Hepatic Artery Resistive Index Research Articles

Неинвазивные маркеры фиброза и цирроза печени у детей с билиарной атрезией

Objective. To identify non-invasive laboratory and ultrasound markers of liver fibrosis and cirrhosis in children with biliary atresia. Patients and methods. This retrospective study enrolled 166 children who underwent the Kasai procedure for biliary atresia. Intraoperative liver biopsy followed by histological examination of the biopsy specimen was performed in all children. According to the results of morphological analysis, patients were divided into two groups: group I included 108 children with moderate fibrosis (F0–2), group II – 58 children with severe liver fibrosis/cirrhosis (F3–4). Prior to surgery, patients underwent a comprehensive examination, which included laboratory parameters (platelets, albumin, gamma-glutamyl transpeptidase, cholinesterase, cholesterol, alkaline phosphatase, total and direct bilirubin, alanine aminotransferase, aspartate aminotransferase, fibrinogen, international normalized ratio, thrombin time, prothrombin index, APRI and AAR indices), and Doppler ultrasound. Results. The correlation analysis revealed a statistically significant, direct, very strong correlation between the degree of fibrosis and patient age at the time of biopsy (ρ = 0.805; p < 0.001), APRI index (ρ = 0.827; p = 0.001), and the hepatic artery diameter (ρ = 0.794, p = 0.042). The correlation between the degree of liver fibrosis and spleen length was statistically significant, direct, and of marked strength (ρ = 0.686; p = 0.010). There was a statistically significant, direct, notably strong correlation between the hepatic artery resistive index (RI) (ρ = 0.639; p = 0.05) and hepatic artery diameter-to-portal vein diameter ratio (HAD-to-PVD ratio) (ρ = 0.683, p = 0.047). The dependence of the probability of liver fibrosis/cirrhosis severity on the values of APRI index was assessed using ROC curves. The AUC value was 0.792 ± 0.056 (95% CI: 0.76–0.88, p = 0.009). The APRI value at the cut-off point was 1.52: with an APRI >1.52 showing a high risk of severe liver fibrosis/cirrhosis, and with lower values, the risk of severe fibrosis/cirrhosis was considered low. The sensitivity and specificity of the model were 73.9 and 71.1%, respectively. Conclusion. The results of the study indicate the significance of biochemical, ultrasound and Doppler parameters in the diagnosis of liver fibrosis/cirrhosis in children with biliary atresia. Key words: biliary atresia, liver fibrosis, liver cirrhosis, APRI index

Non-Alkolik Yağlı Karaciğer Hastalığı Olan ve Olmayan Obez Çocuklarda Hepatik Vasküler Akım Değişikliklerinin Değerlendirilmesi

Objective: To evaluate hepatic vascular flow alterations using Doppler ultrasound in obese children with and without non-alcoholic fatty liver disease.Material and Methods: Ninety-one obese and 30 healthy lean (control) children were enrolled in this study. Obese children were divided into two groups: children with non-alcoholic fatty liver disease and children without non-alcoholic fatty liver disease; according to hepatic fatty changes on ultrasound, and blood serum alanine aminotransferase levels above 30 IU/L. Portal vein diameter, portal blood flow volume and hepatic artery resistive index were calculated using Doppler ultrasound.Results: Portal vein diameter and portal blood flow volume values in children with non-alcoholic fatty liver disease were found close to the controls. However, the values of portal vein diameter and portal blood flow volume were lower in children without non-alcoholic fatty liver disease group than the other groups (p<0.001). Hepatic artery resistive index was higher in children without non-alcoholic fatty liver disease group than children with non-alcoholic fatty liver disease group (0.64±0.1 and 0.60±0.1, respectively) (p=0.03), whereas hepatic artery resistive index was found to be close in children with non-alcoholic fatty liver disease and controls. These findings were similar to the differences in hepatic vascular changes observed during the development of non-alcoholic fatty liver disease, which were described in physio-pathological studies.Conclusion: Portal vein diameter, portal blood flow volume and hepatic artery resistive index values in obese children show significant differences according to the presence or absence of fatty liver. These differences are consistent with hepatic physio-pathological changes in non-alcoholic fatty liver disease. Therefore, hepatic vascular Doppler indices may be a new tool that can be used to monitor the development and progression of non-alcoholic fatty liver disease in obese children.

Assessment of hepatic function, perfusion and parenchyma attenuation with indocyanine green, ultrasound and computed tomography in a healthy rat model: Preliminary determination of baseline parameters in a healthy liver.

