Background/Purpose: There is a considerable variation in the use of vascular imaging techniques in the preoperative assessment of children scheduled for liver transplantation. Duplex Doppler ultrasound scan (US), magn...Background/Purpose: There is a considerable variation in the use of vascular imaging techniques in the preoperative assessment of children scheduled for liver transplantation. Duplex Doppler ultrasound scan (US), magnetic resonance angiography (MRA), and conventional angiography are used to varying extents. The authors compared the results of preoperative vascular imaging studies with operative findings to determine their accuracy and usefulness. Methods: Results of preoperative vascular imaging in 37 consecutive children undergoing cadaveric liver transplantation were compared with operative findings. Those undergoing relatively elective transplantations were investigated by US and MRA (group 1), whereas those requiring urgent transplants were assessed only by US (group 2). Results: The median age of the cohort (15 boys; 22 girls) was 4 years (19 days to 16 years) and the median weight was 17 kg (2.9 to 82 kg). In group 1 (n = 26), 20 children had a normalcaliber, patent portal vein at transplant and 6 had a narrow but patent portal vein requiring venous reconstruction in 4. The sensitivity and specificity of MRA in the detection of an abnormally narrow portal vein were 100% (6/6) and 95% (19/20), respectively. If reversed or absent flow in the portal vein on US was taken as an indication of a potentially abnormal vein, the sensitivity and specificity of Doppler US were 83% (5/6) and 95% (19/20), respectively. Magnetic resonance angiography revealed arterial anomalies in 4 children but failed to detect small accessory hepatic arteries in 5. The single patient with an aberrant vena cava was identified by MRA. In group 2 (n = 11), venous findings at operation and on US were concordant in 10 (91% ) cases; one infant with reversed flow in the portal vein on US had a thrombosed vein at surgery. Magnetic resonance angiography was useful in 2 patient groups: those with reversed flow on Doppler US or suspected portal vein thrombosis in whom an abnormal portal vein was present in 86% (6/7) and infants with the biliary at展开更多
RichaaConti教授曾任美国心脏病学学会（American College of Cardiology，ACC）主席，多年担任ACCEL主编和临床心脏病学杂志总编辑。他是国际著名的临床医学家和医学教育家。Conti教授1987年首次访华，近十年来每年出席长城国际心脏病...RichaaConti教授曾任美国心脏病学学会（American College of Cardiology，ACC）主席，多年担任ACCEL主编和临床心脏病学杂志总编辑。他是国际著名的临床医学家和医学教育家。Conti教授1987年首次访华，近十年来每年出席长城国际心脏病学术大会，作了重要的学术演讲，主持中青年优秀论文评审和病例讨论，并在多所医学院校与我合作，作了如何成为合格临床医生的演讲（讲稿已发表在临床心脏病学杂志）。在2010年的“长城会”上，我特邀Conti教授为中华心血管病杂志撰稿，并商定了本文的内容。我国心血管影像学发展很快，发挥其在筛查、评估、诊断和治疗作用的同时，如何趋利避害，控制电离辐射隐患，应引起影像专业之外的广大临床医务人员的关注和重视。本文明确强调，目前状态的导管或CT技术不宜用于无症状人群的筛查。加强影像专业之外的临床医生的影像学培训是本届分会主抓的一项中心工作，这项全员培训工程中应含有电辐射伤害的内容。作为一位资深的临床医学家，Conti教授提出将患者接受电辐射的病史，如同用药、手术治疗、吸烟史一样记录入病历。这一建议应引起我国卫生行政部门、医院与专业学会和专业人员的充分重视。在我国医疗卫生机构运营机制中存在的趋利性和过度检查、过度医疗的弊端日益显现的情况下，更应规范使用心血管影像技术。我特别呼吁，避免对心血管病低危人群，尤其是中青年女性不恰当应用CT与导管造影。若不引起重视，不仅对患者无益，反而会增加他们患癌症的风险。国内一些豪华体检中心，不是以公众健康和广大患者的利益为本，个体化设计体检方案，而是根据患者的经济支付能力推出少到数千元，多则几万元的含有数项具电辐射危害的检查项目的“豪华套餐”。这种检查如年年进行�展开更多
