PURPOSE: We wanted to assess the usefulness of MRCP after intravenous morphine administration in the evaluation of the hepatopancreatic pancreatico-biliary ductal system. MATERIALS AND METHODS: We studied 15 patients who were suspected of having disease of hepatopancreatic ductal system and they did not have any obstructive lesion on ultrasonography and/or CT. MRCP was acquired before and after morphine administration (0.04 mg/kg, intravenously). Three radiologists scored the quality of the images of the anatomic structures in the hepatopancreatic ductal system. We directly compared the quality of the images obtained with using the two methods and the improvement of the artifacts by pulsatile vascular compression. RESULTS: The MRCP images obtained after intravenous morphine administration were better than those obtained before morphine administration for visualizing the hepatopancreatic ductal system. On direct comparison, the MRCP images obtained after morphine administration were better in 12 cases, equivocal in two cases, and the images before morphine administration were better in only one case. In three patients, MRCP before morphine injection showed signal loss at the duct across the pulsatile hepatic artery. In two of three patients, MRCP after morphine injection showed no signal loss in this ductal area. CONCLUSION: MRCP after intravenous morphine administration enables physicians to see the hepatopancreatic ductal system significantly better and the artifacts caused by pulsation of the hepatic artery can be avoided.
Artifacts ; Hepatic Artery ; Humans ; Morphine* ; Ultrasonography

Doppler ultrasonography of the hepatic vasculature is an integral part of evaluating precirrhotic and cirrhotic patients. While the reversal of the portal venous flow is a well-recognized phenomenon, other flow patterns, although not as easily understood, may play an important role in assessing the disease status. This article discusses the different characteristic flow patterns observed from the portal vein, hepatic artery, and hepatic vein in patients with liver cirrhosis or related complications and procedures. Knowledge of these different flow patterns provides additional information that may reinforce the diagnosis of cirrhosis, help in staging, and offer prognostic information for determining the direction of therapy. Doppler ultrasonography is invaluable when liver transplantation is being considered and aids in the diagnosis of cirrhosis and portal hypertension.
Diagnosis ; Fibrosis* ; Hepatic Artery ; Hepatic Veins ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Liver Transplantation ; Portal Vein ; Ultrasonography, Doppler ; Ultrasonography, Doppler, Color

BACKGROUND/AIMS: Clinical validation is required to determine whether Doppler measurements are comparable before and after administering ultrasound contrast agent (USCA). The purpose of this study is to explore whether the use of USCA affects spectral Doppler analysis in recipients of liver transplantation (LT). METHODS: For this study, 36 patients were examined using Doppler ultrasonography (US) along with a contrast-enhanced US for surveillance of vascular complications after LT. The following spectral Doppler US parameters were measured before and after administration of USCA: peak systolic velocity, end-diastolic velocity, resistive index, and systolic acceleration time of the graft hepatic artery; peak flow velocity of the graft portal vein; and peak flow velocity and venous pulsatility index of the graft hepatic vein. RESULTS: The mean peak systolic and end-diastolic velocities of the hepatic artery and the peak flow velocity of the portal and hepatic veins were increased after intravenously administration of the USCA, ranging from 10% to 13%. However, the changes were not statistically significant (P=0.097, 0.103, 0.128, and 0.190, respectively). There were no significant differences in other measured parameters, including the resistive index (P=0.205) and systolic acceleration time (P=0.489) of the hepatic artery and venous pulsatility index (P=0.494) of the hepatic vein. CONCLUSIONS: The measured velocities of graft hepatic vessels tended to increase after administration of USCA, but without statistical significance. The comparison of serial Doppler parameters with or without injection of USCA is valid during Doppler surveillance in recipients of LT.
Acceleration ; Contrast Media* ; Doppler Effect ; Hepatic Artery ; Hepatic Veins ; Humans ; Liver Transplantation* ; Liver* ; Microbubbles ; Portal Vein ; Transplants ; Ultrasonography* ; Ultrasonography, Doppler