Defining reference intervals in experimental animal models plays a crucial role in pre-clinical studies. The hepatic parameters in healthy animals provide useful information about type and extension of hepatic damage. However, in the majority of the cases, to obtain them require an invasive techniques. Our study combines these determinations with dynamic functional test and imaging techniques to implement a non-invasive protocol for liver evaluation. The aim of the study was to determine reference intervals for hepatic function, perfusion and parenchyma attenuation with analytical and biochemical blood parameters, indocyanine green, ultrasound and computed tomography in six healthy SD rats. Six males healthy SD rats were followed for 4 weeks. To determine hepatic function, perfusion and parenchyma attenuation analytical and biochemical blood parameters, indocyanine green, ultrasound and computed tomography were studied. Results were expressed as Means ± standard error of mean (SEM). The significance of differences was calculated by using student t-test, p < 0.05 was considered statistically significant. Indocyanine green clearance 5 and 10 minutes after its injection was 80.12% and 96.59%, respectively. Approximate rate of decay during the first 5 minutes after injection was 38% per minute. Hepatic perfusion evaluation with the high-frequency ultrasound was related to cardiovascular hemodynamic and renal perfusion. Portal area, hepatic artery resistance index, hepatic artery and portal peak systolic velocity and average between hepatic artery and porta was 3.41 ± 0.62 mm2, 0.57 ± 0.04 mm2/s, 693.24±102.53 mm2/s, 150.72 ± 17.80 mm2/s and 4.82 ± 0.96 mm2/s, respectively. Heart rate, cardiac output, left renal artery diammetre and renal blood flow were 331.01 ± 22.22 bpm, 75.58 ± 8.72 mL/min, 0.88 ± 0.04 mm2 and 13.65 ± 1.95 mm2/s. CT-scan hepatic average volume for each rat were 21.08±3.32, 17.57±2.76, 14.87±2.83 and 13.67±2.45 cm3 with an average attenuation coefficient of 113.51±18.08, 129,19±7.18, 141,47±1.95 y 151,67±1.2 HU. Indocyanine green and high-frequency ultrasound could be used in rats as a suitable marker of liver function. Computed tomography, through the study of raw data, help to characterize liver parenchyma, and could be a potential tool for early detection of liver parenchymal alterations and linear follow-up of patients. Further studies in rats with liver disease are necessary to verify the usefulness of these parameters.

Role of Portal Hemodynamics in Mortality and Adverse Out-come Prediction of Hyponatremic Cirrhotic Patients

Background: Cirrhotic patients have variable degrees of hepatic dysfunction. Impaired portal hemodynamics and hyponatremia occurs in the setting of end-stage liver disease. Aim: to uncover the role of portal hemodynamics in mortality and adverse outcome prediction of hyponatremic cirrhotic patients. Subjects and Methods:Eighty cirrhotic patients with hyponatremia (serum Na<130mmol/L) were included. ]iagnosis of hepatic encephalopathy using West Haven criteria, laboratory investigations, modified Child-Pugh and MELD scores were calculated, abdominal ultrasonography with Doppler study of portal circulation and upper GIT endoscopy were performed and the patients were followed up during their stay in hospital. Results:Serum sodium level has high statistically significant negative correlation with modified Child-Pugh score (P <0.001) and with MELD score (P <0.001). Most of the patients developed hepatic encephalopathy, spontaneous bacterial peritonitis, hepato-renal syndrome, and bleeding recorded in some patients; meanwhile mortality in 10% of the patients. In addition, apart from Hepatic Artery resistive Index, the difference in MELD score, MELD-Na score and Portal vein congestive Index between non-survived and survived patients was statistically insignificant, although all these indices were highly significant with hepatic encephalopathy, Portal vein congestive Index is highly significant in hepatorenal syndrome and bleeding esophageal varices, and Hepatic Artery resistive Index is highly significant in hepatorenal syndrome. Analysis of the receiver operating characteristic curve revealed that Portal vein CI was the most sensitive indicator (sensitivity 78.5%) and hepatic A resistive Index was the most specific indicator for prediction of mortality in hyponatremia cirrhotic patients. Conclusion:portal vein CI and hepatic A. RI can be used in the prediction of mortality in hyponatremia cirrhotic patients.

