Hemodynamic features of Doppler ultrasonography in patients with portal hypertension: intraoperative direct measurement of portal pressure in the portal venous system.

OBJECTIVE: The purpose of this study was to investigate the relationship between a series of portal hemodynamic parameters obtained with Doppler ultrasonography and portal pressure measured directly from patients with portal hypertension (PHT). METHODS: Fifty-seven patients with a clinical diagnosis of PHT who accepted surgical therapy were investigated. The portal pressure was measured directly intraoperatively. Relevant parameters were compared and measured, including the hepatic artery pulsatility index (HAPI), hepatic artery resistive index (HARI), splenic artery resistive index, splenic artery pulsatility index (SpAPI), congestion index (CI) of the portal vein, hepatic buffer index (HBI), liver vascular index (LVI), and PHT index (PHI). RESULTS: Doppler parameters for the postprandial HAPI, SpAPI, CI, LVI, HBI, and PHI were statistically different in patients with PHT and healthy control subjects (P<0.05). The portal pressure was significantly correlated with the HARI (r=0.699; P<.001), HAPI (r=0.582; P<.001), LVI (r=-0.501; P=.003), HBI (r=0.441; P=.009), and Child-Pugh scores (r=0.589; P=.044). CONCLUSIONS: The HAPI, LVI, and HBI are indicative indices in patients with PHT, suggesting that color Doppler ultrasonography can be used as a noninvasive evaluation method for PHT degree. The changes in the HAPI, LVI, and HBI that accompany the increase in portal pressure can reflect hepatic resistance and hepatic artery buffer capacity accurately.     

Inter-observer variability of portal hemodynamics measured by Doppler ultrasound on three different locations of portal vein

Doppler ultrasound is a noninvasive modality for portal hemodynamic study. However, inter-observer variability has been observed. This study has investigated ways to produce less inter-observer variability. Doppler ultrasound portal vein hemodynamic studies were carried out by three well-trained specialists on 20 healthy hospital staff members. The intra-hepatic, first branch, right portal vein, the hilar portal vein, and the extra-hepatic portal vein were chosen for study. With respect to the diameter of portal veins, a significant inter-observer variability was found for the first branch right portal vein and the extra-hepatic portal vein, but not for the hilar portal vein. For maximal portal vein velocity studies, inter-observer variability was not found at any location. A significant failure rate was noted for the measurement of extra-hepatic portal vein velocity. Only 8 volunteers had complete data from all of the three investigators. A significant variability was also noted for the average velocity of extra-hepatic portal vein. We conclude that Doppler ultrasound hemodynamic studies of the hilar portal vein has the most acceptable inter-observer variability and thus should be used for longitudinal portal hemodynamic studies. © 1996 John Wiley & Sons, Inc.     

Splenic vein aneurysm with calcification of splenic and portal veins

Splenic vein aneurysm is a rare disease, and calcifications in the portal venous system are also rare. Here we present a case of splenic vein aneurysm associated with calcification of the splenic and portal veins, a condition that to our knowledge has not been reported before.     

多普勒超声评价丹参对肝硬化门静脉血流动力学的影响

目的 通过多普勒超声检测门静脉系统血流,评价丹参对肝硬化患者门静脉血流动力学影响,并探讨多普勒超声的应用价值。方法 将肝硬化患者分为丹参治疗组及对照组,分别于治疗前、治疗2周后及治疗8～12周后用彩色多普勒超声检测门静脉及脾静脉的管径、最大流速及血流量,比较治疗前后血流参数的变化。结果 丹参治疗2周及8～12周后门静脉血流速度持续加快,门静脉管径、脾静脉管径及血流量持续下降,差异有显著性,而门静脉血流量无明显变化,对照组各项血流参数无显著性变化。结论 丹参可降低门脉阻力,加快门静脉血流速度,同时降低脾静脉血流量,达到降低门脉压的效果。多普勒超声检测门脉系统血流有助于评价药物治疗门脉高压的效果。     

Doppler sonographic findings in children with idiopathic portal vein cavernous deformity and variceal hemorrhage.

OBJECTIVE: To describe the flow patterns in the portal vascular territory in children with portal vein cavernous deformity. METHODS: The study included 12 children (age 4-10 years) with hematemesis, melena, or both in whom B-mode gray scale sonography revealed small anechoic spaces replacing the site of the portal vein. The portal vein cavernous deformity was present either alone (in 8 patients) or with congenital hepatic fibrosis (in 4). Doppler sonography (color and spectral) was performed to assess the flow in the portal vascular territory, splenic vein, intrasplenic veins, and abdominal collaterals. RESULTS: Doppler sonography confirmed the venous flow waveform in the cavernous portal vein in all children with normal flow direction in the few intrahepatic portal vein branches and also in the intrahepatic veins. Splenomegaly was present in all. The intrasplenic veins were dilated in all but had normal flow direction except in 2 with spontaneous trans-splenic shunts. Gallbladder varices were shown in 4 patients, and perisplenic collaterals were shown in 3. CONCLUSIONS: Doppler sonography is a valuable noninvasive imaging technique for assessment of the portal hemodynamic profile in patients with portal vein cavernous deformity, which can affect subsequent treatment decision making. Trans-splenic shunts are uncommon, but this Doppler sonographic report documents such shunts in children with portal hypertension.     

