Hepatic arterial resistance after mixed-meal ingestion in healthy subjects and patients with chronic liver disease

Abstract

This study investigated hemodynamic changes in the resistance index of the hepatic artery after mixed-meal ingestion. We used color Doppler sonography to measure hemodynamic changes in the right hepatic artery in response to mixed-meal ingestion (225 ml, 69 g, 300 kcal) in 9 healthy subjects, 15 patients with chronic hepatitis with low-grade fibrosis (no bridging), 10 patients with chronic hepatitis with moderate-grade (bridging) fibrosis, and 18 patients with cirrhosis. After mixed-meal ingestion, the mean (+/-standard error) maximum increase in the resistance index of the right hepatic artery in healthy subjects was 31+/-2%. These changes were significantly greater than those in patients with chronic hepatitis with low-grade fibrosis (22+/-2%; p<0.05), patients with chronic hepatitis with moderate-grade fibrosis (11+/-2%; p<0.01), and cirrhotic patients (5+/-2%; p<0.01). Mixed-meal ingestion produced significantly smaller increases in the resistance index in cirrhotic patients than in patients with chronic hepatitis with low-grade fibrosis (p<0.01). A postprandial increase in the resistance index of 15% or less was associated with 100% sensitivity, 72% specificity, and 84% accuracy in distinguishing patients with cirrhosis from patients with chronic hepatitis. The response of the resistance index after mixed-meal ingestion decreases as the severity of hepatic fibrosis increases. Doppler evaluation of postprandial increases in the resistance index of the right hepatic artery may be useful in differentiating between patients with chronic hepatitis and those with cirrhosis.