文摘Background/Purpose: There is a considerable variation in the use of vascular imaging techniques in the preoperative assessment of children scheduled for liver transplantation. Duplex Doppler ultrasound scan (US), magnetic resonance angiography (MRA), and conventional angiography are used to varying extents. The authors compared the results of preoperative vascular imaging studies with operative findings to determine their accuracy and usefulness. Methods: Results of preoperative vascular imaging in 37 consecutive children undergoing cadaveric liver transplantation were compared with operative findings. Those undergoing relatively elective transplantations were investigated by US and MRA (group 1), whereas those requiring urgent transplants were assessed only by US (group 2). Results: The median age of the cohort (15 boys; 22 girls) was 4 years (19 days to 16 years) and the median weight was 17 kg (2.9 to 82 kg). In group 1 (n = 26), 20 children had a normalcaliber, patent portal vein at transplant and 6 had a narrow but patent portal vein requiring venous reconstruction in 4. The sensitivity and specificity of MRA in the detection of an abnormally narrow portal vein were 100% (6/6) and 95% (19/20), respectively. If reversed or absent flow in the portal vein on US was taken as an indication of a potentially abnormal vein, the sensitivity and specificity of Doppler US were 83% (5/6) and 95% (19/20), respectively. Magnetic resonance angiography revealed arterial anomalies in 4 children but failed to detect small accessory hepatic arteries in 5. The single patient with an aberrant vena cava was identified by MRA. In group 2 (n = 11), venous findings at operation and on US were concordant in 10 (91% ) cases; one infant with reversed flow in the portal vein on US had a thrombosed vein at surgery. Magnetic resonance angiography was useful in 2 patient groups: those with reversed flow on Doppler US or suspected portal vein thrombosis in whom an abnormal portal vein was present in 86% (6/7) and infants with the biliary at
文摘RichaaConti教授曾任美国心脏病学学会（American College of Cardiology，ACC）主席，多年担任ACCEL主编和临床心脏病学杂志总编辑。他是国际著名的临床医学家和医学教育家。Conti教授1987年首次访华，近十年来每年出席长城国际心脏病学术大会，作了重要的学术演讲，主持中青年优秀论文评审和病例讨论，并在多所医学院校与我合作，作了如何成为合格临床医生的演讲（讲稿已发表在临床心脏病学杂志）。在2010年的“长城会”上，我特邀Conti教授为中华心血管病杂志撰稿，并商定了本文的内容。我国心血管影像学发展很快，发挥其在筛查、评估、诊断和治疗作用的同时，如何趋利避害，控制电离辐射隐患，应引起影像专业之外的广大临床医务人员的关注和重视。本文明确强调，目前状态的导管或CT技术不宜用于无症状人群的筛查。加强影像专业之外的临床医生的影像学培训是本届分会主抓的一项中心工作，这项全员培训工程中应含有电辐射伤害的内容。作为一位资深的临床医学家，Conti教授提出将患者接受电辐射的病史，如同用药、手术治疗、吸烟史一样记录入病历。这一建议应引起我国卫生行政部门、医院与专业学会和专业人员的充分重视。在我国医疗卫生机构运营机制中存在的趋利性和过度检查、过度医疗的弊端日益显现的情况下，更应规范使用心血管影像技术。我特别呼吁，避免对心血管病低危人群，尤其是中青年女性不恰当应用CT与导管造影。若不引起重视，不仅对患者无益，反而会增加他们患癌症的风险。国内一些豪华体检中心，不是以公众健康和广大患者的利益为本，个体化设计体检方案，而是根据患者的经济支付能力推出少到数千元，多则几万元的含有数项具电辐射危害的检查项目的“豪华套餐”。这种检查如年年进行�
