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Cai WB, Yin JK, Li QY, Yang YL, Duan YY, Zhang L. The severity of portal hypertension by a non-invasive assessment: acoustic structure quantification analysis of liver parenchyma. BMC Med Imaging 2022; 22:85. [PMID: 35550032 PMCID: PMC9097305 DOI: 10.1186/s12880-022-00817-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 05/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background Acoustic structure quantification (ASQ) has been applied to evaluate liver histologic changes by analyzing the speckle pattern seen on B-mode ultrasound. We aimed to assess the severity of portal hypertension (PHT) through hepatic ultrasonography. Methods Sixty patients diagnosed with PHT and underwent surgical treatment with portosystemic shunts were enrolled. Portal pressure (PP) was measured intraoperatively. Patients were divided into subgroups according to the severity of gastroesophageal varices and Child–Pugh class. Three difference ratio (Cm2) values on ASQ histogram mode were analyzed for their relationships with PP, degree of gastroesophageal varices and Child–Pugh liver function. Thirty healthy volunteers matched with the patients for gender and age were enrolled as controls. Comparisons among groups and correlation of the parameters with PP were analyzed. Area under the receive operating characteristic curve was used to evaluate the predicting value of ASQ parameters. Results In the patients, the ASQ parameters peak Cm2 (Cm2max), mean Cm2 (Cm2mean) and the highest occurred Cm2 value of the obtained red curve (RmaxCm2) were all greatly increased (P < 0.0001, P < 0.0001, P = 0.027). Multiple comparisons indicated that, regardless of Child–Pugh class and degree of gastroesophageal varices, the patients had significantly increased Cm2max and Cm2mean compared with the controls (all P < 0.0001). No differences among subgroups were observed. Cm2max was significantly statistically correlated with PP (r = 0.3505, P < 0.01), degree of varices (r = 0.4998, P < 0.0001). Youden’s index for Cm2max with a cut-off value of 140.3 for predicting the presence of PHT, gastroesophageal varices and liver function equal to or worse than Child–Pugh class B were 0.8, 0.91 and 0.84, respectively. Conclusions ASQ analysis of ultrasonographic images may have a role in the evaluation of the severity of PHT by detecting liver histologic changes in the speckle pattern caused by cirrhosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-022-00817-2.
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Affiliation(s)
- Wen-Bin Cai
- Department of Ultrasound Diagnosis, Tangdu Hospital, The Fourth Military Medical University, Xin Si Road, Ba Qiao District, Xi'an, China.,Department of Ultrasound Diagnostics, General Hospital of Tibet Military Region, Lhasa, China
| | - Ji-Kai Yin
- Department of General Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Qiao-Ying Li
- Department of Ultrasound Diagnosis, Tangdu Hospital, The Fourth Military Medical University, Xin Si Road, Ba Qiao District, Xi'an, China
| | - Yi-Lin Yang
- Department of Ultrasound Diagnosis, Tangdu Hospital, The Fourth Military Medical University, Xin Si Road, Ba Qiao District, Xi'an, China
| | - Yun-You Duan
- Department of Ultrasound Diagnosis, Tangdu Hospital, The Fourth Military Medical University, Xin Si Road, Ba Qiao District, Xi'an, China
| | - Li Zhang
- Department of Ultrasound Diagnosis, Tangdu Hospital, The Fourth Military Medical University, Xin Si Road, Ba Qiao District, Xi'an, China.
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Han SK, Kim MY, Kang SH, Baik SK. Application of ultrasound for the diagnosis of cirrhosis/portal hypertension. J Med Ultrason (2001) 2022; 49:321-331. [PMID: 35179669 DOI: 10.1007/s10396-022-01191-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022]
Abstract
With advances in technologic approaches in patients with cirrhosis, including the improvement of management, a simple, one-step approach for advanced fibrotic state of the liver is clinically useful. Although refining the diagnosis of cirrhosis to reflect disease heterogeneity is essential, current diagnostic tests have not kept pace with the progression of this new paradigm. There are unmet needs in primary care centers with respect to patients with cirrhosis. Liver biopsy and measurement of hepatic venous pressure gradient in patients with cirrhosis are the gold standards for the estimation of hepatic fibrosis, and they have diagnostic and prognostic value. However, both approaches are invasive and cannot be used repeatedly in clinical practice. Ultrasonography (US) is safe, easy to perform, inexpensive, and yields numerical and accurate results. Conventionally, the size of the liver and spleen, bluntness of the liver edge, nodularity of the liver surface, and coarseness of the liver parenchyma have been known as useful parameters for hepatic fibrosis or portal hypertension (PHT) in chronic liver disease. Additionally, some functional US indices including Doppler and CEUS-based examination have been suggested as promising markers for diagnosing cirrhosis and PHT. Identification of the reproducibility and long-term prognostic value through further investigations can demonstrate the clinical usefulness of functional US indices, which are characterized as quantitative parameters for hepatic fibrosis and PHT.
