Doppler ultrasound in liver cirrhosis: correlation of hepatic artery and portal vein measurements with model for end-stage liver disease score in Egypt

Ahmed Abdelrahman Mohamed Baz,Khaled Helmy El-Kaffas,Rana Magdy Mohamed

doi:10.1186/s43055-020-00344-6

Ahmed Abdelrahman Mohamed Baz, Khaled Helmy El-Kaffas + Show 1 more

Open Access

https://doi.org/10.1186/s43055-020-00344-6

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Abstract

BackgroundLiver cirrhosis is a multi-etiological entity that alters the hepatic functions and vascularity by varying grades. Hereby, a cross-sectional study enrolling 100 cirrhotic patients (51 males and 49 females), who were diagnosed clinically and assessed by model for end-stage liver disease (MELD) score, then correlated to the hepatic Doppler parameters and ultrasound (US) findings of hepatic decompensation like ascites and splenomegaly.ResultsBy Doppler and US, splenomegaly was evident in 49% of patients, while ascites was present in 44% of them. Increased hepatic artery velocity (HAV) was found in70% of cases, while 59% showed reduced portal vein velocity (PVV).There was a statistically significant correlation between HAV and MELD score (ρ = 0.000), but no significant correlation with either hepatic artery resistivity index (HARI) (ρ = 0.675) or PVV (ρ =0.266).Moreover, HAV had been correlated to splenomegaly (ρ = 0.000), whereas HARI (ρ = 0.137) and PVV (ρ = 0.241) did not significantly correlate.Also, ascites had correlated significantly to MELD score and HAV (ρ = 0.000), but neither HARI (ρ = 0.607) nor PVV (ρ = 0.143) was significantly correlated.Our results showed that HAV > 145 cm/s could confidently predict a high MELD score with 62.50% and 97.62 % sensitivity and specificity.ConclusionDoppler parameters of hepatic vessels (specifically HAV) in addition to the US findings of hepatic decompensation proved to be a non-invasive and cost-effective imaging tool for severity assessment in cirrhotic patients (scored by MELD); they could be used as additional prognostic parameters for improving the available treatment options and outcomes.

Highlights

Liver cirrhosis is a multi-etiological entity that alters the hepatic functions and vascularity by varying grades
Liver cirrhosis is a worldwide clinical problem that has various infective and metabolic etiologies like hepatitis and alcoholic; the superadded hepatic fibrotic changes and development of regenerative nodules are considered the mainstay culprit of hepatic decompensation and lead to alteration of the hepatic vascular profile that result in portal hypertension [1]
The Doppler parameters and ultrasound findings were including the following: Hepatic artery velocity (HAV) Our results showed increased hepatic artery velocity (HAV) in 70% of the study population; it was considered as an indicator of chronic liver disease. (HAV: mean ± SD, 91.72 ± 46.26) (Table 1) (Fig. 1a)

Summary

Introduction

Liver cirrhosis is a multi-etiological entity that alters the hepatic functions and vascularity by varying grades. Liver cirrhosis is a worldwide clinical problem that has various infective and metabolic etiologies like hepatitis and alcoholic; the superadded hepatic fibrotic changes and development of regenerative nodules are considered the mainstay culprit of hepatic decompensation and lead to alteration of the hepatic vascular profile that result in portal hypertension [1]. The most commonly utilized (clinical/laboratory) scoring systems for morbidity and mortality prediction in cirrhotic patients are Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) scores. They could be especially applied for those who would undergo surgeries or interventions. The MELD score had surpassed CTP in its use, being calculated by more objective parameters (laboratory tests) than do the CTP, the serum creatinine (one of the MELD parameters) had added value in highlighting the importance of the kidney functions in predicting the mortality risk in end-stage hepatic disease patients [2, 3]

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