Hepatic Vein Waveform Research Articles

Tu1028 Correlation Between Liver Histology and Novel Magnetic Resonance Imaging in Adult Patients With Nonalcoholic Fatty Liver Disease

A S L D A b st ra ct s correlation was observed between PI signal and fibrosis scores (r = 0.33; p = 0.04). When patients were stratified according to their liver parenchyma PI signal, a significant difference was achieved between patients with Ishak score 1-2 vs 3-5 (p = 0.01). The median DI was 0.39 ± 0.15 (0.17 0.61); because DI is given by the ratio between the minimum velocity/ maximum velocity of downward HV flow, with higher DI, HV waveforms tended to become abnormal (r = 0.7, p = 0.01). All patients with Ishak > 3 had an abnormal hepatic vein waveform; DI > 0.45 was significantly more likely to be seen in patients with Ishak > 3. Conclusions: We report preliminary results suggesting that CEUS with software-based quantitative analysis in addition to standard Doppler indices may provide a useful noninvasive tool in assessing the severity of liver fibrosis in a clinical setting.

Comparison of Portal Vein Doppler Indices and Hepatic Vein Doppler Waveform in Patients with Nonalcoholic Fatty Liver Disease with Healthy Control

The purpose of the present study is to investigate the association of nonalcoholic fatty liver disease (NAFLD) with the doppler waveform pattern of hepatic veins and portal vein doppler indices. This assay may be useful in evaluating the natural course of NAFLD and monitor treatment efficacy on follow-up. This case control study was performed in 31 patients with NAFLD and 31 normal healthy adults who served as the control group. The patients presented with elevated liver enzymes levels (ALT/AST) and hyperechogenic livers in the B-mode ultrasonography examination. Eleven patients had a liver biopsy. After an 8-hour fast,B-mode and duplex doppler ultrasonography were performed, and the waveform patterns of the right hepatic vein, portal vein diameter, grade of fatty liver, portal vein pulsatility index (VPI), and mean flow velocity (MFV) were measured. VPI and MFV values were 0.42 ± 0.92 and 17.27 ± 5.34 cm/second, respectively, in the control group and 0.25 ± 0.50 and 12.82 ± 4.32 cm/second in patients with NAFLD (P< 0.01). The frequency of abnormal hepatic vein doppler waveform patterns (biphasic or monophasic) was significantly higher in patients with NAFLD (55.2%) versus control subjects (3.2%) (P < 0.001). There was no correlation between the degree of fat infiltration and VPI (P = 0.714), MFV (P = 0.911), or hepatic vein waveform pattern (P = 0.197). We found no correlation between liver enzyme levels and MFV or VPI. However, the rate of abnormal hepatic vein was higher in patients with enzyme levels that exceeded twice the normal value (P = 0.05). Patients with NAFLD have a high rate of abnormal hepatic vein doppler waveform patterns, and decreased VPI and MFV are suggestive of reduced vascular compliance in the liver. Elevated liver enzymes levels do not influence VPI or MFV, but patients with abnormal enzymes have higher rates of abnormal hepatic vein doppler waveform patterns.

Comparison of Portal Vein Doppler Indices and Hepatic Vein Doppler Waveform in Patients with Nonalcoholic Fatty Liver Disease with Healthy Control

: Background: The purpose of the present study is to investigate the association of nonalcoholic fatty liver disease (NAFLD) with the doppler waveform pattern of hepatic veins and portal vein doppler indices.Objectives: This assay may be useful in evaluating the natural course of NAFLD and monitor treatment efficacy on follow-up.Patients and Methods: This case control study was performed in 31 patients with NAFLD and 31 normal healthy adults who served as the control group. The patients presented with elevated liver enzymes levels (ALT/AST) and hyperechogenic livers in the B-mode ultrasonography examination. Eleven patients had a liver biopsy. After an 8-hour fast, B-mode and duplex doppler ultrasonography were performed, and the waveform patterns of the right hepatic vein, portal vein diameter, grade of fatty liver, portal vein pulsatility index (VPI), and mean flow velocity (MFV) were measured.Results: VPI and MFV values were 0.42 ± 0.92 and 17.27 ± 5.34 cm/second, respectively, in the control group and 0.25 ± 0.50 and 12.82 ± 4.32 cm/second in patients with NAFLD (P < 0.01). The frequency of abnormal hepatic vein doppler waveform patterns (biphasic or monophasic) was significantly higher in patients with NAFLD (55.2%) versus control subjects (3.2%) (P < 0.001). There was no correlation between the degree of fat infiltration and VPI (P = 0.714), MFV (P = 0.911), or hepatic vein waveform pattern (P = 0.197). We found no correlation between liver enzyme levels and MFV or VPI. However, the rate of abnormal hepatic vein was higher in patients with enzyme levels that exceeded twice the normal value (P = 0.05).Conclusions: Patients with NAFLD have a high rate of abnormal hepatic vein doppler waveform patterns, and decreased VPI and MFV are suggestive of reduced vascular compliance in the liver. Elevated liver enzymes levels do not influence VPI or MFV, but patients with abnormal enzymes have higher rates of abnormal hepatic vein doppler waveform patterns. Implication for health policy/practice/research/medical education:This assay can be helpful in diagnosing NAFLD and its effects on liver hemodynamics, evaluating the natural course of NAFLD, and monitoring treatment efficacy on follow-up. Please cite this paper as: Solhjoo E , Mansour-Ghanaei F , Moulaei-Langorudi R , Joukar F. Comparison of Portal Vein Doppler Indices and Hepatic Vein Doppler Waveform in Patients with Nonalcoholic Fatty Liver Disease with Healthy Control. Hepat Mon. 2011;11(9):740-4. DOI: 10.5812/kowsar. 1735143X.729 ©2011 Kowsar M.P.Co. All rights reserved.

