SONOGRAPHIC FINDINGS IN BONE-MARROW TRANSPLANT PATIENTS WITH SYMPTOMATIC HEPATIC VENOOCCLUSIVE DISEASE

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 transplantat ion (14 graft versus host disease and nine hepatitis). Doppler sonogra phic examination was available in all patients with venoocclusive dise ase, in nine of the patients with graft versus host disease, and in th ree of the patients with hepatitis. The hepatic artery resistive index and the overall flow direction, peak forward and retrograde velocitie s, and time-averaged mean velocities in the hepatic veins and main por tal vein were compared. The portal vein waveform was arbitrarily consi dered abnormal in the presence of any of the following: highly pulsati le waveform, very low mean velocity, biphasic flow, or flow reversal. Ascites was the most predictive gray scale sonographic finding for ven oocclusive disease. Doppler sonographic findings of potential value in the diagnosis of hepatic venoocclusive disease include an abnormal po rtal vein waveform, resistive index of greater than 0.75, and marked t hickening and edema of the gallbladder wall. However, the study is lim ited by its retrospective nature and reliance primarily on clinical cr iteria for the diagnosis of venoocclusive disease. Therefore, our find ings will need to be verified in a large prospective study.