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

Abstract

Hepatic artery thrombosis (HAT) is a devastating vascular complication following liver transplantation, requiring prompt diagnosis and rapid revascularization treatment to prevent graft loss. At present, imaging modalities such as ultrasound, computed tomography, and magnetic resonance play crucial roles in diagnosing HAT. Although imaging techniques have improved sensitivity and specificity for HAT diagnosis, they have limitations that hinder the timely diagnosis of this complication. In this sense, the emergence of artificial intelligence (AI) presents a transformative opportunity to address these diagnostic limitations. The develo pment of machine learning algorithms and deep neural networks has demon strated the potential to enhance the precision diagnosis of liver transplant com plications, enabling quicker and more accurate detection of HAT. This article examines the current landscape of imaging diagnostic techniques for HAT and explores the emerging role of AI in addressing future challenges in the diagnosis of HAT after liver transplant.

Keywords: Artificial intelligence; Hepatic artery; Liver transplantation; Postoperative complications; Radiology; Throm bosis.

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).