Middle hepatic vein incorporation in live donor liver graft transplantation; implication and safety

Background: In this study, we have used the middle hepatic vein with the right lobe, and we studied the venous outflow dynamics immediately after transplant retrospectively meanwhile we studied the impact of the graft function on donor functionality and overall donor safety. &#x0D; Method: Between October 2017 to October 2020, we performed 40 adult to adult live donor liver transplants at Zheen International Hospital (Erbil, Kurdistan Region). Postoperative Doppler ultrasound was performed for recipients and donors immediately after surgery and then daily until discharge. &#x0D; Results: The donor age (28.5 ± 6.9) year, male/ female 19/ 21, intensive care unit stay (1.2 ± 0.43), floor stay (5.2 ± 1.4) days, their portal vein velocity (43.5 ± 18.4 ml/sec), hepatic artery resistive index (0.6 ± 0.09) and triphasic/ continuous venous outflow 30/10, their postoperative day one and at the discharge total serum bilirubin were (2.8 ± 1.8) and (2 ± 1.4), their postoperative day one and at the discharge international normalization ratio were (1.7 ± 0.5) and (1.2 ± 0.2) respectively. The recipient age (48.5 ± 11.3), male/female 27/13, intensive care unit stay (4.75 ± 3.9), floor stay (7.7 ± 3.7) days, portal vein velocity (63.96 ± 24.65 ml/sec), hepatic artery peak systolic velocity (74.76 ± 32.85) hepatic artery resistive index (0.7 ± 0.15), and triphasic/continuous venous outflow 27/13. &#x0D; Conclusions: Middle hepatic vein incorporation in live donor liver graft is safe with a favorable outcome for recipient and donor, doppler US is one the important tool for evaluation and follow up of donor and recipient for detection of vascular complications and assessment of venous outflow and graft function. In addition, early discharge of the donor is a reasonable option. &#x0D;

Non-invasive assessment of liver abnormalities in pediatric Fontan patients.

Liver abnormalities are well known among long-term survivors of Fontan palliation, which remains the definite surgery for complex congenital heart disease and single ventricle physiology. Pediatric data however are scarce. We assessed the prevalence and degree of liver abnormalities in pediatric Fontan patients through non-invasive investigations suitable for longitudinal follow-up. Thirty-five patients with a median age of 11.8years (5.2-16.6) and median time since Fontan of 6years (1.17-13.83) were studied. Each child underwent a blood test, liver Doppler ultrasound (US), and transient elastography (TE). Healthy children were used as controls for TE measurement. AST, ALT, γGT, and direct bilirubin were abnormal in respectively 12 (34%), 5 (14%), 24 (69%), and 7 (20%) patients, while platelet count was decreased in 7 (20%). Splenomegaly was present in 7 (20%) patients. Portal vein mean flow velocity was < 15cm/s in 19 (54%) patients indicative of portal hypertension. Twenty-two patients (63%) showed inferior vena cava collapsibility index values below 17%, indicating venous congestion. Hepatic artery and superior mesenteric artery resistance index were inversely correlated with time post Fontan (p < 0.05). TE values in Fontan patients were significantly higher than controls, with a median of 12.6 versus 4.6kPa (p < 0.001) and were already increased shortly after Fontan completion.Conclusion: Liver abnormalities are frequently observed in pediatric Fontan patients. The non-invasive investigations used were not able to confirm liver fibrosis or differentiate hepatic congestion from fibrosis. Based on our findings, we propose a prospective screening protocol with serial measurements of laboratory, (Doppler) US, and TE parameters. What is Known: • Hepatic dysfunction is a well-known consequence of the Fontan circulation. • The natural history of Fontan-associated liver disease in the pediatric age group remains unclear. What is New: • Liver abnormalities are frequently observed in pediatric Fontan patients; however, differentiating liver fibrosis and hepatic congestion with non-invasive investigations remains challenging.Sonographic Doppler measurements may improve our insight in both Fontan-associated liver disease development and the functioning of the Fontan circulation. • A prospective screening protocol is proposed to improve our ability to detect Fontan-associated liver disease early on and understand its natural history.

Contrast-Enhanced Ultrasonography-Based Hepatic Perfusion for Early Prediction of Prognosis in Acute Liver Failure.

