Abstracts S183

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Hepatofugal Portal Venous Flow on Doppler US in PatientsFollowing Liver Transplantation: Is it Always a Sign of the Life-Threatening Complication?Woo Kyoung Jeong, Hanayng University Kuri Hospital, HanyangUniversity College of Medicine, KoreaKyoung Won Kim, Asan Medical Center, University of UlsanCollege of Medicine, Korea, Democratic People’s RepPyo Nyun Kim, Asan Medical Center, University of Ulsan College ofMedicine, KoreaGi Won Song, Asan Medical Center, University of Ulsan College ofMedicine, KoreaShin Hwang, Asan Medical Center, University of Ulsan College ofMedicine, KoreaSung Gyu Lee, Asan Medical Center, University of Ulsan College ofMedicine, Korea

Purpose: To categorize hepatofugal portal flow (HFPF) on Doppler USin patients following liver transplantation (LT) according to presumedcauses based on radiologic and pathologic findings, and to investigateclinical significance.Materials and Methods: We searched database of LT recipients in ourinstitution. After review of radiological and pathological reports, wefound 30 patients in whom Doppler US revealed HFPF, and classifiedinto three groups: A, hepatic inflow; B, hepatic outflow; C, parenchy-mal abnormalities. We also categorized Doppler pattern into 1) con-tinuously HFPF (pattern 1), 2) to-and-fro pattern of which overallamount of hepatofugal larger than hepatopetal (pattern 2), 3) to-and-fropattern of which hepatofugal smaller than hepatopetal (pattern 3). Weinvestigated clinical features and Doppler pattern in each group,Results: In patients classified as group A, presumed cause was portalinsufficiency (n�8). In group B, it was hepatic outflow obstruction atanastomosis (n�4) and post-anastomotic problems such as tricuspidregurgitation or high central venous pressure (n�4). In group C, it wasacute rejection (n�6), hepatocytic necrosis (n�5), and liver cirrhosis(n�1). Two patients without obvious cause who improved spontane-ously classified to miscellaneous. Sixteen (53%) of the patients withHFPF improved with medical treatment, 7 (23%) improved after in-tervention or surgery, and other 7 were dead. Mortality of group C was33.3%, which was the highest value among three groups. About Dopp-ler pattern, four patients who showed pattern 1 were dead.Conclusion: HFPF reflects various pathologic conditions after LT, andits clinical significance is also diverse depending on the causes.

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Non Alcoholic Fatty Liver: An Overview of Current DiagnosisGillian Kennedy, Bond University, Australia

Non Alcoholic Fatty Liver Disease (NAFLD) is a condition that isfrequently seen but seldom investigated. Until recently, NAFLD wasconsidered benign, self-limiting and unworthy of further investigation.This opinion is based on retrospective studies with relatively smallnumbers and scant follow-up of histology data. The prevalence foradults, in the USA is, 30%, and NAFLD is an increasing form of liverdisease in the paediatric population . Australian data, from New SouthWales, suggests the prevalence of NAFLD in “healthy” 15 year olds asbeing 10%.An association exists between NAFLD, Non Alcoholic Steatosis Hep-atitis (NASH) and irreversible liver damage, cirrhosis and hepatomaand also with Metabolic Syndrome. This Syndrome is categorised byincreased insulin resistance (IR) and NAFLD is thought to be thehepatic representation. Those with NAFLD have an increased risk of

death, atherosclerosis and cardiovascular disease.

Liver biopsy is considered the gold standard for diagnosis, and gradingand staging, of non-alcoholic fatty liver disease, however, when apatient presents with raised fasting blood glucose, low HDL (highdensity lipoprotein), and elevated fasting triacylglycerols they arelikely to have NAFLD.Of the imaging techniques MRI is the least variable and the mostreproducible.With CT scanning liver fat content can be semi quantitatively esti-mated.Ultrasound permits early detection of fatty liver, often in the preclinicalstages before symptoms are present and serum alterations occur. Ear-lier, accurate reporting of this condition will allow appropriate inter-vention resulting in better patient health outcomes.

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Ultrasonographic Atlas of Hyperechoic Focal Liver LesionsKyeong Ah Kim, Korea University Guro Hospital, KoreaChang Hee Lee, Korea University Guro Hospital, KoreaJae Woong Choi, Korea University Guro Hospital, KoreaJongmee Lee, Korea University Guro Hospital, KoreaCheol Min Park, Korea University Guro Hospital, Korea

Characterization of hyperechoic focal liver lesions in the abdominalultrasound has always been a challenge for the radiologist. In thisexhibit, we discuss and illustrate the sonographic features and differ-ential diagnosis of various focal hepatic lesions which show hyper-echogenicity on ultrasound images. These include (1) malignant pri-mary or secondary neoplasms (hepatocellular carcinoma, metastases),(2) benign neoplastic lesions (hepatic adenoma, hemangioma, angio-myolipoma), (3) non-neoplastic lesions (small hyperechoic hepaticlesions in patients with cirrhosis, benign regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver, and inflam-matory lesions). Familiarity with the sonographic features of thesehyperechoic focal liver lesions can help ensure correct diagnosis andproper management.

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Intraoperative Doppler Sonography Using High-FrequencyTransducer During Living Donor Liver Transplantation withModified Right-lobe Graft: Spectrum of Vascular Complications-“The Way It Is”Kyoung Won Kim, Departments of Radiology, Asan Medical Center,University of Ulsan College of Medicine, KoreaHan Song Mun, Departments of Radiology, Asan Medical Center,University of Ulsan College of Medicine, KoreaHyun Joo Lee, Departments of Radiology, Asan Medical Center,University of Ulsan College of Medicine, KoreaGi Won Song, Departments of Liver Transplantation Surgery, AsanMedical Center, University of Ulsan College of Medicine, KoreaShin Hwang, Departments of Liver Transplantation Surgery, AsanMedical Center, University of Ulsan College of Medicine, KoreaSung Gyu Lee, Departments of Liver Transplantation Surgery, AsanMedical Center, University of Ulsan College of Medicine, Korea

The purpose of this exhibit is to discuss technical and anatomic con-siderations on intraoperative Doppler sonography(IODS) with high-frequency(HF) transducer during living donor liver transplantation-(LDLT) with modified right-lobe graft(MRG), to illustrate anastomoticconfiguration(AC) of hepatic vasculature and hemodynamics, and toexhibit spectrum of vascular complications.As illustrated in this exhibit, IODS with supreme resolution by HFtransducer reveals “THE WAY IT IS” of the hepatic vasculatures andhemodynamics during LDLT with MRG. Thus, it enables radiologists

to make an earliest diagnosis of various vascular complications of