肝动脉舒张期血流在预测肝移植术后肝动脉血栓形成中的意义

目的 回顾性分析肝动脉舒张期异常血流状况在预测肝移植术后肝动脉血栓形成中是否有意义。方法 对2000年8月至2003年6月间，在我院接受原位肝移植术的54例术后可测及肝动脉信号患者的多普勒超声检查结果及其临床资料行回顾性分析。根据肝动脉舒张期的血流状况将探测结果分为3类：舒张期正向血流，舒张期反向血流和舒张期无血流信号。同时对所有病例的门静脉血流状况进行多普勒分析。结果 54例中12例出现舒张期异常血流，其中4例表现为舒张期反向血流，8例表现为舒张期无血流信号。12例中1例有肝动脉吻合口狭窄，无出现肝动脉血栓形成者。所有病例的门静脉血流未见异常。结论 肝移植术后早期肝动脉舒张期无血流或反向血流与肝动脉血栓形成之间没有相关性，肝动脉舒张期无血流或反向血流不能作为预测肝动脉血栓形成的判定指标。     

W-shaped diastolic Doppler waveform in the hepatic artery of a patient with acute rejection after living donor liver transplantation

Waveform analysis of arterial Doppler sonography signals is widely used in clinical practice. A characteristic, W-shaped diastolic waveform has been reported in the renal artery of renal transplant recipients in cases of renal vein thrombosis or severe acute rejection. Although Doppler sonography is widely used for the evaluation of liver transplants, we found no report of this waveform in cases of outflow block or severe acute rejection. We report the case of a patient with an adult living-donor liver transplant in whom the W-shaped sign occurred during severe acute rejection with massive liver parenchyma destruction.     

Longstanding arterioportal fistula after laparoscopic liver biopsy

We present two patients with hepatocellular carcinoma (HCC) on liver cirrhosis in whom color Doppler sonography documented an incidental peripheral arterioportal fistula due to a previous liver biopsy under laparoscopy. Detection of the fistula helped in preventing the occurrence of a portal thrombus. Color Doppler sonography should be performed prior to transarterial embolization in patients with HCC on liver cirrhosis with a past history of liver biopsy under laparoscopy.     

Visualization of blood flow in hepatic vessels and hepatocellular carcinoma using B-flow sonography

PURPOSE: A B-flow sonographic technique was recently developed to provide direct visualization of blood flow with gray-scale sonography. Compared with color Doppler sonography, B-flow imaging has wideband resolution and a high frame rate. The purpose of this study was to evaluate the usefulness of B-flow sonography for visualizing blood flow in hepatic vessels and tumor vascularity in patients with liver cirrhosis or hepatocellular carcinoma (HCC). METHODS: Twenty-five patients with liver cirrhosis, including 15 with HCC, were studied by B-flow and color Doppler sonography. Blood-flow detection rates in portal veins and hepatic arteries and tumor vascularity in HCC were analyzed, and the 2 methods were compared. RESULTS: Using B-flow, blood flow was visualized in the portal vein in 23 (92%) of 25 patients and was visualized in the hepatic artery separately from the portal vein in 9 (36%) of 25 patients. The blood-flow signals were visualized only within vessels, never "bleeding" outside the vessel's lumen. Blood flow in the portal vein was observed with color Doppler sonography in all 25 patients, but the hepatic artery was never clearly separated from the portal vein. Vascularity within the HCC tumor was detected in 9 (60%) of 15 nodules with B-flow imaging, and fine arteries flowing into the tumor were observed in 6 nodules. Color Doppler sonography detected blood flow in 13 (87%) of the 15 HCC nodules. CONCLUSIONS: Blood flow in hepatic vessels and tumor vessels of HCC were visualized with B-flow sonography. B-flow sonography is a potentially useful technique for the evaluation of liver vascularity and intratumoral vessels.     

Sonographic and color Doppler findings of rupture of liver tumors

We present six cases of ruptured liver tumor (hepatocellular carcinoma, five cases; liver metastasis, one case) in which gray-scale sonography revealed an ascites containing constantly moving dense high-echo spots, leading to a high suspicion of acutely developing hemoperitoneum. Color Doppler sonography helped in detecting the rupture site by demonstrating a high-velocity jet flow from it. Although four of six patients were dead within 3 months, detection of the rupture site by color Doppler sonography made the initial transarterial embolization therapy easy and prompt. Received: 17 June 1997/Accepted: 6 August 1997     