Background and AimsAcute liver failure (ALF) is a rare but dramatic clinical syndrome characterized by massive hepatic necrosis leading to multiorgan failure. It is difficult to predict the outcomes in patients with ALF using existing prognostic models. We aimed to analyze hepatic perfusion using contrast‐enhanced ultrasound and Doppler ultrasound in patients with ALF and investigate its utility as a prognostic biomarker.Approach and ResultsIn this prospective observational study, 208 patients with acute liver injury/ALF were enrolled from 2015 to 2019. We evaluated 50 consecutive patients with ALF with Doppler ultrasound and contrast‐enhanced ultrasound performed on admission. The cases were divided into the following two groups: survivors (recovered without surgical intervention) and nonsurvivors (died of ALF or underwent liver transplantation). The time to peak and peak intensity of hepatic artery, portal vein, hepatic vein, and liver parenchyma were calculated using the time‐intensity curve analysis. The hepatic artery (HA) resistive index was calculated using the fast Fourier transform analysis of Doppler ultrasound. The time interval (TI) between the time to peak of HA and liver parenchyma (LP) was significantly shorter in the nonsurvivors than in the survivors (P < 0.0001). The area under the receiver operating curve values for TI (HA, LP), Japanese scoring system, HE prediction model, Model for End‐Stage Liver Disease score, and King’s College Hospital criteria for the prediction of poor prognosis were 0.953, 0.914, 0.861, 0.816, and 0.731, respectively. The most appropriate cutoff value of TI (HA, LP) was 6.897 seconds; the sensitivity, specificity, positive and negative predictive values were 94.4%, 90.6%, 85.0%, and 96.7%, respectively.ConclusionsTI (HA, LP) accurately predicts the outcome in patients with ALF and may be useful in clinical decision making.

Refined ultrasonographic criteria for sinusoidal obstruction syndrome after hematopoietic stem cell transplantation.

Hepatic sinusoidal obstruction syndrome (SOS)/veno-occlusive disease is a life-threatening complication after hematopoietic stem cell transplantation (HSCT). We previously reported the efficacy of the Hokkaido Ultrasonography (US)-based scoring system (HokUS-10) for US findings. To establish easier-to-use criteria, we retrospectively evaluated US findings from 441 patients, including 30 patients with SOS using the HokUS-10 scoring system. Using logistic regression analysis, we established the novel diagnostic criteria HokUS-6. In the presence of ascites, US diagnosis was made in the presence of two of the following 6 parameters: moderate amount of ascites, the appearance of a paraumbilical vein blood flow signal, gallbladder wall thickening, portal vein dilatation, portal vein velocity decrease, and hepatic artery resistive index increase. The AUC, sensitivity, and specificity of HokUS-6 were 0.974 (95% confidence interval 0.962-0.990), 95.2%, and 96.9%, respectively. The scores were significantly higher in patients with severe SOS than in those with non-severe SOS (p = 0.013). Furthermore, the scores before HSCT were significantly higher in patients who developed SOS than in controls (p = 0.001). The HokUS-6 is an easy and useful way to diagnose and identify the risk of SOS.

Assessment of Hepatic Function and Parenchyma Attenuation with Indocyanine Green, Ultrasound and CT in a Rat Model: Preliminary Standardization of Baseline Parameters

Purpose: Standardization in experimental animal models plays a crucial role in preclinical studies by providing useful information on the type and extent of liver disease. However, it is necessary to combine these determinations with functional dynamics imaging and testing techniques to implement a non-invasive protocol for liver evaluation. Method: Six healthy SD rats were followed for 4 weeks. The aim was to determine hepatic function, perfusion and parenchyma attenuation with biochemical blood parameters, indocyanine green, ultrasound and computed tomography. Results: Indocyanine green clearance 5 and 10 minutes after its injection was 80.12% and 96.59%, respectively. Hepatic perfusion evaluation with the high-frequency ultrasound was related to cardiovascular hemodynamic and renal perfusion. Portal area, hepatic artery resistance index and average between hepatic artery and porta was 3.41 ± 0.62 mm 2 , 0.57 ± 0.04 mm 2 /s and 4.82 ± 0.96 mm 2 /s, respectively. Heart rate, cardiac output, left renal artery diammetre and renal blood flow were 331.01 ± 22.22 bpm, 75.58 ± 8.72 mL/min, 0.88 ± 0.04 mm 2 and 13.65 ± 1.95 mm 2 /s. CT-scan hepatic average volume for each rat were 21.08±3.32, 17.57±2.76, 14.87±2.83 and 13.67±2.45 cm 3 with an average attenuation coefficient of 113.51±18.08, 129,19±7.18, 141,47±1.95 y 151,67±1.2 HU. Conclusion: Indocyanine green and high-frequency ultrasound could be used in rats as a suitable marker of liver function. Computed tomography help to characterize liver parenchyma, and could be a potential tool for early detection and linear follow-up of patients. Further studies in rats with liver disease are necessary to verify the usefulness of these parameters.Table 1Indocyanine Green plasma clearance (ICG) rateICG plasma concentration (μg/mL)Min 1Min 5Min 10Rat 1128.1±55.61819.45±2.285.41±3.32Rat 2161.47±65.8228.58±9.235.75±3.60Rat 3160.63±27.6833.14±6.957.44±0.52Rat 4189.16±51.0538.13±2.863.47±0.05Rat 5165.91±23.9147.51±8.822.90±0.76Rat 6130.65±10.2119.24±3.546.91±0.99Average ICG Concentration (μg/mL)155.99±23.1131.01±11.015.31±1.82Average Clearance %0.0080.1296.59 Open table in a new tab μg/mL: microgram/mililitre

Hemodynamic Changes of Hepatic & Renal Vessels in Systemic Bacterial Infection with Fever in HCV Related Cirrhosis.

