The use of color doppler flow imaging in the diagnosis of acute alcoholic hepatitis: Evidence of intrahepatic arterial dilatation

Abstract

Objective: In this article, a color Doppler flow imaging investigation was performed to demonstrate the segmental arterial dilatation within the liver parenchyma of patients with acute alcoholic hepatitis and to compare these findings with those obtained in a group of patients with alcoholic liver disease, but without clinical and biochemical parameters suggesting acute hepatitis. Methods: Color Doppler flow imaging was performed in 59 patients with a previously established diagnosis of alcoholic disease of the liver. Among those patients, 25 fulfilled physical and biochemical criteria of acute alcoholic hepatitis. Ultrasound scans were performed by two independent, equally skilled investigators with a 3.5 MHz transducer. Based on a previous observation, special attention was given to whether a intrahepatic arterial dilatation was present. Results: Of the 59 patients with alcoholic liver disease, intrahepatic arterial dilatation was seen in 29 (49.2%) patients. In 27 of 29 patients (93.1%) with intrahepatic arterial dilatation the arterial nature of one of the vessels was confirmed by pulsed-Doppler flowmetry. Intrahepatic arterial dilatation was observed in 22 of 25 (88.0%) patients with acute alcoholic hepatitis. Among the 34 patients with advanced alcoholic liver disease, but without physical and biochemical evidence of acute hepatitis, the presence of intrahepatic arterial dilatation was found in 7 (20.6%) patients. A systolic hepatic bruit was heard in 19 of 25 (76.0%) patients with acute alcoholic hepatitis, all of whom had intrahepatic arterial dilatation. Comparing patients with acute alcoholic hepatitis who had intrahepatic arterial dilatation with those who had not, significant difference was found with respect to the values of serum bilirubin and aspartate transaminase. For technical reasons an accurate and reproducible measurement of hepatic artery resistive index (RI) was possible in 41 (69.5%) patients (18 patients with and 23 patients without acute alcoholic hepatitis). For the 18 patients with acute alcoholic hepatitis, the mean RI was 0.74 ± 0.08, a level that was significantly lower than that observed in the 23 patients without physical and biochemical findings of acute alcoholic hepatitis (0.85 ± 0.05); P < 0.05). Conclusion: This study provides a reliable assessment of the accuracy of color Doppler flow imaging in diagnosing intrahepatic arterial dilatation as an important and very frequent finding in patients with acute alcoholic hepatitis.