Introduction Hepatic veno-occlusive disease HVOD) is a serious, early complication of bone-marrow transplantation BMT) that usually occurs during the first 3 weeks of marrow infusion [1±3]. It is caused by the fibrous obliter- ation of terminal hepatic venules and small sublobular veins, which is induced by the total-body irradiation Mary Beth McCarville Fredric A.Hoffer Scott C. Howard Olga Goloubeva William M.Kauffman Hepatic veno-occlusive disease in children undergoing bone-marrow transplantation: usefulness of sonographic findings Received: 22 May 2000 Accepted: 6 September 2000 Supported in part by Cancer Center Sup- port CORE) grant P30 CA 21765 from the National Cancer Institute, and by the American Lebanese Syrian Associated Charities ALSAC). Presented at the SPR 2000 Meeting M.B.McCarville  ) )´F.A.Hoffer´ W.M.Kauffman Department of Diagnostic Imaging, St. Jude Children's Research Hospital, 332 North Lauderdale, Memphis, TN 38105±2794, USA e-mail: beth.mccarville@stjude.org Tel.:+1-901-4952399 Fax:+1-901-4954398 S.C.Howard Department of Hematology-Oncology, St. Jude Children's Research Hospital, 332 North Lauderdale, Memphis, Tennessee, USA O.Goloubeva Department of Biostatistics and Epidemiology, St. Jude Children's Research Hospital, 332 North Lauderdale, Memphis, Tennessee, USA Present address: W.M. Kauffman, Depart- ment of Radiology, Northern New Mexico Medical Center, Shiprock, New Mexico, USA Abstract Background. Reports of the usefulness of ultrasonography in the diagnosis of hepatic veno-occlu- sive disease HVOD) have present- ed conflicting results. Objective. To determine the useful- ness of gray-scale or Doppler ultra- sonographic measurements in the diagnosis of HVOD in pediatric pa- tients undergoing BMT. Materials and methods. We prospec- tively obtained 202 serial sonograms on 48 patients and examined the as- sociation between the clinical diag- nosis of HVOD McDonald criteria) and eight ultrasound pa- rameters, including the hepatic ar- tery resistive index HARI), direction and velocity of portal ve- nous flow, and thickness of the gall bladder wall. Results. HVOD developed in 29 of the 48 patients. The portal venous velocity increased after BMT in the group without HVOD and de- creased in the group with HVOD; this difference was significant P = 0.01). However, there was a great deal of variability in velocity measurements for individual pati- ents. The mean HARI was 0.64 in the group with HVOD and 0.63 in the group without HVOD, and there was no difference between the two groups in the pattern of change in HARI relative to the day of BMT P = 0.4). There was also no signifi- cant difference in thickness of the gallbladder wall between the two groups P = 0.6). Conclusion. No ultrasound parame- ter studied was as useful as the Mc- Donald criteria for diagnosing HVOD. Pediatr Radiol 2001) 31: 102±105 Ó Springer-Verlag2001