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Hepatic Venous Congestion after Living Donor Liver Transplantation with Right Lobe Graft: Two-Phase CT Findings¹

¹ From the Departments of Radiology (B.S.K., T.K.K., M.G.L., J.H.K., K.W.K., K.B.S., P.N.K., H.K.H.), Pathology (J.S.K.), and Surgery (S.G.L.), Asan Medical Center, University of Ulsan, Seoul, Korea; and Department of Information and Statistics, Daejeon University, Korea (W.K.). Received March 24, 2003; revision requested June 18; final revision received October 28; accepted December 18. Address correspondence to T.K.K., Department of Medical Imaging, Toronto General Hospital, 200 Elizabeth St, Toronto, ON, Canada M5G 2C4 (e-mail: taekyoung.kim@uhn.on.ca).

View larger version (56K): [in a new window]   Figure 1. Diagram shows the two-phase spiral CT features in patients with hepatic venous congestion after LDLT. White areas indicate hyperattenuation, light gray areas indicate isoattenuation, and dark gray areas indicate hypoattenuation. A = HAP, P = PVP.

View larger version (114K): [in a new window]   Figure 2a. Transverse CT scans obtained in a 51-year-old man with hepatic venous congestion. (a) HAP CT scan shows slight hypoattenuation (arrows) in segment VIII of the transplanted liver. (b) PVP CT scan shows wedge-shaped hyperattenuation (white arrows) in the corresponding area. The border between hyper- and isoattenuating areas is intersected by the anterior segmental branch of the portal vein. The well-enhanced tributary (black arrow) of the middle hepatic vein and the peripheral portal vein (arrowhead) is identified at the area of hyperattenuation. (c) Four-week follow-up CT scan obtained during the PVP shows that this area is slightly hyperattenuating with a decreased attenuation difference and without atrophy.

View larger version (124K): [in a new window]   Figure 2b. Transverse CT scans obtained in a 51-year-old man with hepatic venous congestion. (a) HAP CT scan shows slight hypoattenuation (arrows) in segment VIII of the transplanted liver. (b) PVP CT scan shows wedge-shaped hyperattenuation (white arrows) in the corresponding area. The border between hyper- and isoattenuating areas is intersected by the anterior segmental branch of the portal vein. The well-enhanced tributary (black arrow) of the middle hepatic vein and the peripheral portal vein (arrowhead) is identified at the area of hyperattenuation. (c) Four-week follow-up CT scan obtained during the PVP shows that this area is slightly hyperattenuating with a decreased attenuation difference and without atrophy.

View larger version (133K): [in a new window]   Figure 2c. Transverse CT scans obtained in a 51-year-old man with hepatic venous congestion. (a) HAP CT scan shows slight hypoattenuation (arrows) in segment VIII of the transplanted liver. (b) PVP CT scan shows wedge-shaped hyperattenuation (white arrows) in the corresponding area. The border between hyper- and isoattenuating areas is intersected by the anterior segmental branch of the portal vein. The well-enhanced tributary (black arrow) of the middle hepatic vein and the peripheral portal vein (arrowhead) is identified at the area of hyperattenuation. (c) Four-week follow-up CT scan obtained during the PVP shows that this area is slightly hyperattenuating with a decreased attenuation difference and without atrophy.

View larger version (138K): [in a new window]   Figure 3a. Transverse CT scans obtained in a 44-year-old man with hepatic venous congestion. (a) HAP CT scan shows hypoattenuation (arrows) in segments V and VIII. (b) PVP CT scan shows a fan-shaped area of hypoattenuation (short arrows) with surrounding hyperattenuation (long arrows) in this area. Note the anterior segmental branch of the portal vein (arrowhead). (c) Four-week follow-up CT scan shows decrease of the hypoattenuating area (short arrows), although there is no change in size in the hyperattenuating area (long arrows).

View larger version (137K): [in a new window]   Figure 3b. Transverse CT scans obtained in a 44-year-old man with hepatic venous congestion. (a) HAP CT scan shows hypoattenuation (arrows) in segments V and VIII. (b) PVP CT scan shows a fan-shaped area of hypoattenuation (short arrows) with surrounding hyperattenuation (long arrows) in this area. Note the anterior segmental branch of the portal vein (arrowhead). (c) Four-week follow-up CT scan shows decrease of the hypoattenuating area (short arrows), although there is no change in size in the hyperattenuating area (long arrows).

View larger version (111K): [in a new window]   Figure 3c. Transverse CT scans obtained in a 44-year-old man with hepatic venous congestion. (a) HAP CT scan shows hypoattenuation (arrows) in segments V and VIII. (b) PVP CT scan shows a fan-shaped area of hypoattenuation (short arrows) with surrounding hyperattenuation (long arrows) in this area. Note the anterior segmental branch of the portal vein (arrowhead). (c) Four-week follow-up CT scan shows decrease of the hypoattenuating area (short arrows), although there is no change in size in the hyperattenuating area (long arrows).

View larger version (133K): [in a new window]   Figure 4a. Transverse CT scans obtained in a 57-year-old woman with hepatic venous congestion. (a) PVP CT scan shows a well-demarcated hypoattenuating area in segment VIII. Arrow indicates the nonenhancing hepatic vein. Peripheral portal veins are unopacified. (b) Four-week follow-up CT scan shows that this area has become atrophied (arrows).

View larger version (130K): [in a new window]   Figure 4b. Transverse CT scans obtained in a 57-year-old woman with hepatic venous congestion. (a) PVP CT scan shows a well-demarcated hypoattenuating area in segment VIII. Arrow indicates the nonenhancing hepatic vein. Peripheral portal veins are unopacified. (b) Four-week follow-up CT scan shows that this area has become atrophied (arrows).

View larger version (150K): [in a new window]   Figure 5. Transverse PVP CT scan obtained in a 45-year-old man with hepatic venous congestion. Scan shows a well-demarcated hypoattenuating area (arrows) in segments VI and VII. This finding suggests congestion of the drainage area of the inferior right accessory hepatic vein.

View larger version (148K): [in a new window]   Figure 6. Photomicrograph of a liver biopsy specimen obtained in a 49-year-old man with hepatic venous congestion shows marked sinusoidal dilatation and damage of hepatocytes (arrows), which are consistent with hepatic venous congestion. (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (22K): [in a new window]   Figure 7. Changes in serum total bilirubin level according to hepatic venous congestion in patients who underwent LDLT. Graph demonstrates that patients with hypoattenuating areas during PVP had significantly higher serum bilirubin levels than did patients without hepatic attenuation difference or patients with hyperattenuation. Data are presented as geometric mean. = absence of hepatic attenuation difference during PVP, = hyperattenuation during PVP, = hypoattenuation during PVP.