PURPOSE: The anastomosis of hepatic artery to recipient vessel has a major role in a liver transplantation, so its occlusion is the most important cause of failure of liver transplantations. We made the study to reveal the peculiarities in pediatric liver transplantations compared with adult cases. METHODS: From January 1999 to September 2005, we performed 99 cases of pediatric liver transplantation. The mean age at operation was 4.17 years of age. The hepatic vein and portal vein are anastomosed by the general surgeons and then the hepatic artery is anastomosed by the plastic surgeons. The Doppler ultrasonography and computed tomography were used for postoperative checkup for hepatic artery patency. RESULTS: There were no immediate complications, but hepatic arterial occlusion was developed in 3 cases (2.8%). In pediatric patients, the anastomosis of hepatic artery is more difficult than adults because of the rapid respiratory and pulse rate, the small vascular diameter, and the large gap of diameter difference between the recipient and the donor vessels. CONCLUSION: We could confirm that pediatric liver transplantations are relatively safe but long learning curve was needed.
Adult ; Child* ; Heart Rate ; Hepatic Artery* ; Hepatic Veins ; Humans ; Learning Curve ; Liver Transplantation* ; Liver* ; Portal Vein ; Tissue Donors ; Ultrasonography, Doppler

BACKGROUND/AIMS: Portal hypertension occurs as a consequence of liver cirrhosis and is responsible for serious complications such as variceal bleeding, ascites and hepatic encephalopathy. The hepatic venous pressure gradient (HVPG) is the gold standard for assessment of portal hypertension. However, use of the HVPG is limited by being an invasive test. This prospective study evaluated whether the parameters identified by the non-invasive Doppler ultrasonography reflect the HVPG and could potentially be used for the assessment of the severity of portal hypertension in patients with liver cirrhosis. METHODS: HVPG and Doppler ultrasonographic parameters, including the damping index (DI) of the hepatic vein waveform, the portal venous velocity and flow, the splenic venous velocity and flow, the pulsatility and the resistive index of the hepatic, splenic and renal arteries were measured in 114 patients with liver cirrhosis and compared. RESULTS: The DI of the Doppler hepatic vein waveform was significantly correlated with the grade of the HVPG, i.e. with a higher HVPG, an increase in the DI was observed (p<0.01). The other Doppler parameters did not correlate with the HVPG grade. CONCLUSIONS: The results of this study showed that the DI measurements of the hepatic vein waveform by Doppler ultrasonography might provide a noninvasive assessment of the severity of portal hypertension.
Ascites ; Hemorrhage ; Hepatic Encephalopathy ; Hepatic Veins ; Humans ; Hypertension, Portal ; Liver ; Liver Cirrhosis ; Prospective Studies ; Renal Artery ; Ultrasonography, Doppler ; Venous Pressure

Angiography ; Female ; Hepatic Artery ; abnormalities ; diagnostic imaging ; Humans ; Middle Aged ; Tomography, X-Ray Computed ; Ultrasonography

Securing the source of hepatic artery inflow is essential for living donor liver transplantation. However, sometimes, the hepatic arteries of the recipients are in poor condition for a good anastomosis in living donor liver transplantation; problems include severe arteriosclerosis, intimal dissection, and significant intimal injuries caused by previous transarterial procedures. In these conditions, the right gastroepiploic artery has generally been the preferred artery because of its anatomical location, size and length. Here, a case of successful hepatic artery reconstruction is reported using the right gastroepiploic artery in living donor liver transplantation. The recipient's hepatic arterial intima was severely injured by multiple transarterial chemoembolization and unsuitable for reconstruction. Instead, the right gastroepiploic artery was anastomosed to the hepatic artery of the graft. Arterial blood flow was satisfactory on Doppler ultrasonography during the operation, and complications related to the hepatic artery were not detected during the follow-up period. Therefore, the right gastroepiploic artery may be considered as a suitable alternative for hepatic artery reconstruction in living donor liver transplantation.
Arteries ; Arteriosclerosis ; Follow-Up Studies ; Gastroepiploic Artery ; Hepatic Artery ; Humans ; Liver ; Liver Transplantation ; Living Donors ; Transplants ; Tunica Intima ; Ultrasonography, Doppler

