DIAGNOSIS OF VENOOCCLUSIVE DISEASE OF THE LIVER AFTER BONE-MARROW TRANSPLANTATION - VALUE OF DUPLEX SONOGRAPHY

OBJECTIVE. The purpose of this study was to determine if duplex sonogr aphy of the hepatic vasculature can be used to detect venoocclusive di sease in patients who have had bone marrow transplantation. SUBJECTS A ND METHODS. Twenty-seven bone marrow transplant recipients were serial ly studied with hepatic duplex sonography before (n = 27) and biweekly after (n = 136) transplantation. Duplex waveforms were obtained from the hepatic artery and the portal and hepatic venous systems. Clinical records were reviewed to confirm the clinical diagnosis of venoocclus ive disease (n = 5), including its time of onset and duration. Patient s with venoocclusive disease were further split into two groups: those with clinically active disease and those with clinically inactive dis ease. The resistive index in the hepatic artery, the velocity in the p ortal vein, and the differences among bone marrow transplant values be fore and after transplantation were compared among the groups. RESULTS . On the basis of data obtained before transplantation, a resistive in dex greater than 0.76 and a change in resistive index greater than 0.1 0 after transplantation were considered abnormal. Similarly, velocity in the portal vein after transplantation was considered abnormal when the value was less than 4.3 cm/sec or more than 50.3 cm/sec. There was no statistically significant difference in the resistive index in the hepatic artery or velocity in the portal vein among patient groups. H epatopetal portal venous flow was shown in 26 of 27 patients during th e study. Portal venous flow was reversed in one patient with venoocclu sive disease. Appropriately directed hepatic venous flow was demonstra ted in all 27 patients. CONCLUSION. Our study shows that resistive ind ex in the hepatic artery, velocity and flow direction in the portal ve in, and flow direction in the hepatic vein as detected by duplex sonog raphy are of no value in the diagnosis of venoocclusive disease after transplantation.