The MDCT examinations of 11 patients (4 men and 7 women,
median age 44,5 years,
age range 37-67 years),
who underwent OLT due to fulminant hepatic failure between 2003 and 2012 in our liver and multiorgan transplantation department,
were retrospectively evaluated.
These patients were grouped according to the etiology of the acute liver failure: 4 toxic hepatitis (Table 1) (2 from paracetamol,
1 from alcohol and 1 related to drugs used for tuberculosis therapy),
3 hepatitis B,
1 had a mixed etiology by HBV and alcohol (Table 2) and 3 had a vascular etiology (Table 3) (1 thrombotic thrombocytopenic purpura,
1 related to anti-platelets autoantibody syndrome in a patient with Budd-Chiari in heparin therapy for polycytemia vera and 1 ischemic hepatitis).
Abdominal MDCT examinations were performed with 16-channel MDCT scanner (LightSpeed 16,
General Electric Medical System,
Milwaukee,
WI,
USA) or 64 channel (VCT LightSpeed,
General Electric Medical System,
Milwaukee,
WI,
USA) before and after intravenous injection of 2 ml/kg of non ionic iodinate contrast (Iomeron 300,
300 mg/ml,
Bracco,
Milan,
Italy) at a rate of 2-3 ml/s using a power injector and bolus tracking.
Precontrast and arterial phase images of the upper abdomen and whole abdomen portal phase images with 2,5 mm slice thickness and 1,25 mm interval were obtained.
The timing between the onset of clinical symptoms leading to hospitalization and abdominal MDCT examination was about 1,4 days (range 1-3 days).
The interval between abdominal MDCT examination and liver transplantation was 2,8 days (range 1-9 days).
The MDCT examinations were evaluated by 2 radiologists with 15 and 5 years of CT scan experience respectively,
searching the main alterations described in literature [3-6,
10]: hepatic volume variations,
smooth or nodular liver contours,
hepatic and periportal density,
THAD (Transient Hepatic Attenuation Differences),
morphology of hepatic veins,
morphology of gall bladder wall (thickness and density),
ascites,
splenomegaly,
colic wall (thickness and density).
These morphology and density alterations were correlated with their corresponding histopathologic findings found in explanted liver by two pathologists with 18 and 5 years experience in liver pathology.