ulceration

29-Year-Old Woman With Fever and Bilateral Lower Extremity Lesions

29-Year-Old Woman With Fever and Bilateral Lower Extremity Lesions

Efficient interpolated compressed sensing reconstruction scheme for 3D MRI

3D magnetic resonance imaging (3D MRI) is one of the most preferred medical imaging modalities for the analysis of anatomical structures where acquisition of multiple slices along the slice select gradient direction is very common. In 2D multi-slice acquisition, adjacent slices are highly correlated because of very narrow inter-slice gaps. Application of compressed sensing (CS) in MRI significantly reduces traditional MRI scan time due to random undersampling. The authors first propose a fast interpolation technique to estimate missing samples in the k-space of a highly undersampled slice (H-slice) from k-space (s) of neighbouring lightly undersampled slice/s (L-slice). Subsequently, an efficient multislice CS-MRI reconstruction technique based on weighted wavelet forest sparsity, and joint total variation regularisation norms is applied simultaneously on both interpolated H and non-interpolated L-slices. Simulation results show that the proposed CS reconstruction for 3D MRI is not only computationally faster but significant improvements in terms of visual quality and quantitative performance metrics are also achieved compared to the existing methods.

Contrast-enhanced ultrasound for the evaluation of hepatic artery occlusion after liver transplantation

Introduction:Vascular complications after liver transplantation remain a major threat to the survival of recipients.HAT is a major cause of graft loss and patient mortality, with an incidence between 3% to 8% in transplant recipients.Early detection of HAT is critical because urgent revascularization is required to avoid severe graft loss. Although ultrasound is the preferred first-line imaging modality in patients with suspected HAT, the accuracy and positive predictive value of HAT on Doppler US are reported to be low. Moreover, Doppler examination of the hepatic vasculature is time consuming and requires a high level of operator skill. Conventional angiography remains the gold standard for diagnosis. Recently, contrast-enhanced ultrasound (CEUS) has begun providing real-time angiographic-like images of vessels at bed side and allowing the accurate diagnosis of arterial diseases such as hepatic artery thrombosis. The purpose of this study was to evaluate the efficacy of CEUS in detecting HAT after liver transplantation: Materials and Methods: This is a retrospective data of the medical records of patients undergoing Liver transplantation in the Osmania General Hospital, Hyderabad between 2016 to 2018. Status of hepatic vascular assessment following liver transplantation done by conventional Doppler Ultra sonography and Contrast Enhanced Ultrasonography tests were obtained from registries of medical records. Results:23 cases of post Liver transplantation aged between 4years and 58 years, with a median age of 30 years were included in the analysis. There were 20 males and 3 females. 14 patients underwent DDLT, 7 patients underwent LDLT, 1underwent split Liver transplantation and another 1 patient underwent Auto liver transplantation. Doppler US was inconclusive regarding patency of the hepatic artery (HA) circulation in 5 (21.7 %) of 23 transplantations. CEUS was performed in these 5 patients and detected HA thrombosis (HAT) in 2 cases and patent HA in 3 transplants. These 5 Transplants were confirmed by CT Angiography /conventional Angiography. In the subset of transplantations examined with CEUS, the sensitivity, specificity and accuracy of CEUS were 100%. CEUS was done at bedside without any Radiation and Nephro toxicity. In approximately 21.7% of cases, conventional Doppler US did not provide sufficient visualization of the HA after liver transplantation. In these cases, correct diagnosis was achieved by supplementary CEUS. Conclusion:CEUS may be a new approach for early diagnosis of postoperative vascular complications after Liver Transplantation, and it can be performed at the bedside. It is safe will not cause any nephron toxicity and Radiation. CEUS is a fast, non-ionizing imaging modality for the initial exclusion of vascular complications after liver transplantation. CEUS shows a high specificity and PPV in the detection of vascular complications. In unclear cases CT still is considered as the gold standard