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Affiliation(s)
- Seul Ki Han
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsanro, Wonju, 220-701, Republic of Korea
| | - Moon Young Kim
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsanro, Wonju, 220-701, Republic of Korea.,Regeneration Medicine Research Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.,Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Seong Hee Kang
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsanro, Wonju, 220-701, Republic of Korea.,Regeneration Medicine Research Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Soon Koo Baik
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsanro, Wonju, 220-701, Republic of Korea. .,Regeneration Medicine Research Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea. .,Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
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Gupta A, Bhatnagar V, Dhua AK, Jana M, Singh A, Malik R. Correlation of Hepatic Artery Resistive Index with Portal Pressure and Serum Nitric Oxide Levels in Patients with Extrahepatic Portal Vein Obstruction. J Indian Assoc Pediatr Surg 2020; 25:38-42. [PMID: 31896898 PMCID: PMC6910058 DOI: 10.4103/jiaps.jiaps_244_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/21/2019] [Accepted: 03/13/2019] [Indexed: 12/02/2022] Open
Abstract
Aim: The aim was to study the correlation of hepatic artery resistive index (HARI) with the portal pressure (PP) and its surrogate marker serum nitric oxide (NO) levels and to determine the validity of HARI as noninvasive indirect marker of PP in extrahepatic portal venous obstruction (EHPVO) pre- and postoperatively. Methods: A prospective study was conducted on 19 patients with EHPVO undergoing proximal lienorenal (LR) shunt or devascularization from February 2016 to January 2018. HARI, calculated from Doppler sonography, and NO were measured preoperatively and 14, 30 and 90 days postoperatively. Intraoperatively, PP was measured before splenectomy, and both PP and NO were measured postshunt. Results: Mean age was 10.58 ± 2.85 years, and male:female ratio was 15:4. LR shunt was done in 16 while three patients required devascularization. There was a significant fall in the HARI (0.06 ± 0.02, P = 0.02), NO (14.31 ± 2.66 μmol/l, P < 0.001), and PP (11.81 ± 1.03 mmHg, P < 0.001) following shunt surgery. However, fall in HARI did not correlate with fall in PP. Preoperative HARI also did not correlate with preshunt/devascularization PP nor with preoperative NO. Postoperatively, HARI did not correlate with NO at 14-, 30-, and 90-day follow-up. Conclusion: HARI bears no correlation with PP or NO. Hence, it cannot be used as an indirect marker of PP.
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Affiliation(s)
- Abhishek Gupta
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Veereshwar Bhatnagar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Kumar Dhua
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Archana Singh
- Department of Biochemistery, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Malik
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Elwan N, Salah R, Hamisa M, Shady E, Hawash N, Abd-Elsalam S. Evaluation of portal pressure by doppler ultrasound in patients with cirrhosis before and after simvastatin administration - a randomized controlled trial. F1000Res 2018; 7:256. [PMID: 29707200 PMCID: PMC5883384 DOI: 10.12688/f1000research.13915.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2018] [Indexed: 12/27/2022] Open
Abstract
Background: Portal hypertension is one of the most frequent complications of cirrhosis. β-adrenergic blockers, with or without organic nitrates, are currently used as hypotensive agents. Statins such as simvastatin seem to be safe for patients with chronic liver diseases and exert multiple pleiotropic actions. This study aimed to assess PTH using Doppler ultrasound in patients with cirrhosis before and after simvastatin administration. Methods: This randomized controlled clinical trial was conducted on 40 patients with cirrhosis who were randomized into 2 groups: group I included 20 patients with cirrhosis who were administered 20 mg of simvastatin daily for 2 weeks and then 40 mg daily for another 2 weeks, and group II included 20 patients with cirrhosis