Grayscale and Spectral Doppler Ultrasound in the Diagnosis of Hepatic Veno-occlusive Disease/Sinusoidal Obstruction Syndrome After Hematopoietic Stem Cell Transplantation in Children.

The aim of this study is to determine the ultrasound criteria in the diagnosis of hepatic veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) after hematopoietic stem cell transplantation (HSCT) in children. A total of 158 pediatric patients underwent HSCT between January 2016 and January 2018. In all, 71 patients with clinically suspicious hepatic VOD/SOS have been followed with serial ultrasound examinations. Hepatomegaly, gallbladder wall thickening, ascites, pleural effusion, reverse flow in the portal vein, and diameter and peak systolic velocity of the hepatic artery were evaluated. Patients were divided into 2 groups retrospectively: VOD/SOS and non-VOD/SOS. The predictive value of all findings was determined, respectively. Gallbladder wall thickening, increase of diameter and peak systolic velocity of the hepatic artery, and the presence of ascites are highly predictive for VOD/SOS (P=0.001 and < 0.05). The reversed portal venous flow was developed in 3 patients in the VOD/SOS group, no significant difference was found between the 2 groups (P>0.05). Hepatomegaly was recorded in 29 (70.7%) patients in the VOD/SOS group, 13 of them was presented related to a primary disease. Pleural effusion is not associated with the diagnosis of VOD/SOS (P>0.05). Gallbladder wall edema, an increase of peak systolic velocity of the hepatic artery, and the presence of ascites are highly related to the diagnosis of VOD/SOS in children after HSCT. Ultrasound findings must be correlated with clinical criteria.

The Diagnostic Value of Hepatic Arterial Velocity in Venoocclusive Disease After Pediatric Hematopoietic Stem Cell Transplantation.

The aim of this study was to determine usefulness of measurements of maximal systolic velocity of the hepatic artery with Doppler ultrasonography in the diagnosis of venoocclusive disease (VOD) after hematopoietic stem cell transplantation. We prospectively obtained 5 sonograms per patient: pretransplantation, day +1, +7, +14, and +28 on 36 nonconsecutive children who underwent hematopoietic stem cell transplantation. We examined the hepatic artery, the portal, hepatic and splenic veins, the thickness of the gallbladder wall, the presence of ascites, and the liver and spleen size. The diagnosis of VOD was based on clinical and laboratory data. Patients were divided into 2 groups: those with VOD (n=18) and those without VOD (n=18). The variance of 2 groups was analyzed. Vmax of the hepatic artery had a strong correlation with clinical VOD diagnosis (P<0.001). There was no statistically significant difference in the other Doppler parameters. The results of our study showed that the measurement of Vmax of the hepatic artery can provide important support in the diagnosis of VOD and can be useful in the follow-up of treatment response.