To study the hemodynamic changes of hepatic & renal vessels in systemic bacterial infection with fever in HCV related cirrhosis with possible complications. Three groups of patients with systemic bacterial infection with fever were included in the study; group І included 15 patients with decompensated cirrhosis, group ІІ included 15 patients with compensated cirrhosis and group ІІІ included 10 patients without liver affection. Laboratory parameters and Doppler US of hepatic and renal vessels were evaluated during and after subsidence of fever in all patients. Forty patients were enrolled in this prospective study. There were 22 male and 18 female patients. We found that the direction of blood flow in the portal and splenic veins was hepatopetal and the veins were non pulsatile in all cases with no change during and after subsidence of infection. There was no significant difference in portal or splenic vein diameters during and after subsidence of infection in the three studied groups. However, the mean values of portal and splenic veins peak velocities were significantly lower during infection in cirrhotic groups. The mean value of hepatic artery resistive index during fever was significantly higher than after fever in cirrhotic groups. Renal resistive and pulsatility indices were significantly higher during fever in cirrhotic groups. Systemic bacterial infection with fever can affect hepatic haemodynamics leading to aggravation of portal hypertension and increasing the risk of complications as variceal bleeding and hepatic encephalopathy and can also affect renal haemodynamics with increased risk of renal impairment.

Relationship between Hepatic Artery Resistive Index and Liver Fibrosis Score in Non-Alcoholic Fatty Liver Disease Patient

Background: Nonalcoholic fatty liver disease (NAFLD) is one of the most important precursors of chronic liver disease all over the world. Doppler ultrasonography is an essential part of evaluating the vascular haemodynamic variation seen within NAFLD. Objective: Assessment of the role of Hepatic Artery Resistive Index (HARI) in NAFLD patient and the relation between HARI and grading of fatty liver by ultrasound. Patients and methods: One hundred Egyptian patients diagnosed to have NAFLD based on ultrasound abdomen 35, 35, and 30 patients in grade1, grade 2, and grade3 NAFLD, respectively and 20 healthy subjects as control group were subjected to hepatic artery Doppler study. The study was carried out in the Outpatient Clinic of Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt. Results: Our study results showed high statistical significant difference (p-value < 0.001) between studied groups as regards hepatic artery resistance index. There was an inverse relationship between HARI and different grades of fatty liver in patients (p < 0.001). Hepatic artery resistance index (RI) decreased as the severity of diffuse fatty infiltration increases. Conclusion: Hepatic artery resistance index (RI) decreases as the severity of diffuse fatty infiltration increases.

Relationship between Hepatic Artery Resistive Index and Liver Fibrosis Score in Non-Alcoholic Fatty Liver Disease Patient

Background: Nonalcoholic fatty liver disease (NAFLD) is one of the most important precursors of chronic liver disease all over the world. Doppler ultrasonography is an essential part of evaluating the vascular haemodynamic variation seen within NAFLD. Objective: Assessment of the role of Hepatic Artery Resistive Index (HARI) in NAFLD patient and the relation between HARI and grading of fatty liver by ultrasound. Patients and methods: One hundred Egyptian patients diagnosed to have NAFLD based on ultrasound abdomen 35, 35, and 30 patients in grade1, grade 2, and grade3 NAFLD, respectively and 20 healthy subjects as control group were subjected to hepatic artery Doppler study. The study was carried out in the Outpatient Clinic of Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt. Results: Our study results showed high statistical significant difference (p-value < 0.001) between studied groups as regards hepatic artery resistance index. There was an inverse relationship between HARI and different grades of fatty liver in patients (p < 0.001). Hepatic artery resistance index (RI) decreased as the severity of diffuse fatty infiltration increases. Conclusion: Hepatic artery resistance index (RI) decreases as the severity of diffuse fatty infiltration increases.

Shear wave elastography for evaluation of the urgency of liver transplantation in pediatric patients with biliary atresia.

