Multidetector computed tomography for preoperative assessment of hepatic vasculature and prediction of splenic artery steal syndrome in patients with liver cirrhosis before transplantation

• DOI: 10.1007/s00330-009-1535-y
• Publication Date: 2009-08-06T09:04:02Z
• Authors: Christian Grieser; Timm Denecke; Ingo G. Steffen; Maria Avgenaki; Vera Fröhling; Martina Mogl; Dirk Schnapauff; Lukas Lehmkuhl; Lars Stelter; Florian Streitparth; Jan Langrehr; Jan-Holger Rothe; Bernd Hamm; Enrique Lopez Hän...
• Keywords: Liver Cirrhosis; Male; Incidence; Reproducibility of Results; Comorbidity; Middle Aged; Risk Assessment; Sensitivity and Specificity; Liver Transplantation; 3. Good health; 03 medical and health sciences; Hepatic Artery; Postoperative Complications; 0302 clinical medicine; Risk Factors; Germany; Preoperative Care; Humans; Female; Single-Blind Method; Tomography, X-Ray Computed; Splenic Artery

The purpose of this study was to evaluate the accuracy of MDCT for preoperative assessment of hepatic vascular anatomy and the identification of liver-transplantation (OLT) patients at risk of developing subsequent splenic artery steal syndrome (SASS). A total of 145 patients with liver cirrhosis who had undergone OLT and had pre-operative three-phase MDCT (4- to 64-rows) within 100 days before OLT were enrolled retrospectively. MDCT and 3Ds were reviewed by two independent blinded observers (O1/O2). Pre-operative imaging findings were correlated with intra-operative results; findings indicative for SASS were correlated with clinical data and DSA. Among all 145 patients, 16 patients (11%) showed accessory hepatic arteries (accuracy O1/O2, 97%; with 3Ds, 100%); 32 (22%) patients had replaced hepatic arteries (accuracy O1, 97%; O2, 95%; with 3Ds, 100%; kappa = 0.87 and 0.89, P < 0.001). Among 119 patients, 12 patients developed SASS after OLT. The logistic regression model revealed the spleen volume (P = 0.0105) as a predictive factor of SASS. With spleen volumes >or=829 ml, an accuracy of 75% for prediction of SASS was obtained. MDCT with three-dimensional post-processing (3Ds) was highly accurate for pre-operative hepatic vessel evaluation in patients before OLT. In addition, spleen volume was a predictive factor for developing SASS after OLT.