Journal of Ultrasound in Medicine, Vol 16, Issue 9 575-586, Copyright © 1997 by American Institute of Ultrasound in Medicine
Sonographic findings in bone marrow transplant patients with symptomatic hepatic venoocclusive disease
M. J. Sharafuddin, M. C. Foshager, M. Steinbuch, D. J. Weisdorf and D. W. Hunter
Department of Radiology, University of Minnesota Hospital and Clinic, Minneapolis, USA.
Sonographic findings were retrospectively compared between 19 patients with
hepatic venoocclusive disease and 23 patients with other common causes of
symptomatic liver dysfunction after bone marrow transplantation (14 grafts
versus host disease and nine hepatitis). Doppler sonographic examination
was available in all patients with venoocclusive disease, in nine of the
patients with graft versus host disease, and in three of the patients with
hepatitis. The hepatic artery resistive index and the overall flow
direction, peak forward and retrograde velocities, and time-averaged mean
velocities in the hepatic veins and main portal vein were compared. The
portal vein waveform was arbitrarily considered abnormal in the presence of
any of the following: highly pulsatile waveform, very low mean velocity,
biphasic flow, or flow reversal. Ascites was the most predictive gray scale
sonographic finding for venoocclusive disease. Doppler sonographic findings
of potential value in the diagnosis of hepatic venoocclusive disease
include an abnormal portal vein waveform, resistive index of greater than
0.75, and marked thickening and edema of the gallbladder wall. However, the
study is limited by its retrospective nature and reliance primarily on
clinical criteria for the diagnosis of venoocclusive disease. Therefore,
our findings will need to be verified in a large prospective study.