To investigate the role of two-dimensional shear wave elastography (2D-SWE) in the preoperative evaluation of pediatric patients with biliary atresia awaiting liver transplantation. Among a total of 152 pediatric patients enrolled in this single-institution prospective study between March 2018 and August 2019, 143 patients (age range, 4-97months; median age, 7months; 84 males, 59 females) who underwent successful routine ultrasound examination, SWE examination, and blood test before liver transplantation were included in the final analysis. The values of liver stiffness measured by SWE were compared with ultrasound and blood test parameters by Spearman's correlation analysis. The overall median liver stiffness with 2D-SWE was 29.0±10.9kPa, with a range of 9.0-53.3kPa. The success rate of 2D-SWE measurements was 98.0% (149/152). Liver stiffness measurement (LSMs) had no significant correlation with gender, age, weight, and height of the pediatric recipients. LSMs were correlated with ultrasound parameters including portal vein (PV) maximum velocity, PV direction, hepatic artery resistance index (HARI), spleen diameter, ascites, and blood test parameters (albumin level, platelet count level, and international normalized ratio). In the pediatric recipients with hepatofugal PV flow, high HARI (HARI≧0.90), and ascites, or without Kasai operation, LSMs were significantly higher (P<.05). SWE is feasible and valuable for assessing liver damage in children with biliary atresia awaiting liver transplantation and might be used as selection criteria for children in need of priority access to liver transplantation.

Ультразвукові параметри печінки та показники портальної гемодинаміки при коморбідності неалкогольної жирової хвороби печінки з артеріальною гіпертензією

Об’єктом дослідження були 269 пацієнтів, які входили у три групи: група І – пацієнти з коморбідністю НАЖХП та ГХ ІІ стадії, 2 ступеню (121 пацієнт), група ІІ – пацієнти з коморбідністю НАЖХП та РПАГ ІІ стадії, 2 ступеню (88 пацієнтів), група ІІІ – пацієнти з НАЖХП (60 пацієнтів). Вік пацієнтів складав від 18 до 66 років. Середній вік пацієнтів становив (48,07±10,81) року. Контрольна група – 20 здорових осіб аналогічної вікової категорії чоловічої та жіночої статі. Для оцінки стану печінки використовували ультразвуковий метод дослідження на ультразвуковій діагностичній системі „GE”, США. За нашими даними, показники кровотоку у портальній вені погіршуються як у пацієнтів з НАЖХП так і її коморбідністю з ГХ або РПАГ. Індекс резистивності загальної печінкової артерії знижується у більшій мірі у пацієнтів з НАЖХП та її коморбідністю з ГХ або РПАГ порівняно як з хворими з ізольованою НАЖХП, так і з групою контролю. Пульсаційний індекс загальної печінкової артерії достовірно не відрізняється від хворих з коморбідністю та ізольованою НАЖХП, але достовірно перевищує показник у групі контролю. Це також свідчить про наявність порушень у системі артеріального печінкового кровотоку у досліджених хворих. Різниця між показниками портальної гемодинаміки відсутня при коморбідності НАЖХП з ГХ та коморбідності НАЖХП з РПАГ. Отриманні дані свідчать про те, що наявність коморбідності з ГХ або РПАГ у пацієнтів з НАЖХП, погіршує стан портального кровотоку, що може впливати на перебіг захворювання.

Can portal vein pulsatility index be used as predictive parameter with hepatic artery resistive index for liver fibrosis in nonalcoholic hepatosteatosis?

Aim: Nonalcoholic fatty liver disease (NAFLD) is a clinical entity with a broad spectrum of isolated liver steatosis, steatohepatitis and even cirrhosis. In the development of hepatitis or cirrhosis, flow changes in the hepatic artery and portal vein may be detected. The aim of this study was to investigate the significance of the changes in hemodynamic findings according to the steatosis grade in patients with nonalcoholic hepatosteatosis. Materials and Methods: the study was performed with B-mode and Doppler ultrasonographic (US) measurements of patients who applied to the radiology department for abdominal ultrasonography examination between February and September 2018. Hepatic artery resistive index (HARI) and portal vein pulsatility index (PVPI) were evaluated. Thirty patients without steatosis and 30 patients from each 3 hepatosteatosis grade were included into the study. As the criteria for inclusion of patients in the study, there was no history of additional disease. p&amp;lt;0.05 values were considered statistically significant. Results: HARI was significantly lower in grade 3 steatosis than the control group, grade 1 and 2 steatosis (p&amp;lt;0.05). In grade 3 steatosis, portale vein diameter was significantly wider than the control group, grade 1 and 2 steatosis (p&amp;lt;0.05). PVPI was significantly lower in grade 2 steatosis than the control group and grade 1 steatosis (p&amp;lt;0.05). Significant hemodynamic changes were detected in the hepatic artery and portal vein when compared with control and patients groups. Conclusion: The evaluation of PVPI is considered as a noninvasive valuable method as if HARI in the evaluation of liver parenchymal damage in NAFLD.