Assessment of intrahepatic blood flow by Doppler ultrasonography: Relationship between the hepatic vein, portal vein, hepatic artery and portal pressure measured intraoperatively in patients with portal hypertension

BackgroundAbnormality of hepatic vein (HV) waveforms evaluated by Doppler ultrasonography has been widely studied in patients with chronic liver disease. We investigated the correlation between changes in HV waveforms and portal vein velocity (PVVel), the hepatic artery pulsatility index (HAPI), and also the extent of abnormal Doppler HV waveforms expressed as damping index (DI), severity of portal hypertension expressed as Child-Pugh scores and portal pressure (PP) measured directly from patients with portal hypertension (PHT) to evaluate the indicative value of abnormal HV waveforms and discuss the cause of abnormal HV waveform.MethodsSixty patients who had been diagnosed with PHT and accepted surgical therapy of portosystemic shunts were investigated. PP was measured intraoperatively. Thirty healthy volunteers with no history of chronic liver disease were enrolled as the control group. HV waveforms were categorized as triphasic, biphasic or monophasic. DI was compared as the quantitative indicator of abnormal HV waveforms. Another two Doppler parameters, PVVel and HAPI were also measured. These Doppler features were compared with PP, Child-Pugh scores and histological changes assessed by liver biopsy.ResultsIn the patient group, the Doppler flow waveforms in the middle HV were triphasic in 31.6%, biphasic in 46.7%, and monophasic in 21.6% of subjects. These figures were 86.7%, 10.0%, and 3.3%, respectively, in healthy subjects. With the flattening of HV waveforms, the HAPI increased significantly (r = 00.438, p < 0.0001), whereas PVVel decreased significantly (r = -0.44, p <0.0001). Blood flow parameters, HAPI, PVVel and HV-waveform changes showed no significant correlations with Child-Pugh scores. The latter showed a significant correlation with PP (r = 0.589, p = 0.044). Changes of HV waveform and DI significantly correlated with PP (r = 0.579, r = 0.473, p <0.0001), and significant correlation between DI and Child-Pugh scores was observed (r = 0.411, p = 0.001). PP was significantly different with respect to nodule size (p < 0.05), but HV-waveform changes were not significantly correlated with pathological changes.ConclusionIn patients with PHT, a monophasic HV waveform indicates higher portal pressure. Furthermore, quantitative indicator DI can reflect both higher portal pressure and more severe liver dysfunction. Flattening of HV waveforms accompanied by an increase in the HAPI and decrease in PVVel support the hypothesis that histological changes reducing HV compliance be the cause of abnormality of Doppler HV waveforms from the hemodynamic angle.

