HEPATIC VENOOCCLUSIVE DISEASE AFTER MYELOABLATIVE TREATMENT AND BONE-MARROW TRANSPLANTATION - VALUE OF GRAY-SCALE AND DOPPLER US IN 100 PATIENTS

PURPOSE: To determine the value of gray-scale ultrasonography (US) and Doppler US in the prediction, diagnosis, and prognostic assessment of hepatic veno-occlusive disease (HVOD). MATERIALS AND METHODS: One hun dred patients (median age, 22 years; range, 18 months to 59 years) rec eiving total body irradiation or busulfan therapy as intensive treatme nt before hematopoietic stem cell transplantation were studied prospec tively. Each patient underwent gray-scale and Doppler US examination b efore transplantation and weekly thereafter while hospitalized (about four examinations per patient). Seven gray-scale morphologic criteria and seven Doppler criteria were studied, yielding three individual sco res: gray-scale score, Doppler score, and total score. RESULTS: Twenty -five patients developed HVOD; nine of these patients died. Positive p redictive values of the 14 criteria were 31%-95%, and negative predict ive values were 85%-96%. The three scores correlated with the clinical diagnosis of HVOD. Depending on the cutoff value, the positive predic tive value of the total score was 44%-89% and the negative predictive value was 91%-98%. The gray-scale and Doppler criteria differed signif icantly between patients with HVOD and those with graft-versus-host di sease of the liver (P = 10(-4)). CONCLUSION: Even if there is overlap in findings between patients with and those without HVOD, gray-scale a nd Doppler US are valid for positive and differential diagnosis and ha ve predictive and prognostic relevance.