Markedly elevated hepatic arterial velocity-HAV greater than 200 cm/s-is not specific to hepatobiliary disease.

The aim of the study was to review the different etiologies and outcomes of patients with hepatic artery velocities greater than 200 cm/s. This retrospective study included 88 hospitalized patients in whom angle-corrected proper hepatic artery flow velocities greater than 200 cm/s were obtained during an abdominal ultrasonographic examination. Peak systolic hepatic artery flow velocities, hepatic artery resistance index, and portal vein flow velocities were evaluated. The patients were then allocated to one of four groups based on their primary underlying diagnosis: structural liver disease, nonstructural liver disease, generalized infection, or miscellaneous. The median hepatic artery velocity was similar for all groups, ranging from 226 to 238 cm/s. The maximum portal venous velocities were not significantly different between groups. No lab values were statistically different between the groups, except total bilirubin that was greater in the nonstructural liver disease group (8 mg/dL). Overall, 9/88 (10.2%) of patients with elevated hepatic artery velocity died within 30 days of their ultrasonographic examination. Elevated hepatic artery velocity greater than 200 cm/s in hospitalized patients is not specific to primary hepatobiliary disease but may indicate acute hepatic dysfunction from other causes such as infection or sepsis.

Ultrasound in Hepatic Veno-occlusive Disease (HVOD) after Pediatric Hematopoietic Stem Cell Transplantation (HSCT): Comparison of Diagnostic Criteria Including the Pediatric Criteria of European Society for Blood and Marrow Transplantation (EBMT)

The European Society for Blood and Marrow Transplantation (EBMT) has recently announced new diagnostic criteria for pediatric hepatic veno-occlusive disease (HVOD) after hematopoietic stem cell transplantation (HSCT). We retrospectively inspected 97 ultrasound exams of 60 pediatric HSCT patients, and compared its diagnostic value using the Baltimore, Seattle and pediatric EBMT criteria. Nine of the ten patients who were diagnosed as HVOD only in the EBMT criteria had severe or very severe HVOD. In the Seattle and EBMT criteria, portal vein velocity, peak systolic velocity and resistance index of hepatic artery, gallbladder wall thickening and ascites were statistically significant. No ultrasound variable showed significant association in the Baltimore criteria. All patients with portal vein velocity below 10 cm/s were in higher EBMT grade. A scoring system was developed, to evaluate the overall relationship of the ultrasound findings with the diagnosis of HVOD, showing fair (0.768 and 0.733) AUC in the ROC curve of EBMT and Seattle criteria.

Role of hepatic colour duplex ultrasound in assessment of non alcoholic fatty liver disease-nafld

Abstract Background Gray-scale ultrasonography (US) is an initial, easy to use and widely available imaging modality for NAFLD, the presence of fat infiltration in the liver in the absence of excessive alcohol consumption and other causes of liver disease, is the most common cause of fatty liver, with a prevalence as high as 15-25% in many populations. Objective to determine the effect of obesity and NAFLD on the Doppler waveform pattern of the liver vascularity. Methods A case control study, conducted at Ain Shams University in the period between july and December 2018 . In both groups, liver span &amp; subcutaneous fat was measured by ultrasonographic examination. Hepatic vein waveform pattern &amp; portal vein mean flow velocity were assessed &amp; hepatic artery resistance index was measured by duplex Doppler ultrasonography examination. Results Our study included 50 patients , 20 were control &amp; 30 were cases.. The mean age of cases was 45.30 ± 10.15 SD &amp; the mean age of control was 32.70 ± 10.95 SD rendering the mean age of cases &amp; control of high statistical significance (p value=0.000). The Subcutaneous fat showed high significant statistical difference between cases &amp; control groups with mean subcutaneous fat in control =0.75 ± 0.14 SD &amp; mean subcutaneous fat in cases= 1.23 ± 0.42 SD with p –value = 0.000. The liver span showed high significant statistical difference between cases &amp; control groups with mean in control =15.11 ± 0.85 SD &amp; mean liver span in cases= 17.46 ± 1.67SD ( p value = 0.000). Hepatic vein wave pattern was normal in all 20 control (100%). In the 30 cases,the Hepatic vein wave pattern was triphasic in 12 patients (40%) &amp; biphasic or monophasic In 18 patients (60%) with high statistical significance (p-value =0.000). There was negative correlation between the hepatic vein velocity &amp; BMI with ( p value=0.0032). There was no statistically significant difference between cases &amp; control as regards all Doppler indices including the Hepatic artery RI(resistive index), Hepatic artery PSV(peak systolic velocity), Portal vein velocity(maximum &amp; minimum)&amp; hepatic vein velocity (maximum velocity) where the p value was more than 0.05. Conclusion Patients with NAFLD have a high rate of abnormal hepatic vein Doppler waveform patterns ,which can be biphasic or monophasic rather than alterations in hepatic artery resistance index values by duplex Doppler ultrasonography. Also the fatty infiltration of hepatocytes can increase liver span &amp; the subcutaneous fat.