who did not receive simvastatin as a control group. All patients underwent full clinical examination, laboratory investigations, and abdominal Doppler ultrasound at baseline and after 30 days to evaluate portal vein diameter, blood flow volume, direction and velocity of portal vein blood flow, hepatic artery resistance and pulsatility indices, splenic artery resistance index, portal hypertension index (PHI), liver vascular index, and modified liver vascular index (MLVI). Results: There was a highly significant decrease in the hepatic artery resistance index in group I, from 0.785 ± 0.088 to 0.717 ± 0.086 (P < 0.001). There was a significant decrease in the PHI in group I , from 3.915 ± 0.973 m/sec to 3.605 ± 1.168 m/sec (P = 0.024). Additionally, there was a significant increase in the MLVI in group I from 11.540 ± 3.266 cm/sec to 13.305 ± 3.222 cm/sec, an increase of 15.3% from baseline (P = 0.009). No significant adverse effects were detected. Conclusions: Simvastatin is safe and effective in lowering portal hypertension. [ClinicalTrials.gov Identifier: NCT02994485]
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Affiliation(s)
- Nadia Elwan
- Department of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta, Gharbia Governorate, Egypt
| | - Raafat Salah
- Department of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta, Gharbia Governorate, Egypt
| | - Manal Hamisa
- Department of Radiology, Tanta University, Tanta, Gharbia Governorate, Egypt
| | - Ebtsam Shady
- Department of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta, Gharbia Governorate, Egypt
| | - Nehad Hawash
- Department of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta, Gharbia Governorate, Egypt
| | - Sherief Abd-Elsalam
- Department of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta, Gharbia Governorate, Egypt
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El Sherbiny W, AbdelRahman A, Diasty M, Shaltout SW. Changes in Doppler parameters of portal pressure after interventional management of hepatocellular carcinoma. Abdom Radiol (NY) 2016; 41:1532-8. [PMID: 26971951 DOI: 10.1007/s00261-016-0704-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hepatocellular carcinoma (HCC) has many options for management; some of them are complicated by development of portal hypertension (PHT). Doppler ultrasound is an effective method to diagnose and monitor PHT changes after HCC ablation procedures. The aim of this study is to investigate changes in portal pressure hemodynamics of HCC patients following treatment with different interventional strategies: radiofrequency ablation (RFA), microwave ablation (MWA), and transarterial chemoembolization (TACE). A total of 60 patients with HCC were divided into three main groups, and each group received a different type of therapy (RFA, MWA, and TACE). Full medical record and basic investigations were performed including Doppler ultrasound and upper GIT endoscopy for evaluation of PHT parameters, and then repeated after three months of ablation. RFA is associated with the increased splenic artery resistive index, while MWA has no significant impact on PHT indices. TACE has led to a marked increase in liver vascular index with significant decrease in hepatic artery resistive index and PHI after treatment. No significant changes in esophageal varices were observed by upper GIT endoscopy following all ablation methods. RFA is quite safe but associated with degree of PHT. On the contrary, TACE is associated with improved PHT parameters. MWA has no significant association to development of PHT following the technique. Doppler ultrasound could be used as a reliable and effective method of evaluation of PHT post ablation for HCC.
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Affiliation(s)
- Walid El Sherbiny
- Tropical Medicine Department, Mansoura Faculty of Medicine, Mansoura University Hospital, Mansoura, 35516, Egypt
| | - Ashraf AbdelRahman
- Diagnostic Radiology Department, Mansoura University Children Hospital, Mansoura, Egypt
| | - Muhammad Diasty
- Tropical Medicine Department, Mansoura Faculty of Medicine, Mansoura University Hospital, Mansoura, 35516, Egypt
| | - Shaker Wagih Shaltout
- Tropical Medicine Department, Mansoura Faculty of Medicine, Mansoura University Hospital, Mansoura, 35516, Egypt.
