Ultrasound protocols for transplant liver
Transplant Liver
Day One
- As imaging in the immediate post transplant period can be extremely difficult, detailed assessment of the liver parenchyma is not essential (though it should be attempted).
- The aim of the study is to confirm rule out significant narrowing or occlusion of hepatic vascular connections, rule out bile duct obstruction and identify any significant peri-hepatic collections
Assess:
- Hepatic vasculaturE
- Bile duct calibre
- Peri-hepatic collections / pleural space
Standard documentation:
- Longitudinal and transverse views to demonstrate any peri-heptic collections
- Longitudinal view of the porta hepatis, demonstrating the bile duct with measurement of calibre
- Colour Doppler images / PW Doppler spectral waveforms +/- clip store of:
- Main, left and right portal veins
- Main, left and right hepatic artery (if possible measure R.I. and acceleration time)
- Main, left and right hepatic veins
- IVC
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FOLLOW-UP STUDIES
- Imaging of transplant livers (even well after transplantation) is often very difficult, assessment of parenchymal detail should be attempted but may be severely limited due to technical restictions.
- Assessment may be limited to the liver and porto-hepatic vasculature or may be extended to a full scan of the upper abdomen as indicated by the referring clinician or radiologist.
Assess:
- Hepatic size
- Hepatic echotexture / echogenicty
- Hepatic contour
- Intrahepatic biliary tree
- Hepatic vasculature
- Bile duct calibre
- Bile duct lumen
- Peri-hepatic collections / pleural space
- Remainder of upper abdomen if indicated
Standard documentation:
- Longitudinal view of lateral segment of the left lobe
- Longitudinal view of the left lobe and caudate lobe and IVC
- Longitudinal view of the porta hepatis
- Longitudinal views of the right lobe and gall bladder
- Longitudinal view of the mid right hepatic lobe
- Longitudinal view of the right lobe and right kidney
- Transverse view of the hepatic veins / IVC
- Transverse view of the portal vein
- Bile duct view with intrahepatic measurement.
- Bile duct view with extrahepatic measurement.
- Colour Doppler images / PW Doppler spectral waveforms +/- clip store of:
- Main, left and right portal veins
- Main, left and right hepatic artery
- Main, left and right hepatic veins
- IVC
- Views of other upper abdominal structures as per protocol (only if indicated)
nb: Views obtained may be significantly altered and/or reduced from the above list depending on technical considerations. |
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