Sonographic findings in bone marrow transplant patients with symptomatic hepatic venoocclusive disease

Abstract

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 transplantation (14 graft versus host disease and nine hepatitis). Doppler sonographic examination was available in all patients with venoocclusive disease, in nine of the patients with graft versus host disease, and in three of the patients with hepatitis. The hepatic artery resistive index and the overall flow direction, peak forward and retrograde velocities, and time-averaged mean velocities in the hepatic veins and main portal vein were compared. The portal vein waveform was arbitrarily considered abnormal in the presence of any of the following: highly pulsatile waveform, very low mean velocity, biphasic flow, or flow reversal. Ascites was the most predictive gray scale sonographic finding for venoocclusive disease. Doppler sonographic findings of potential value in the diagnosis of hepatic venoocclusive disease include an abnormal portal vein waveform, resistive index of greater than 0.75, and marked thickening and edema of the gallbladder wall. However, the study is limited by its retrospective nature and reliance primarily on clinical criteria for the diagnosis of venoocclusive disease. Therefore, our findings will need to be verified in a large prospective study.