Hepatic veno-occlusive disease in children undergoing bone-marrow transplantation: usefulness of sonographic findings

Background. Reports of the usefulness of ultrasonography in the diagnosis o f hepatic veno-occlusive disease (HVOD) have presented conflicting results. Objective. To determine the usefulness of gray-scale or Doppler ultrasonogr aphic measurements in the diagnosis of HVOD in pediatric patients undergoin g BMT. Materials and methods. We prospectively obtained 202 serial sonograms on 48 patients and examined the association between the clinical diagnosis of HV OD (McDonald criteria) and eight ultrasound parameters, including the hepat ic artery resistive index (HARI), direction and velocity of portal venous f low, and thickness of the gall bladder wall. Results. HVOD developed in 29 of the 48 patients. The portal venous velocit y increased after BMT in the group without HVOD and decreased in the group with HVOD; this difference was significant (P = 0.01). However, there was a great deal of variability in velocity measurements for individual patients . The mean HARI was 0.64 in the group with HVOD and 0.63 in the group witho ut HVOD, and there was no difference between the two groups in the pattern of change in HARI relative to the day of BMT (P = 0.4). There was also no s ignificant difference in thickness of the gallbladder wall between the two groups (P = 0.6). Conclusion. No ultrasound parameter studied was as useful as the McDonald c riteria for diagnosing HVOD.