Color Doppler sonographic signs of respiration-dependent hepatofugal portal flow

PURPOSE: The role of respiration in modulating blood flow in the portal vein is unclear. The aim of this study was to investigate the phenomenon of respiration-dependent periodic hepatofugal portal venous blood flow as detected on color Doppler sonography. METHODS: Within 1 year, we identified 13 patients with respiration-dependent reversal of blood flow in the portal vein that was diagnosed on color Doppler sonography. This phenomenon was investigated by color Doppler sonographic examination of the portal venous flow during both mid-inspiration breath-holding and a respiratory cycle including deep inspiration; evaluation of hepatic vein Doppler waveforms as normal (triphasic) or decreased (flattened); and echocardiographic examination to determine the presence or absence of tricuspid regurgitation. RESULTS: The patients' median age was 53 years (range, 26-87 years). Seven of the 13 patients had heart disease (tricuspid regurgitation) with or without liver disease, 3 had liver disease without heart disease, and 3 had other diseases with no evidence of heart or liver disease. On Doppler sonography, 10 of the 13 patients had increased portal venous pulsatility (7 of the 10 had tricuspid regurgitation; the other 3 did not); the remaining 3 patients had neither increased pulsatility nor tricuspid regurgitation. Sonographic follow-up within 4 weeks in 4 of the 13 patients revealed loss of the respiration-dependent hepatofugal portal flow. CONCLUSIONS: Respiration-dependent hepatofugal portal flow is a rare finding associated with periodic portal hypertension in patients with right heart insufficiency and liver disease. Its clinical significance is unclear. Among our patients, its occurrence was predominantly associated with an increased venous pulsatility index due to tricuspid regurgitation or venous outflow obstruction. Further study is needed to investigate whether periodic respiration-dependent hepatofugal portal flow is predictive of the occurrence of continuous flow reversal.     

Doppler超声和CT在肝癌定性诊断中的对照研究

本文对１０２例（共１１９个）均经手术及／或病理证实的肝内实质占位进行了Ｄｏｐｐｌｅｒ超声（ＣＤＦＩ和ＰＤ）与ＣＴ的对照研究。其中，原发性肝癌６９例（７５个病灶），转移性肝癌５例（６个病灶），肝海绵状血管瘤２２例（３０个病灶），其它病变６例（８个病灶）。结果表明Ｄｏｐｐｌｅｒ（ＣＤＦＩ＋ＰＤ）与常规超声相结合，则其对肝癌定性诊断的特异性（９７．２２％）显著高于ＣＴ诊断的特异性（７１．４５％），同时亦显著高于常规超声特异性（６６．６７％），因而认为Ｄｏｐｐｌｅｒ超声在肝癌定性诊断的特异性方面优于ＣＴ。研究还发现ＣＴ的特异性较低主要是由于≤３ｃｍ组的特异性较低所致。另外，Ｄｏｐｐｌｅｒ超声对肝癌定性诊断的敏感性（９５．１８％）亦高于ＣＴ（９０．１２％），但统计学上无显著性差异（Ｐ＞０．０５），而其准确性（９５．８０％）却显著高于ＣＴ（８４．４８％）（Ｐ＜０．０５），因此Ｄｏｐｐｌｅｒ超声为肝癌诊断提供了一个新的手段。     

Hepatic focal nodular hyperplasia: findings with color Doppler sonography

Color Doppler sonographic images of five patients with a total of six lesions of FNH were reviewed. All cases were confirmed pathologically. All six lesions showed increased intralesional flow in comparison to surrounding liver parenchyma on color Doppler sonography. Four of the six lesions showed significant peripheral flow; two of the six lesions showed central flow radiating peripherally from a central vessel. We conclude that increased color Doppler flow may be a characteristic feature of FNH. Increased internal flow has also been reported in HCC and hepatic metastatic disease. Considerable overlap is seen in color Doppler flow patterns. However, in patients clinically at low risk for malignancy, detection of a liver mass with increased color Doppler flow should suggest the diagnosis of FNH.     