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Elwir S, Hal H, Veith J, Schreibman I, Kadry Z, Riley T. Radiographical findings in patients with liver cirrhosis and hepatic encephalopathy. Gastroenterol Rep (Oxf) 2015; 4:221-5. [PMID: 26463277 PMCID: PMC4976681 DOI: 10.1093/gastro/gov049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/23/2015] [Indexed: 01/28/2023] Open
Abstract
Background and aims: Hepatic encephalopathy is a common complication encountered in patients with liver cirrhosis. Hepatic encephalopathy is not reflected in the current liver transplant allocation system. Correlation was sought between hepatic encephalopathy with findings detected on radiographic imaging studies and the patient’s clinical profile. Methods: A retrospective analysis was conducted of patients with cirrhosis, who presented for liver transplant evaluation in 2009 and 2010. Patients with hepatocellular carcinoma, ejection fraction less than 60% and who had a TIPS (transjugular intrahepatic portosystemic shunting) procedure or who did not complete the evaluation were excluded. Statistical analysis was performed and variables found to be significant on univariate analysis (P < 0.05) were analysed by a multivariate logistic regression model. Results: A total of 117 patients met the inclusion criteria and were divided into a hepatic encephalopathy group (n = 58) and a control group (n = 59). Univariate analysis found that a smaller portal vein diameter, smaller liver antero-posterior diameter, liver nodularity and use of diuretics or centrally acting medications showed significant correlation with hepatic encephalopathy. This association was confirmed for smaller portal vein, use of diuretics and centrally acting medications in the multivariate analysis. Conclusion: A decrease in portal vein diameter was associated with increased risk of encephalopathy. Identifying patients with smaller portal vein diameter may warrant screening for encephalopathy by more advanced psychometric testing, and more aggressive control of constipation and other factors that may precipitate encephalopathy.
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Affiliation(s)
- Saleh Elwir
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania (PA), USA
| | - Hassan Hal
- Department of Radiology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Joshua Veith
- Penn State Milton S. Hershey Medical Center and School of Medicine, Hershey, PA, USA
| | - Ian Schreibman
- Division of Gastroenterology and Hepatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Zakiyah Kadry
- Division of Transplant Surgery, Penn State Milton S. Hershey Medical Center, Hershey PA, USA
| | - Thomas Riley
- Division of Gastroenterology and Hepatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Liver and spleen stiffness and other noninvasive methods to assess portal hypertension in cirrhotic patients: a review of the literature. Eur J Gastroenterol Hepatol 2015; 27:992-1001. [PMID: 26020376 DOI: 10.1097/meg.0000000000000393] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Portal hypertension (PH) is one of the most important causes of morbidity and mortality in patients with chronic liver disease. PH measurement is crucial to stage and predict the clinical outcome of liver cirrhosis. Measurement of hepatic vein pressure gradient is considered the gold standard for assessment of the degree of PH; however, it is an invasive method and has not been used widely. Thus, noninvasive methods have been proposed recently. We critically evaluated serum markers, abdominal ultrasonography, and particularly liver and spleen stiffness measurement, which represent the more promising methods to stage PH degree and to assess the presence/absence of esophageal varices (EV). A literature search was carried out on MEDLINE, EMBASE, Web of Science, and Scopus for articles and abstracts. The search terms used included 'liver cirrhosis', 'portal hypertension', 'liver stiffness', 'spleen stiffness', 'ultrasonography', and 'portal hypertension serum biomarker'. The articles cited were selected on the basis of their relevance to the objective of the review. The results of available studies indicate that individually, these methods have a mild accuracy in predicting the presence of EV, and thus they cannot substitute endoscopy to predict EV. When these tests were used in combination, their accuracy increased. In addition to the PH staging, several serum markers and spleen stiffness measurement can predict the clinical outcome of liver cirrhosis with a good accuracy, comparable to that of hepatic vein pressure gradient. In the future, noninvasive methods could be used to select patients requiring further investigations to identify the best tailored clinical management.
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Rameshbabu CS, Wani ZA, Rai P, Abdulqader A, Garg S, Sharma M. Standard imaging techniques for assessment of portal venous system and its tributaries by linear endoscopic ultrasound: a pictorial essay. Endosc Ultrasound 2014. [PMID: 24949362 DOI: 10.4103/2303-9027.117724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Linear Endosonography has been used to image the Portal Venous System but no established standard guidelines exist. This article presents techniques to visualize the portal venous system and its tributaries by linear endosonography. Attempt has been made to show most of the first order tributaries and some second order tributaries of splenic vein, superior mesenteric vein and portal vein.
