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Three-dimensional multislice helical computed tomography with the volume rendering technique in the detection of
Giuseppe Brancatelli1, Sanjeev Katyal, Michael P Federle
1Department of Radiology, University of Pittsburgh Medical Center, Pennsylvania 15213, USA.
Insights
Three-dimensional computed tomographic arteriography (3D CTA) with volume rendering is a highly accurate, noninvasive method for detecting vascular complications in liver transplant recipients. This technique offers excellent sensitivity and negative predictive value for identifying issues like hepatic artery stenosis and thrombosis.
Area of Science:
- Radiology
- Transplant Surgery
- Vascular Imaging
Background:
- Hepatic artery stenosis and thrombosis are frequent complications following liver transplantation.
- Digital subtraction angiography (DSA) is the traditional gold standard for diagnosis.
- Advancements include 3D helical computed tomographic arteriography (3D CTA) with various display techniques.
Purpose of the Study:
- To evaluate the utility and accuracy of 3D CTA utilizing the volume rendering (VR) technique.
- To assess its effectiveness in detecting vascular complications post-liver transplant.
Main Methods:
- Thirty-five liver transplant patients underwent 3D CTA with VR.
- Digital subtraction angiography (DSA) served as the reference standard for 20 patients.
- Imaging and clinical follow-up were used for the remaining 15 patients; two blinded reviewers assessed the CTA images.
Main Results:
- 3D CTA with VR identified various vascular issues, including 10 hepatic artery stenoses, 6 thromboses, 2 pseudoaneurysms, and 2 portal vein stenoses.
- The technique demonstrated 100% sensitivity, 89% specificity, and 95% accuracy in detecting vascular lesions.
- It achieved a 92% positive predictive value and 100% negative predictive value.
Conclusions:
- Three-dimensional computed tomographic arteriography (3D CTA) with volume rendering is a valuable noninvasive tool.
- It accurately detects vascular complications in liver transplant patients.
- This technique offers a reliable alternative for diagnosis.
Background:
Hepatic artery stenosis and thrombosis are common complications in liver transplant patients. Digital subtraction angiography (DSA) has served as the gold standard to make this diagnosis. More recently, three-dimensional helical computed tomographic arteriography (3D CTA) with maximum intensity projection and shaded surface display techniques has been compared with DSA. The purpose of this study was to determine whether 3D CTA with the volume rendering technique is a useful and accurate tool in the detection of vascular complications after liver transplantation.
Methods:
Thirty-five consecutive liver transplant patients underwent 3D CTA with volume rendering technique. The standard of reference was DSA for 20 patients and imaging and clinical follow-up for 15 patients. Two blinded reviewers evaluated the axial and 3D CTA images in consensus.
Results:
3D CTA with volume rendering technique detected 10 hepatic artery stenoses, six hepatic artery thromboses, two hepatic artery pseudoaneurysms, two splenic artery aneurysms, two portal vein stenoses, and four redundant hepatic arteries. In one case computed tomography (CT) detected a moderate hepatic artery stenosis, while conventional angiography showed a normal artery. The sensitivity of CT for detecting vascular lesions was 100%, specificity was 89% (8 of 9), accuracy was 95% (19 of 20), positive predictive value was 92% (11 of 12), and negative predictive value was 100% (8 of 8).
Conclusions:
3D CTA is a useful and accurate noninvasive technique for detection of vascular complications in liver transplant patients.