Improving the radiological diagnosis of hepatic artery thrombosis after liver transplantation: Current approaches and future challenges

Figure 1 Doppler ultrasound evaluation of the hepatic artery. A: Intercostal color and spectral doppler image of a normal hepatic artery at the porta hepatis in the liver graft of a 51-year-old woman on postoperative day 3 after transplant, depicting a rapid systolic upstroke with continuous low-velocity diastolic flow and a normal resistive index; B: Subcostal color doppler image of the right hepatic lobe in a 46-year-old man on postoperative day 2 demonstrates vascular flow in the portal vein, with no hepatic artery flow detected on color or spectral doppler images at the porta hepatis.

Figure 2 Computed tomography angiography evaluation of hepatic artery thrombosis in liver graft. A 51-year-old woman on postoperative day 7 after a liver transplant. A: Axial abdominal computed tomography angiography (CTA) images at maximum intensity projection (white arrow); B: Coronal 3D volume rendering CTA reconstruction showing absence of vascular opacification of vessels distal to occlusion of the hepatic artery (white arrow).

Figure 3 Magnetic resonance imaging of liver graft. Axial T₂-weighted single-shot fast spin-echo image. A: Fat saturation (Fat-sat); B: Contrast enhanced T₁-weighted gradient-echo image in late arterial; C: Portal phase; D: Depicts a homogeneous signal intensity at graft parenchyma, with adequate representation of intrahepatic and extrahepatic arterial branches, venous vessels and biliary ducts, in a 32-year-old man on postoperative surveillance after a liver transplantation.

Figure 4 Visceral angiography performed 3 d after orthotopic liver transplant. A: Demonstrated complete occlusion of the hepatic artery (white arrow); B: Recanalization of the hepatic artery after thrombectomy, with improved intrahepatic blood flow (white arrow).