The postoperative hepatic artery resistance index after living donor liver transplantation can predict early allograft dysfunction.

To investigate whether postoperative hepatic hemodynamics have an impact on graft function.Using a retrospective cohort with 262 adult living donor liver transplantation (LDLT) recipients, we discussed the relationship between postoperative hepatic hemodynamics and patient outcomes.According to the definition of early allograft dysfunction (EAD), the patients were classified into the EAD group (43 patients) and the non-EAD group (219 patients). In terms of postoperative hemodynamic parameters, there was no significant differences between these 2 groups regarding hepatic artery flow (HAF), hepatic artery velocity (HAV), portal vein flow (PVF), and portal vein velocity (PVV), except for the hepatic artery resistance index (HARI) which was somewhat higher in the EAD group on postoperative day 3 (POD3) (0.70 vs 0.61, P < .05). According to these results, we used a ROC curve and found that a HARI of 0.68 was the cutoff point (with 73.8% sensitivity and 58.3% specificity) for predicting EAD after LDLT. In addition, multivariate analysis showed that fulminant hepatic failure, pretransplant hepatorenal syndrome, and HARI ≥ 0.68 on POD3 were independent risk factors for postoperative EAD.Our results showed that postoperative hemodynamics might influence graft function by altering hepatic artery flow.

Role of Colour Doppler Ultrasound in the Diagnosis and Grading of Liver Cirrhosis Compared with Transient Elastograpgy (Fibroscan)

The purpose of this study was to determine the morphological changes in hepatic vasculature and the flow hemodynamics in portal vein, hepatic veins and hepatic artery using various Doppler parameters in cirrhotic patients and to evaluate the variation in Doppler flow hemodynamics within cirrhotic livers as compared to liver stiffness measured by transient elastography. Study sample of 100 eligible patients with compensated liver cirrhosis were enrolled. All were examined with a pulsed Doppler flowmeter with a 3.75 MHz convex and sector probe. Liver texture, splenic size, portal and splenic vein diameters, portal vein velocity, hepatic artery resistive index and waveform of the hepatic vein were evaluated in all subjects comparing results with liver stiffness measured by transient elastography. All the data were collected, tabulated and statistically analyzed using an IBM personal computer with Statistical Package of Social Science version 22. The mean age of the patients was found to be 51.8 ± 10.2 years. The mean value of liver stiffness was 39.7 ± 18.0 kPa. The echotexture of liver was coarse with irregular margin in 69 patients (69.0%), coarse with smooth margin in 24 patients (24.0 %) and normal in 7 patients (7.0 %). The size of spleen was enlarged in 92.0 % of patients. Portal vein diameter was enlarged in 66.0 % of patients. Portal vein velocity shows abnormality in 65.0 % of patients. Hepatic vein waveform in 7.0% of patients was triphasic and non-triphasic in 93.0%. Hepatic artery restrictive index increased above normal range in 69.0 % of patients. Splenic vein diameter was enlarged in 92.0 %. There were statistically highly significant relations (P value < 0.001) between liver stiffness measured by transient elastography and liver texture, hepatic vein waves in colour Doppler US. A highly significant negative correlation (P value < 0.001) was found between Fibroscan results and portal vein velocity in our included cirrhotic patients. Fibroscan results had highly significant positive correlations (P value < 0.001) with splenic size, portal vein diameter, HARI and splenic vein diameter. Colour Doppler US play an important role in the diagnosis of the morphological changes in hepatic vasculature and the flow hemodynamics in portal vein, hepatic veins and hepatic artery. Fibroscan could predict changes in intrahepatic vascular resistance and it improves the accuracy of Doppler US in the detection of cirrhosis.