PURPOSE: The hepatic arteries of transplant recipients are sometimes in too poor a condition to make a good anastomosis in living donor liver transplantation. The aim of this study was to evaluate the outcome of hepatic artery reconstruction using the recipient's right gastroepiploic artery. METHODS: A total of 153 LDLTs were performed at Seoul National University Hospital from January 1999 to December 2003. In 10 cases, arterial reconstruction was performed by anastomosis of the donor's hepatic artery to the recipient's right gastroepiploic artery. Hepatic artery reconstruction was carried out with the aid of an operating microscope and with using the interrupted Carrel's technique. The adequate blood flow was verified during the operation by the Doppler ultrasonography and also daily for seven days after transplantation by means of Doppler ultrasonography. The median length of the follow-up was 40 months (range: 20~60 months). RESULTS: In seven cases out of ten, the recipient's right gastroepiploic artery was initially used due to arterial thrombosis or because of severe endothelial damage of the recipient's hepatic artery. In the remaining three cases, the graft was revascularized using the recipient's right gastroepiploic artery. In all cases, excellent hepatic arterial flow was confirmed by the Doppler ultrasonography during the operation. Complications related to the hepatic artery were not detected during the follow-up period. CONCLUSION: The recipient's right gastroepiploic artery is a suitable alternative for hepatic artery reconstruction in LDLT.
Follow-Up Studies ; Gastroepiploic Artery* ; Hepatic Artery* ; Humans ; Liver Transplantation* ; Liver* ; Living Donors* ; Seoul ; Thrombosis ; Transplantation ; Transplants ; Ultrasonography, Doppler

We report a case of histopathologically confirmed hepatic angiosarcoma. A 29-year old patient was admitted with fever and palpable tender mass in the right upper abdomen. On ultrasonography, a large, well circumscribed mixed echoic mass was seen in the right lobe of the liver. On CT scan, irregular enhancement was seen mainly in the peripheral portion of the mass ; the central portion was not enhanced. The mass showed low signal intensity on T1W1, and high signal intensity on T2WI. Peripheral nodular enhancement was noted on Gd-enhanced MR images; In the peripheral portion of the mass,
Abdomen ; Adult ; Angiography ; Fever ; Hemangiosarcoma* ; Hepatic Artery ; Humans ; Liver* ; Radionuclide Imaging ; Sarcoma ; Tomography, X-Ray Computed ; Ultrasonography

PURPOSE: To evaluate therapeutic effect according to embolic materials, and the usefulness of transcatheter arterial embolization (TAE) in the treatment of pseudoaneurysm and aneurysm. MATERIALS AND METHODS: We evaluated 12 patients who since 1987 had suffered arterial pseudoaneurysm or aneurysm. Ten were males and two were females, and their ages ranged from 10 months to 67 years (mean 34 years). The arteries involved were the superficial temporal (n=3), the renal (n=3), the hepatic (n=2), the gastroduodenal (n=2), the persistent sciatic (n=1), and the superior gluteal artery (n=1). All patients underwent diagnostic arteriography and TAE with gelfoam particles, coil, and detachable balloon, or a combination of these. Follow-up, of between three and 74 months duration, involved computed tomography, angiography, ultrasound, and the evaluation of clinical symptoms. RESULTS: All patients were treated successfully with TAE and there was no recurrence during the follow-up. Seven patients (58.3%) were treated only coils; the site of their aneurysm or pseudoaneurysm was the superficial temporal (n=2), the renal (n=2), the gastroduodenal (n=2), or the superior gluteal artery (n=1). Four patients (33.3%) with a small pseudoaneuysm arising from the distal branch of a small artery-the hepatic (n=2), the superficial temporal (n=1), or the renal (n=1)-were treated with gelfoam particles, and a pseudoaneurysm of the hepatic artery too small for the insertion of a coil was embolized completely with gelfoam particles. A detachable balloon was used in one case with a huge pseudoaneurysm arising from the persistent sciatic artery, in which embolization with a large coil was not effective. CONCLUSION: TAE is safe and effective in the treatment of arterial pseudoaneurysm and aneurysm. Coil was the preferred material, but for a small pseudoaneurysm arising from the distal branch of a small artery, gelfoam was preferred . For the embolization of a huge pseudoaneurysm, a adtachable balloon was useful.
Aneurysm* ; Aneurysm, False* ; Angiography ; Arteries ; Female ; Follow-Up Studies ; Gelatin Sponge, Absorbable ; Hepatic Artery ; Humans ; Male ; Recurrence ; Ultrasonography