To investigate the efficiency of contrast-enhanced ultrasound (CEUS) in the diagnosis of hepatic artery occlusion (HAO) and record the incidence of HAO-related complications (intrahepatic necrosis and biliary complications) during further conventional ultrasound follow-up.

The data of 633 patients who underwent pediatric liver transplantation was retrospectively selected. CEUS was performed in cases with suspicious HAO based on conventional ultrasound. The accuracy, sensitivity, and specificity of CEUS for diagnosis of HAO were analyzed using the fourfold table. The diagnostic criteria for HAO included surgery, digital subtraction angiography (DSA)/computed tomography angiography (CTA), and follow-up (persistent no flow or progressive change from tardus parvus waveform to no flow on Doppler US follow-up studies associated with the development of ischemic necrosis or a nonanastomotic biliary complication, such as bile duct necrosis/biloma/bile leakage). The incidence of HAO-related complications (intrahepatic necrosis and biliary complications) during further conventional ultrasound follow-up was also recorded.

CEUS was performed in 42 children with suspected HAO based on conventional ultrasound. Thirty-three HAOs, including one late HAO (5 months after liver transplantation), met the diagnostic criteria for HAO. Among the 34 HAOs diagnosed by CEUS, one showed partial thrombosis at the anastomotic site of the hepatic artery on subsequent DSA, for which HAO was excluded; six with negative CEUS findings were confirmed by the clinical follow-up; the other two were ruled out because hepatic artery stenosis (HAS) was diagnosed by CEUS and confirmed by CTA. The accuracy, sensitivity, and specificity of CEUS in diagnosing HAO were 97.5% (39/40), 100% (33/33), and 85.7% (6/7), respectively. The formation of collateral circulation after hepatic artery occlusion was observed by conventional ultrasound for 11 (10-14) days. Based on ultrasound and other imaging examinations (CT/MRI), among the 33 patients with hepatic artery occlusion, 15 had intrahepatic ischemia lesions (45.5%), 5 had choloma (15.1%), 1 had biliary leakage (3.0%), 9 had ischemic cholangitis (27.3%), and 2 had simple third-grade intrahepatic bile duct dilatation (6.1%).

CEUS shows a high accuracy and sensitivity in the diagnosis of HAO. Negative CEUS findings will avoid invasive angiography; however, when CEUS indicates HAO, DSA should be performed for verification to avoid unnecessary surgery. In addition, ultrasound plays an important role in the follow-up of complications associated with hepatic artery occlusion.