Power Doppler imaging and evaluation of the resistive index in focal nodular hyperplasia of the liver

Focal lesions of the liver represent a significant diagnostic problem for various imaging modalities. The aim of this study was to assess the value of power Doppler sonography versus conventional color Doppler imaging in the depiction of hypervascular focal nodular hyperplasia (FNH) of the liver and to investigate the resistive index (RI) in the lesions' feeding arteries. Eighteen histologically proved FNHs in 14 patients were evaluated by gray-scale ultrasound, conventional color Doppler, and power Doppler sonography. With conventional color Doppler, a feeding arterial vessel could be depicted in only 4/18 lesions and hypervascularization was detected in 6/18 lesions. Power Doppler was more sensitive in detecting feeding arteries (16/18) within hypervascular lesions (15/18). RI values in the feeding arteries (mean = 0.51) significantly differed from those in the main hepatic artery or its intraparenchymal branches (mean = 0.68) in the same patient. The mean RI-difference was 0.19, suggesting hemodynamically significant arteriovenous shunting. Power Doppler sonography significantly increases sensitivity in the diagnosis of focal nodular hyperplasia of the liver and reliably permits the distinction of these lesions from hepatocellular carcinomas. Received: 17 January 1996/Accepted after revision: 8 May 1996     

Color doppler sonography avoids misinterpretation of the "parallel channel sign" in the sonographic diagnosis of cholestasis.

PURPOSE: The intrahepatic "parallel channel sign" on gray-scale sonograms is generally interpreted as representing dilated bile ducts, but it may also be caused by enlargement of intrahepatic arteries. This study was performed to evaluate the incidence of misinterpretation of the parallel channel sign without color Doppler sonography and the characteristics of patients in whom misinterpretation of the parallel channel sign is likely to occur. METHODS: A total of 1,100 patients were examined by sonography. All patients with a parallel channel sign on gray-scale sonograms underwent color Doppler sonography. In addition, laboratory values related to cholestasis were measured. RESULTS: The parallel channel sign was observed in 57 patients (5.2%). In 35 (61%) of these patients, color Doppler sonography revealed blood flow in both lumina, indicating that the parallel channel sign was not caused by enlarged bile ducts. Eighty-six percent of this group had nonbiliary liver disease; the enlarged hepatic artery branches were associated with liver cirrhosis in 63% of this group. Color Doppler sonography confirmed that the other 22 patients (39%) had an enlarged intrahepatic bile duct. CONCLUSIONS: Use of color Doppler sonography can help avoid misinterpretation of the parallel channel sign, especially in patients with nonbiliary liver disease.     

Intrahepatic spontaneous portosystemic venous shunt: value of color and power Doppler sonography

Spontaneous portosystemic venous shunts (SPVSs) within the hepatic parenchyma are rare. Fewer than 50 cases have been reported, and most of them were diagnosed by angiography. We present a case of SPVS diagnosed by color Doppler sonography in a 5-year-old boy admitted for bleeding due to rupture of esophageal varices. Conventional color and power Doppler sonography as well as CT showed a large shunt between the posterior branch of the right portal vein and the inferior vena cava. We believe that accurate diagnosis and follow-up of SPVS can be done with color Doppler sonography without resorting to angiography.     

Value of Doppler sonography in assessing the progression of chronic viral hepatitis and in the diagnosis and grading of cirrhosis.

OBJECTIVE: The purpose of this study was to evaluate the value of Doppler sonography in assessing the progression of chronic viral hepatitis and in the diagnosis and grading of cirrhosis. METHODS: Abdominal sonographic and liver Doppler studies were performed in 3 groups: 36 patients with chronic viral hepatitis, 63 patients with cirrhosis, and 30 control subjects with no evidence of liver disease. A series of Doppler indices of hepatic vascularity, including portal vein velocity, portal vein pulsatility score, flow volume of the portal vein, resistive and pulsatility indices of the hepatic artery, modified hepatic index, hepatic vascular index, waveform of the hepatic vein, and focal acceleration of flow, were measured and correlated with liver and spleen size, portal and splenic vein diameter, and presence of ascites and collateral vessels. These indices were compared across the 3 study groups and within the patient groups with respect to presence of inflammation, fibrosis, and steatosis, as determined by histologic evaluation. RESULTS: The most useful indices were portal vein velocity, the modified hepatic index, and nontriphasic flow in the hepatic vein, which were helpful in distinguishing patients from control subjects. Hepatic vascular and modified hepatic indices were useful for differential diagnosis of cirrhosis and chronic viral hepatitis. However, all measurements were limited in their ability to determine the severity of chronic hepatitis. CONCLUSIONS: Doppler sonography is sensitive to hemodynamic alterations resulting from inflammation and fibrosis, and if sonography is the study of choice to follow the progression of hepatitis, it will not be adequate without Doppler imaging. Doppler sonography has high diagnostic accuracy in cirrhosis despite some false-positive conditions. However, it has a limited role in clinical grading.     