小腿交通静脉病变的彩色多普勒超声表现与临床表现分级的相关性研究

目的:探讨下肢静脉功能不全患者小腿交通静脉超声改变与临床表现的关系。方法:用彩色多普勒超声检查下肢静脉功能不全患者45例50条下肢的小腿交通静脉的数目、部位、内径及血流速度,并分别与患者的临床表现分级进行相关性分析。结果:彩色多普勒超声检出交通静脉扩张的“数目、内径及血流速度”与患者临床表现分级呈正相关,相关系数分别为0.48、0.55、0.51,P值均<0.05。结论:随小腿扩张交通静脉数目增加、内径增宽、血流速度升高,临床表现加重。     

Doppler sonographic diagnosis of severe portal vein pulsatility in constrictive pericarditis: Flow normalization after pericardiectomy

This case report describes the noninvasive assessment of hepatic and portal vein hemodynamics in a patient with constrictive pericarditis before and after pericardiectomy. Doppler sonography of the hepatic veins demonstrated a typical W‐shaped pattern with pronounced late diastolic flow reversal that disappeared after surgery. Preoperatively, we observed severe pulsatility of the portal vein with flow reversal in systole; after pericardiectomy, portal venous flow was normal. We concluded that the high right atrial pressure in this patient might have led to increased hepatic venous outflow resistance, with subsequent trans‐sinusoidal shunting between the hepatic artery and portal vein causing severe portal vein pulsatility. After pericardiectomy and a decrease in right atrial pressure, portal vein flow normalized. © 1999 John Wiley & Sons, Inc. J Clin Ultrasound 27:84–88, 1999.     

Diagnostic value of Doppler ultrasound in the assessment of liver cirrhosis in children: Histopathological correlation

We have correlated flow abnormalities in the hepatic vasculature with histological findings in the liver to determine the accuracy of Doppler ultrasound in the diagnosis of liver cirrhosis in children. Eighteen children admitted for evaluation of unknown liver disease were examined prospectively and blindly with Doppler ultrasound prior to liver biopsy. Biopsy specimens showed established cirrhosis in 9 of 18, early cirrhosis in 5 of 18, and no cirrhosis in 4 of 18 children. Doppler studies were also performed on 20 control subjects. The portal vein velocity was decreased (p < 0.0005) and the arterio-portal velocity ratio was increased (p < 0.0005) in the established cirrhosis cohort relative to the controls. For the criteria of the established cirrhosis cohort, the sensitivities of the loss of the reverse flow component in the hepatic veins, the arterio-portal velocity ratio being greater than 3.0, the portal vein velocity being less than 20 cm/s, and the existence of focal flow acceleration in the hepatic veins were 100%, 78%, 67%, and 44%, respectively. The specificity of all of these criteria was 100%. The indicators were not useful in the diagnosis of early cirrhosis. © 1996 John Wiley & Sons, Inc.     

肝硬化门静脉高压门脉血流动力学检测及其临床意义

目的：探讨肝硬化门脉高压患者门脉血流动力学状态并分析其与Child-Pugh肝功能分级的关系。方法：利用多普勒超声技术检测了100例肝硬化门脉高压患者及24例正常人门脉血流动力学状态,并将100例肝硬化门脉高压患者按Child-Pugh肝功能分级分析两者之间的关系。结果：肝硬化门脉高压门脉血流动力学检查与正常对照组比较、门脉高压组门静脉（PV）内径明显增宽、血流速明显减慢、血流量参数明显增加,差异有显著性意义（P＜0．01）;脾静脉（SV）肠系膜上静脉（SMV）内径（D）、血流速度（V）、血流量参数（Q）也有类似改变。A、B、C三级肝硬化的PV内径,按A、B、C顺序显示门静脉宽度逐渐增宽,C级的Dpv较A、B级均有显著性增宽（P＜0．05）,A、B级间差异无显著性意义（P＞0．05）,但B级较A级也有增宽趋势,按A、B、C顺序显示 门静脉血流速度逐渐降低,且各级间比较差异有显著性意义（P＜0．05）。A、B、C级的Qpv相互比较无统计学差异（P＞0．05）。结论多普勒超声检测门脉血流动力学有助于评价肝硬化患者的肝储备功能、门静脉高压程度及预后。     

