Background

Liver transplantation is the state-of-the-art curative treatment for end-stage liver disease. Imaging is a key element in the detection of intraoperative and postoperative complications. So far, only limited data regarding the best radiological approach to monitor children during liver transplantation is available.

Objective

To harmonize the imaging of pediatric liver transplantation, the European Society of Pediatric Radiology Abdominal Taskforce initiated a survey addressing the current status of imaging including the pre-, intra- and postoperative phase. This paper reports the responses related to intraoperative imaging.

Materials and methods

An online survey, initiated in 2021, asked European centers performing pediatric liver transplantation 48 questions about their imaging approach. In total, 26 centers were contacted, and 22 institutions from 11 countries returned the survey.

Results

Intraoperative ultrasound (US) is used by all sites to assess the quality of the vascular anastomosis in order to ensure optimal perfusion of the liver transplant. Vessel depiction is commonly achieved using color Doppler (95.3%). Additional US-based techniques are employed by fewer centers (power angio mode, 28.6%; B-flow, 19%; contrast-enhanced US, 14.3%). Most centers prefer a collaborative approach, with surgeons responsible for probe handling, while radiologists operate the US machine (47.6%). Less commonly, the intraoperative US is performed by the surgeon alone (28.6%) or by the radiologist alone (23.8%). Timing of US, imaging frequency, and documentation practices vary among centers.

Conclusion

Intraoperative US is consistently utilized across all sites during pediatric liver transplantation. However, considerable variations were observed in terms of the US setup, technique preferences, timing of controls, and documentation practices. These differences provide valuable insights for future optimization and harmonization studies.

中文翻译：

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欧洲小儿放射学会小儿肝移植围手术期影像学调查：（2）术中影像学

背景

肝移植是治疗终末期肝病的最先进的治疗方法。影像学是检测术中和术后并发症的关键要素。到目前为止，关于肝移植期间监测儿童的最佳放射学方法的数据有限。

客观的

为了协调儿科肝移植的影像学，欧洲儿科放射学腹部工作组发起了一项调查，探讨影像学的现状，包括术前、术中和术后阶段。本文报告了与术中成像相关的反应。

材料和方法

2021 年发起的一项在线调查向欧洲进行儿科肝移植的中心询问了 48 个有关其影像学方法的问题。总共联系了 26 个中心，来自 11 个国家的 22 个机构返回了调查结果。

结果

所有部位均使用术中超声（US）来评估血管吻合的质量，以确保肝移植物的最佳灌注。血管描绘通常使用彩色多普勒来实现 (95.3%)。较少的中心采用其他基于超声的技术（动力血管模式，28.6%；B 流，19%；对比增强超声，14.3%）。大多数中心更喜欢协作方式，由外科医生负责探头处理，而放射科医生则操作美国机器（47.6%）。较少见的是，术中超声由外科医生单独进行（28.6%）或由放射科医生单独进行（23.8%）。不同中心的超声检查时间、成像频率和记录实践各不相同。

结论

在小儿肝移植过程中，所有部位均一致使用术中超声。然而，在美国的设置、技术偏好、控制时间和文档实践方面观察到了相当大的差异。这些差异为未来的优化和协调研究提供了宝贵的见解。