Flow reversal in the right anterior branch of the portal vein: “Bicolor portal vein” color Doppler analysis

The purpose of this study is to describe a phenomenon of bidirectional flow, “bicolor portal vein” (BPV), within the right anterior branch of the portal vein (RAPV), with color Doppler imaging (CDI). We prospectively studied with CDI the intrahepatic portal vein and its branches in 316 consecutive patients in search of areas of nonlaminar flow within the RAPV. Forty patients were excluded from the study due to varied conditions that precluded an accurate CDI study. A prospective design allowed us to record the frequency of appearance, systematically measure a set of parameters in each patient, and establish different groups for comparison. We found an area of BPV within the RAPV in six patients. Five of them had a history of liver disease (8.2% of the patients with known liver disease). The BPV was consistently portrayed as a well-defined blue oval-shaped area of flow reversal attached to the medial side of the RAPV immediately before its bifurcation, suggesting a rotary motion of blood. All six patients presented a transverse diameter of the RAPV significantly larger than the rest of the patients (p < 0.05). Furthermore, blood flow measurements within the RAPV of the six patients with BPV were found to be significantly higher when compared with the rest of the patients (<0.05). Knowledge of the possible presence of a BPV within the RAPV can prevent diagnostic confusion with reversal of flow, a truly pathologic condition related to liver disease. © 1995 John Wiley & Sons, Inc.     

Echo-enhanced Doppler sonography of focal nodular hyperplasia of the liver.

Lesions of focal nodular hyperplasia are hypervascular, benign focal liver lesions whose differentiation from other focal liver lesions is of significant clinical relevance. The purpose of this study was to investigate the echo-enhancing agent SHU 508A (Levovist) in the evaluation of focal nodular hyperplasia with Doppler sonography. We examined 49 patients with 71 lesions of focal nodular hyperplasia in the liver with gray scale and power Doppler sonography. In all patients Levovist was administered intravenously in a concentration of 300 to 400 mg galactose per milliliter. Visualization of the feeding vessels and the vascularity of the lesions were evaluated, and the resistive indices in the feeders and the hepatic arteries were assessed. In comparison with unenhanced power Doppler sonography, echo-enhanced power Doppler sonography yields a higher sensitivity in the detection of the feeding artery (97% versus 82%) in focal nodular hyperplasia and in the depiction of the radial vascular architecture in such lesions, especially those located in the left lobe of the liver. Lesions less than 3 cm in diameter do not consistently show a characteristic vascular architecture with echo-enhanced Doppler sonography. The resistive index of the tumor-feeding artery (mean, 0.51 +/- 0.09) is significantly (P < 0.0001) lower than that of the hepatic artery (mean, 0.65 +/- 0.06) and decreases as the size of the focal nodular hyperplasia increases. The administration of Levovist may improve the signal-to-noise ratio and thus visualization of the vascular architecture in focal nodular hyperplasia. Lesions located in the left lobe of the liver, which commonly are subject to disturbing motion artifacts in color Doppler sonography, will significantly benefit from the administration of Levovist. Echo-enhanced power Doppler sonography, however, is not capable of depicting a characteristic vascular pattern in small (< or = 3 cm) lesions of focal nodular hyperplasia that would guarantee a specific diagnosis.     

彩色多普勒超声检查在诊断原位肝移植术后胆道并发症中的作用——与胆道造影术对比性研究60例分析

目的：探讨彩色多普勒超声检查（彩超）在肝移植术后胆道并发症诊断中的作用。方法：分析行肝移植的312例患者发生胆道并发症的情况,以胆道造影术为金标准评价彩超在诊断这些患者胆道并发症诊断中的作用。结果：共60例患者行胆道造影术明确胆道并发症的诊断,在胆道造影检查前2周内所行的胆道彩超结果示,彩超诊断胆道梗阻、胆漏、胆泥、胆结石敏感度分别为82％、80％、40％、100％;特异度分别为100％、100％、84％、96％。结论：彩超在诊断胆道并发症中敏感度、特异度较高,对诊断胆道并发症具有一定的意义。     

Echo-enhanced color Doppler sonography in children and adolescents.