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Affiliation(s)
- C S Rameshbabu
- Department of Anatomy, L.L.R.M., Medical College, Meerut 250001, U.P., India
| | - Zeeshn Ahamad Wani
- Department of Anatomy, Jaswant Rai Speciality Hospital, Saket, Meerut 250001, Uttar Pradesh, India
| | | | - Almessabi Abdulqader
- Department of Anatomy, Jaswant Rai Speciality Hospital, Saket, Meerut 250001, Uttar Pradesh, India
| | - Shubham Garg
- Department of Anatomy, Jaswant Rai Speciality Hospital, Saket, Meerut 250001, Uttar Pradesh, India
| | - Malay Sharma
- Department of Anatomy, Jaswant Rai Speciality Hospital, Saket, Meerut 250001, Uttar Pradesh, India
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Rameshbabu CS, Wani ZA, Rai P, Abdulqader A, Garg S, Sharma M. Standard imaging techniques for assessment of portal venous system and its tributaries by linear endoscopic ultrasound: a pictorial essay. Endosc Ultrasound 2014; 2:16-34. [PMID: 24949362 PMCID: PMC4062237 DOI: 10.7178/eus.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 01/08/2013] [Indexed: 12/12/2022] Open
Abstract
Linear Endosonography has been used to image the Portal Venous System but no established standard guidelines exist. This article presents techniques to visualize the portal venous system and its tributaries by linear endosonography. Attempt has been made to show most of the first order tributaries and some second order tributaries of splenic vein, superior mesenteric vein and portal vein.
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Affiliation(s)
- C S Rameshbabu
- Department of Anatomy, L.L.R.M., Medical College, Meerut 250001, U.P., India
| | - Zeeshn Ahamad Wani
- Department of Anatomy, Jaswant Rai Speciality Hospital, Saket, Meerut 250001, Uttar Pradesh, India
| | | | - Almessabi Abdulqader
- Department of Anatomy, Jaswant Rai Speciality Hospital, Saket, Meerut 250001, Uttar Pradesh, India
| | - Shubham Garg
- Department of Anatomy, Jaswant Rai Speciality Hospital, Saket, Meerut 250001, Uttar Pradesh, India
| | - Malay Sharma
- Department of Anatomy, Jaswant Rai Speciality Hospital, Saket, Meerut 250001, Uttar Pradesh, India
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Zhang L, Yin J, Duan Y, Yang Y, Yuan L, Cao T. Assessment of intrahepatic blood flow by Doppler ultrasonography: relationship between the hepatic vein, portal vein, hepatic artery and portal pressure measured intraoperatively in patients with portal hypertension. BMC Gastroenterol 2011; 11:84. [PMID: 21767412 PMCID: PMC3156747 DOI: 10.1186/1471-230x-11-84] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 07/19/2011] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Abnormality of hepatic vein (HV) waveforms evaluated by Doppler ultrasonography has been widely studied in patients with chronic liver disease. We investigated the correlation between changes in HV waveforms and portal vein velocity (PVVel), the hepatic artery pulsatility index (HAPI), and also the extent of abnormal Doppler HV waveforms expressed as damping index (DI), severity of portal hypertension expressed as Child-Pugh scores and portal pressure (PP) measured directly from patients with portal hypertension (PHT) to evaluate the indicative value of abnormal HV waveforms and discuss the cause of abnormal HV waveform. METHODS Sixty patients who had been diagnosed with PHT and accepted surgical therapy of portosystemic shunts were investigated. PP was measured intraoperatively. Thirty healthy volunteers with no history of chronic liver disease were enrolled as the control group. HV waveforms were categorized as triphasic, biphasic or monophasic. DI was compared as the quantitative indicator of abnormal HV waveforms. Another two Doppler parameters, PVVel and HAPI were also measured. These Doppler features were compared with PP, Child-Pugh scores and histological changes assessed by liver biopsy. RESULTS In the patient group, the Doppler flow waveforms in the middle HV were triphasic in 31.6%, biphasic in 46.7%, and monophasic in 21.6% of subjects. These figures were 86.7%, 10.0%, and 3.3%, respectively, in healthy subjects. With the flattening of HV waveforms, the HAPI increased significantly (r = 00.438, p < 0.0001), whereas PVVel decreased significantly (r = -0.44, p <0.0001). Blood flow parameters, HAPI, PVVel and HV-waveform changes showed no significant correlations with Child-Pugh scores. The latter showed a significant correlation with PP (r = 0.589, p = 0.044). Changes of HV waveform and DI significantly correlated with PP (r = 0.579, r = 0.473, p <0.0001), and significant correlation between DI and Child-Pugh scores was observed (r = 0.411, p = 0.001). PP was significantly different with respect to nodule size (p < 0.05), but HV-waveform changes were not significantly correlated with pathological changes. CONCLUSION In patients with PHT, a monophasic HV waveform indicates higher portal pressure. Furthermore, quantitative indicator DI can reflect both higher portal pressure and more severe liver dysfunction. Flattening of HV waveforms accompanied by an increase in the HAPI and decrease in PVVel support the hypothesis that histological changes reducing HV compliance be the cause of abnormality of Doppler HV waveforms from the hemodynamic angle.
