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Impact of splenic circulation: non-invasive microbubble-based assessment of portal hemodynamics

  • Ultrasound
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Abstract

Objective

The objective was to examine the effect of splenic circulation using a microbubble agent to assess the severity of portal hypertension.

Methods

This prospective study consisted of 91 subjects (63.0 ± 12.6 years, 30–86; 60 males, 31 females), 62 cirrhosis and 29 controls, who underwent both Doppler ultrasound and contrast-enhanced ultrasound with a perflubutane microbubble agent. Two microbubble-based parameters for splenic circulation, the minimum circulation time (MCT, s) and the peak enhancement time (PET, s), were assessed with respect to the hepatic venous pressure gradient (HVPG) and other clinical findings.

Results

The MCT and PET showed significant differences between cirrhosis (5.7 ± 1.8; 14.6 ± 3.0) and controls (4.0 ± 1.9, p < 0.0001; 8.9 ± 2.3, p < 0.0001), respectively. However, only PET offered positive correlations with wedged hepatic venous pressure (r = 0.4648, p = 0.0001) and HVPG (r = 0.4573, p = 0.0001). The area under the receiver operating characteristics curve to identify HVPG ≥ 10 mmHg, and 12 mmHg was 0.76 and 0.76, respectively.

Conclusions

The microbubble-based non-invasive assessment of the splenic circulation is effective to identify the severity of portal hypretension presumably by reflecting congestion of splenic venous flow due to increased portal venous pressure.

Key Points

• There is a potential link between splenic circulation and portal hypertension.

• Microbubble-based assessment of splenic circulation is predictive of the severity of portal hypertension.

• Interobserver variability was sufficient in the assessment of splenic enhancement sonograms.

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Abbreviations

CT:

Computed tomography

HVPG:

Hepatic venous pressure gradients

MCT:

Minimum circulation time

PET:

Peak enhancement time

PI:

Pulsatility index

RI:

Resistive index

SD:

Standard deviation

WHVP:

Wedged hepatic venous pressure

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Acknowledgments

The scientific guarantor of this publication is Hitoshi Maruyama. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba, 260-8670, Japan

    Taro Shimada, Hitoshi Maruyama, Takayuki Kondo, Tadashi Sekimoto, Masanori Takahashi & Osamu Yokosuka

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  1. Taro Shimada
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  2. Hitoshi Maruyama
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  3. Takayuki Kondo
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Correspondence to Hitoshi Maruyama.

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Shimada, T., Maruyama, H., Kondo, T. et al. Impact of splenic circulation: non-invasive microbubble-based assessment of portal hemodynamics. Eur Radiol 25, 812–820 (2015). https://doi.org/10.1007/s00330-014-3476-3

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  • DOI: https://doi.org/10.1007/s00330-014-3476-3

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