Fifty-one patients, with a range of underlying pathologic conditions, were studied prospectively to assess the diagnostic value of echo-enhanced color Doppler sonography in the pediatric and adolescent population Their diagnoses included various tumors, vascular disorders, cerebral bleeding, pathologic conditions of small parts, and focal lesions of parenchymal organs. All patients underwent color Doppler sonography before proceeding to echo-enhanced color Doppler sonography. Diagnoses were confirmed by additional imaging (computed tomography, magnetic resonance imaging, angiography, and scintigraphy) performed as appropriate, with or without histologic study. An additional 20 children did not proceed to echoenhanced color Doppler sonography as color Doppler sonography alone was found to be sufficiently diagnostic. Levovist (SHU 508A), a contrast agent based on galactose-encapsulated air microbubbles, is approved for pediatric applications in Austria and was used as the echo-enhancing agent. Echo-enhanced color Doppler sonography was performed a total of 63 times in 51 patients (mean age, 9.8 years). Compared to color Doppler sonography, echo-enhanced color Doppler sonography either detected or enhanced visualization of pathologic conditions in 55 investigations (87.3%), yielding an overall accuracy of 95.2% (sensitivity, 95%), versus 65.7% with color Doppler sonography. One spinal arteriovenous malformation, one cerebral cavernoma, and one liver lesion were missed. The contrast material was easy to administer; no adverse reactions were observed. We conclude that echoenhanced color Doppler sonography is beneficial in pediatric sonography. It enhances visualization of vessels and perfusion, thus offering a nonionizing imaging tool for detection and follow-up evaluation of pathologic conditions with disturbed vasculature in specific cases. In infants and in persons with superficial lesions it did not offer significant advantages over color Doppler sonography.     

Development of intrahepatic arterial shunts in a transplanted liver: a potential pitfall for Doppler sonography

We describe the hemodynamic features and anatomic basis of false-negative Doppler sonographic findings compared with angiographic findings in a 42-year-old woman after orthotopic liver transplantation complicated by hepatic artery thrombosis. Complete common hepatic artery thrombosis was demonstrated by Doppler sonography and digital subtraction angiography (DSA) on the first postoperative day. A thrombectomy was performed. DSA on the third day after transplantation again showed occlusion of the left hepatic artery. No perfusion was observed in the left hepatic lobe. Liver function remained normal. Doppler sonography on days 8, 10, and 16 after transplantation demonstrated arterial blood flow in both the right and left lobes of the liver, suggesting patent left and right hepatic arteries. Repeat DSA revealed that the arterial flow in the left lobe depended on large, intrahepatic shunts originating from the right hepatic artery. Apparently, shunts can develop within a few days in a transplanted liver from radiologically undetectable structures into vessel-like channels capable of supplying the entire left hepatic lobe.     

Dropped omental fat post laparoscopy‐assisted distal gastrectomy with omentectomy mistaken for malignant peritoneal seeding on sonography

We report the sonographic findings in a case of dropped omental fat post laparoscopy‐assisted distal gastrectomy with omentectomy for stomach cancer mistaken for malignant intraperitoneal seeding. Gray‐scale sonography revealed an ovoid‐shaped hyperechoic mass with central poorly defined hypoechoic portion in the right perihepatic space. Color Doppler sonography showed no blood flow within the mass. Contrast‐enhanced CT scan of the liver revealed an oval‐shaped fatty mass with a CT number of ?100 HU. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42 :305–307, 2014     

Doppler sonographic diagnosis of respiration-dependent reversed flow in the hilar splenic vein.

We describe respiration-dependent reversed flow in the splenic vein detected by color Doppler sonography in 2 patients. In case 1, gray-scale sonography in a patient with liver cirrhosis and abdominal pain showed a hyperechoic, thickened colonic segment and diverticula, with increased echogenicity around the diseased colon. The liver was small, with a nodular surface and coarse echotexture. Doppler sonography of the portal and splenic veins showed a constant hepatopetal flow while the patient held her breath in midinspiration and a brief, transient color change restricted to the hilar splenic veins when the patient took a deep breath. In case 2, abdominal sonography in a patient with pneumonia and right-sided abdominal pain showed mural thickening of the appendix and left-sided pneumonic infiltration. The liver size and texture were normal. Color Doppler sonography of the portal and splenic veins showed a constant hepatopetal flow while the patient held his breath in midinspiration and a transient reversal of flow restricted to the splenic veins when the patient took a deep breath. Although the cause of this flow pattern is unclear, increased intra-abdominal pressure is a possible explanation.     

Spectral and color Doppler sonography.

Color Doppler sonography has become an integral part of modern hepatic sonography. Color Doppler can enhance the conspicuity of focal lesions and bile ducts in jaundiced patients by illuminating normal vessels with flow. Spectral and color Doppler may prove useful in limiting the sonographic differential diagnosis of focal liver lesions. Color flow sonography effectively evaluates pseudoaneurysms, A-V fistulae, collaterals, and flow reversal in portal hypertension, venous clot and tumor invasion, Budd-Chiari syndrome, hereditary hemorrhagic telangiectasis, and many other hepatic vascular lesions. We have found it invaluable in evaluating cirrhotic and liver transplant patients.