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Affiliation(s)
- Li Zhang
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
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11
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Miyamoto Y, Onoue K, Nishioka M, Nakata N. Sonographic hemodynamic evaluation of spleno-renal shunt using the Valsalva maneuver. J Med Ultrason (2001) 2010; 37:175-9. [DOI: 10.1007/s10396-010-0266-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 04/20/2010] [Indexed: 10/19/2022]
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Duplex Doppler ultrasound examination of the portal venous system: an emerging novel technique for the estimation of portal vein pressure. Dig Dis Sci 2010; 55:1230-40. [PMID: 19629688 DOI: 10.1007/s10620-009-0887-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Accepted: 06/19/2009] [Indexed: 12/28/2022]
Abstract
PURPOSE Measurement of portal venous pressure in patients with portal hypertension is important to assess efficacy of beta blockers in patients with esophageal varices. Currently, the gold standard for measurement of portal venous pressure is the estimation of hepatic venous pressure gradient (HVPG). Being an invasive technique, serial measurements of HVPG are not feasible in clinical practice. In this respect, duplex Doppler ultrasound (DDUS) examination is an upcoming non-invasive technique for the estimation of portal venous and splanchnic hemodynamics. The aim of the present review is to analyze the current literature focusing on how the two techniques compare to each other in terms of assessing the portal pressure and assessing pitfalls in the current technique. RESULTS Duplex Doppler ultrasound (DDUS) currently has limitations in measuring the portal pressure in a non-invasive way. Hemodynamic venous and arterial indices measured on DDUS correlate with the HVPG. The technique has been refined, however, there is no uniform surrogate marker that can be used in clinical practice. CONCLUSIONS More studies are needed in order to remove the shortcomings in the current technique. The target is to be able to measure the actual portal pressure or at least derive an ideal venous or arterial hemodynamic surrogate marker having close correlation with the HVPG.
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Zekanovic D, Ljubicic N, Boban M, Nikolic M, Delic-Brkljacic D, Gacina P, Klarin I, Turcinov J, Delic-Brkljacic D, Diana DB, Gacina P, Petar G, Klarin I, Ivo K, Turcinov J, Jadranko T. Doppler ultrasound of hepatic and system hemodynamics in patients with alcoholic liver cirrhosis. Dig Dis Sci 2010; 55:458-66. [PMID: 19277866 DOI: 10.1007/s10620-009-0760-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Accepted: 02/03/2009] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The progression of liver cirrhosis eventually increases cardiac output, while blood pressure and systemic vascular resistance are reduced. A complex behavior of portal hemodynamic to hepatic artery and system circulation has not yet been presented. There is a lack in knowledge about the correlation of local and systemic circulation parameters to the degree of liver failure, with respect to presence of ascites and esophageal varices. PATIENTS AND METHODS The study sample was 76 patients hospitalized for established alcoholic liver cirrhosis. Patients were divided into groups according to Child-Pugh clinical score; grade A (n = 24), B (n = 18) and C (n = 18). Ascites was found in 28 patients and esophageal varices in 46. Portal vein flow velocity (PVFV), hepatic artery resistance index (HARI), heart and great vessels within mediastinal cavity were assessed with ultrasound devices equipped with spectral Doppler. RESULTS Significant differences in mean blood pressure, systemic vascular resistance index (SVRI) minute volume, cardiac index and PVFV were found in the group of patients with the most severe stage (C). In regard to presence of ascites statistically significant difference was observed in elevated mean blood pressure and SVRI. Correlation was found between conjugated HARI to blood pressure and to SVRI. CONCLUSIONS In patients with liver cirrhosis there is an inversely reciprocal relationship of conjugated HARI with PVFV, correlating to disease grade. PVFV in cirrhosis decreases and HARI values were over 0.7. Study demonstrated that combining echocardiography with abdominal Doppler ultrasound served as valuable non-invasive diagnostic insight in liver and systemic circulation among different grade of cirrhosis.
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Affiliation(s)
- Drazen Zekanovic
- Department of Internal Medicine, County Hospital Zadar, Zadar, Croatia
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