彩色多普勒超声对小儿门静脉海绵样变性的鉴别诊断

目的:探讨彩色多普勒超声在小儿门静脉海绵样变性中的鉴别诊断价值。方法:应用彩色多普勒超声对30例门静脉海绵样变性的患儿进行检查。结果:小儿门静脉海绵样变性具有特征性的彩色多普勒声像改变,而且根据声像图改变进行分类,与手术病理进行对照研究。结论:彩色多普勒超声对小儿门静脉海绵样变性诊断和鉴别诊断有很大帮助。     

肝硬化门静脉血栓形成研究进展

门静脉血栓形成(portal vein thrombosis, PVT)是由多种病因引起门静脉及其主要分支内形成血栓,造成血流完全或部分中断,其中,肝硬化是主要原因之一。近年来,随着对该疾病认识的逐步提高,已有越来越多的研究关注于此。本文就近年来有关肝硬化PVT的研究进展做一综述。     

Portosystemic collateral shunts originating from the left portal veins in portal hypertension: demonstration by color Doppler flow imaging.

Color Doppler flow imaging was performed in 121 patients with portal hypertension. Portosystemic collateral shunts originating from the left portal veins were seen in 41 of the patients. A single collateral shunt was seen in 27 of these, and multiple collateral shunts were seen in the other 14. Collateral shunts running in the ligamentum teres were seen in 26 of the 41 patients; the veins ran through the liver parenchyma in 25 of these. B-mode ultrasound imaging could not clearly demonstrate vascular structures in 55% of the collateral shunts. Color Doppler flow imaging provided a clear picture of the course of the portosystemic collateral shunts originating from the left portal vein.     

彩色多普勒超声对门静脉广泛血栓肝移植患者围手术期监测的临床意义:附四例分析

目的探讨术前存在广泛门静脉血栓肝移植患者采用彩色多普勒超声(CDI)进行围手术期监测的临床作用。方法对4例术前存在广泛门静脉血栓肝移植患者于术前、术后进行CDI检查。术后首次CDI检查在移植术后24h内进行,术后第1周和第2周隔天1次,以后每周1～2次;主要监测指标包括门静脉主干最大内径、平均血流速(TAMX)、最大流速(Vmax)、血流频谱、侧支循环。结果 4例病例术前CDI检查发现门静脉主干血流缓慢、整段狭窄、完全堵塞、无血流及门静脉内膜严重病变等情况;并探测到多支侧支循环血流丰富、肠系膜上静脉扩张和无法找到满意的门静脉重建部位。这些情况在手术中证实,并指导了肝移植特殊类型手术中供肝门静脉灌注重建。术后2周隔天进行1次的CDI检查显示4例患者门静脉内径、血流方向及流速都呈现正常,取得较好重建效果和良好的肝功能恢复。结论 CDI对监测肝移植术后门静脉并发症具有较好效果,对术前门静脉系统广泛血栓患者,CDI对指导术者在术前思考手术可能遇到问题、设计和准备应变手术方式具有一定价值。     

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.     

超声检测门脉高压患者肝脾动脉阻抗指数与门脉压力相关性研究

目的探讨肝动脉、脾动脉阻力指数（HARI、SpARI）及门脉高压指数（PHI）在评价门脉高压中的应用价值。方法57例临床确诊门脉高压并行门奇断流或脾肾分流术的患者被纳为门脉高压组,对照组为25例健康志愿者。门脉高压组均在术前1d行超声检查,对照组在空腹8h以上行超声检查。采用频谱多普勒检测门静脉平均血流速度（PVVel）、HARI、SpARI及肝脾动脉搏动指数（HAPI、SpARI）,并计算门脉高压指数（PHI）。门脉高压组门脉压力以术中胃网膜右静脉直接测压为准。结果对门脉高压组采用直接压力测定法测得门脉压力为（30.090±4.151）mmHg。门脉高压组HAPI、SpAPI及PHI高于正常对照组（P=0.012,P=0.034,P=0.026）,而PVVel、HARI及SpARI在两组之间差异无统计学意义。以HAPI=1.34诊断门脉高压的敏感性为73%、特异性80%、准确性74%。HARI、HAPI与门脉压力呈显著正相关（r=0.699,r=0.582,P均〈0.001）。门脉压力与肝功能Child-Pugh分级呈显著正相关（r=0.589,P=0.044）。结论HAPI在门脉高压组显著高于正常对照组,且与门脉压力呈显著正相关,因此HAPI可作为评价门脉高压的有效指标。