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Ultrasonography |
1 From the Departments of Internal Medicine (S.K.B., J.W.K., H.S.K., S.O.K.), Radiology (Y.J.K., J.W.P., S.H.K.), and Preventive Medicine (S.J.C.), Yonsei University Wonju College of Medicine, 162 Ilsan-dong, Wonju 220-701, South Korea; Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea (D.K.L., K.H.H.); Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea (S.H.U.); and Liver Unit, University of Calgary, Calgary, Alberta, Canada (S.S.L.). Received July 7, 2005; revision requested September 8; revision received September 21; accepted October 18; final version accepted November 23. Supported by the Ministry of Health and Welfare, Republic of Korea (grant A050021) and the Clinical Research Fund of the Korean Association for the Study of the Liver (unencumbered grant from GlaxoSmithKline Korea). S.S.L. supported by an Alberta Heritage Foundation for Medical Research Senior Scholarship award. Address correspondence to S.K.B. (e-mail: baiksk{at}medimail.co.kr).
Purpose: To prospectively evaluate both the correlation between abnormal Doppler ultrasonography (US) hepatic vein waveforms and the hepatic venous pressure gradient (HVPG) and the response to drug treatment in patients with cirrhosis.
Materials and Methods: Ethics committee approval and informed consent of patients and control subjects were obtained. In 78 patients with cirrhosis (70 men, eight women; mean age, 49.4 years ± 9.7 [standard deviation]) and a history of variceal bleeding, both the hepatic vein waveform—as measured with Doppler US—and the HVPG were measured, and the relationship between them was analyzed. Hepatic vein Doppler waveforms were classified as triphasic, biphasic, or monophasic. Severe portal hypertension was defined as an HVPG of more than 15 mm Hg. In a subgroup of 21 patients, changes in hepatic vein waveform and HVPG were evaluated after intravenous administration of 2 mg of terlipressin. Statistical analyses were performed with Spearman rank correlation, logistic regression analysis, and cross tabulation.
Results: Abnormal hepatic vein waveforms were seen in 72 patients (92%). Forty-four patients (56%) had biphasic waveforms, 28 (36%) had monophasic waveforms, and six (8%) had triphasic waveforms. A positive correlation was found between the extent of abnormalities in hepatic vein waveforms and the increase in HVPG (P < .05). Monophasic waveforms were associated with severe portal hypertension, with a sensitivity of 74% and a specificity of 95%. Twenty patients in the terlipressin subgroup had abnormal baseline waveforms; the baseline waveform improved in 18 patients in association with the HVPG reduction after injection of terlipressin.
Conclusion: Doppler US hepatic vein waveform assessment is useful in the noninvasive evaluation of the severity of portal hypertension and the response to vasoactive drugs in patients with portal hypertension and variceal bleeding.
© RSNA, 2006
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Radiology 2006 240: 309-310.
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  E. J. Halpern Noninvasive Assessment of Portal Hypertension-Can US Aid in the Prediction of Portal Pressure and Monitoring of Therapy? Radiology, August 1, 2006; 240(2): 309 - 310. [Full Text] [PDF]
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