The Role of Duplex Color Doppler Ultrasonography in the Evaluation of Hepatic Arterial Flow and Arterial Resistance Indices in Patients with Liver Cirrhosis
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- Category: Vol. 77, December 2009
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The Role of Duplex Color Doppler Ultrasonography in the Evaluation of Hepatic Arterial Flow and Arterial Resistance Indices in Patients with Liver Cirrhosis, NABIL EL-KADY, ZAKARIA SALAMA, IMAN HAMZA, AHMAD FOUAD, HEBA FADL and GAMAL ESMAT
Abstract
Introduction: Color Doppler ultrasonography is an impor-tant breakthrough in the noninvasive evaluation of splanchnic hemodynamics. However, until present, there is no consensus on the role of Doppler parameters in grading the severity of chronic liver disease. Different studies performed in cirrhotic patients have yielded conflicting results due to differences in the selection of patients with different degrees of hepatic decompensation.
Aim of the Work: The aim of this work is to evaluate hepatic and splenic arterial blood flow and arterial resistance indices by duplex color Doppler ultrasonography in patients with different grades of liver cirrhosis and portal hypertension.
Patients and Methods: Sixty patients with liver cirrhosis and oesophageal varices were enrolled {44 males (73.4%), 16 females (26.6%), mean age 49.1 years ± 7.8 years} in addition to 20 healthy controls (14 males 70%, 6 females 30%, mean age 47.3 years ±7.0 years). Patients were divided into 4 groups. Child A, B and C patients were allocated to groups I, II and III respectively, group 4 patients comprised the control group (20 patients each). Calculated Doppler parameters included diameter, cross sectional area, velocity and flow volume for the hepatic artery splenic artery and portal vein in addition to the hepatic and splenic artery pulsatility and resistive indices and portal vein congestion index. Additionally the Liver vascular index (LVI) and Doppler perfusion index were calculated.
Results: The hepatic artery mean diameter, cross sectional area, velocity and flow volume were comparable among patients and controls. The hepatic artery mean pulsatility and resistive indices (PI and RI) were significantly higher among patients as compared to controls (PI: 0.96±0.147, 1.66±0.25, 1.24±0.114 and 0.89±0.054 and RI: 0.673±0.065, 0.734±0.054, 0.797±0.016 and 0.591±0.024 in groups I-IV respectively) correlating with the Child-Pugh score and oesophageal variceal grading. The splenic artery mean diameter significantly increased among patients. The mean flow volume, PI and RI were significantly higher among patients as compared to the control group (PI: 1.03±0.127, 1.059±0.112, 1.07±0.091, 0.725±0.07, RI: 0.636±0.055, 0.661±0.05, 0.685±0.04, 0.501±
0.02 in groups I-IV respectively). Splenic impedance indices didn’t correlate with the Child grade but correlated with the grade of varices. There is a highly significant decrease of liver vascular index (LVI) and a highly significant increase in Doppler perfusion index (DPI) in patients as compared to the control group.
Conclusion: Doppler and color Doppler ultrasonography are valuable screening procedures for the assessment of the patient with cirrhosis and portal hypertension. The hepatic arterial resistance indices increase in cirrhosis and correlate with the severity of portal hypertension. While, the splenic artery resistance indices are increased in cirrhotic patients and do not correlate with the severity of portal hypertension although it correlates with the degree of oesophageal varices. Neither the portal venous blood flow nor the hepatic arterial blood flow are useful parameparameters for discriminating patients with cirrhosis from healthy subjects.