Changing Waveform During Respiration on Hepatic Vein Doppler Sonography of Severe Portal Hypertension

The purposes of this study were to assess retrospectively whether the waveform change during respiration on hepatic vein Doppler sonography is a parameter of severe portal hypertension as estimated by the hepatic venous pressure gradient (HVPG) and to compare with a hepatic vein damping index (DI) at expiration. Spectral Doppler sonography of the hepatic vein was performed on 22 consecutive patients who underwent HVPG measurement for portal hypertension with liver cirrhosis. From the maximum and minimum velocities of systolic hepatofugal venous flow on Doppler sonography, 3 parameters were derived: damping index at expiration (DI(exp)), damping index ratio (DI(ratio)), and damping index difference (ΔDI) between inspiration and expiration. Considering an HVPG level of 12 mm Hg or higher as the threshold level for high-grade portal hypertension, we assessed the diagnostic capability of these Doppler sonographic parameters to discriminate using receiver operating characteristic curve analysis. Area under the curve values for the DI(ratio) and ΔDI (0.875 and 0.889, P = .807 and .682, respectively) were slightly higher than the area for the DI(exp) (0.861; respectively). When the DI(exp) was greater than 0.56, the sensitivity and specificity for high-grade portal hypertension were 66.7% and 100.0%, respectively. In the case of the DI(ratio), the sensitivity and specificity were 77.8%, and 100.0% at greater than 0.69. The corresponding sensitivity and specificity at a value of 0.25 or less for the ΔDI were 83.3% and 100.0%. The ratio and difference of the DI of the hepatic vein waveform are helpful parameters in assessing the severity of portal hypertension as well as using the existing DI on its own.

Hepatic vein waveforms in liver cirrhosis re-evaluated

There are many studies on changes in Doppler waveforms of hepatic veins in cirrhotic liver. It is postulated that dampening of phasic oscillations appears with worsening of liver function. Our aim was to reevaluate the significance of Doppler waveforms of hepatic vein in cirrhotic patients and to correlate with hepatic blood flow. One hundred and thirty-five consecutive patients of liver cirrhosis and 60 age and sex matched non-cirrhotic controls were enrolled in this study. Doppler waveforms were obtained from right hepatic vein during normal respiration. Other parameters measured were flow volume of portal trunk, right portal vein and proper hepatic artery. Waveforms of the hepatic vein were classified into triphasic, biphasic and flat patterns. Flat waveform was rare and appeared in only 3% cases. There was no correlation between liver dysfunction and patterns of waveforms. Inflow, particularly to the right lobe, was significantly elevated in cases associated with the non-triphasic waveforms. This study shows that the flat waveforms have no diagnostic value. Role of hepatic blood flow seems to be important suggesting hemodynamic changes rather than liver dysfunction as a plausible cause of change in waveforms.

Correlation of hepatic vein Doppler waveform and hepatic artery resistance index with the severity of nonalcoholic fatty liver disease

The study was conducted to evaluate the effect of various degrees of fatty infiltration in patients with nonalcoholic fatty liver disease on hepatic artery resistance index and hepatic vein waveform patterns. After identification and grading of fatty infiltration, 60 patients and 20 normal healthy subjects were examined using color and spectral Doppler sonography. The level of fatty liver infiltration was ascertained and graded by biopsy in patients and excluded by MRI in controls. The patients were allocated to four study groups consecutively, until the required number was reached, according to infiltration level as follows: normal (group A), mild (group B), moderate (group C), and severe (group D). The hepatic vein waveforms were classified into the three following groups: triphasic, biphasic, and monophasic waveform. The hepatic artery resistance index was calculated as the mean of three different measurements. The incidence of monophasic and biphasic hepatic vein waveform was 2 (10%) for group B, 11 (55%) for group C, 16 (80%) for group D, and none for group A. The difference in the distribution of triphasic Doppler waveform pattern between the patients and the control group was significant (p < 0.001). Hepatic artery resistance index was 0.81 (+ or - 0.02), 0.78 (+ or - 0.03), 0.73 (+ or - 0.03), and 0.68 (+ or - 0.05), respectively, in groups A, B, C, and D and was significantly different between groups (p < 0.001). As the severity of nonalcoholic fatty infiltration increases, the incidence of abnormal hepatic vein waveforms increases and hepatic artery resistance index decreases.

Effects of respiratory manoeuvres on hepatic vein Doppler waveform and flow velocities in a healthy population

Objective This study was performed to determine the variations in Doppler waveforms and flow velocity during respiratory manoeuvres in healthy individuals with no liver disease. Materials and methods In total, 100 individuals (75 women and 25 men) without known cardiac or liver disease were examined prospectively with duplex Doppler ultrasonography (US). We recorded the Doppler waveforms and peak systolic velocities ( V max) of the middle hepatic vein during normal respiration, during breath-holding after quiet expiration and also during deep inspiration. Doppler waveforms are categorised as triphasic, biphasic or monophasic. Results During normal respiration, hepatic venous waveforms were triphasic in 93% of subjects, monophasic in 6% and biphasic in 1%. During breath-holding after quiet expiration, the percentages were 91%, 6% and 3%, respectively. During deep inspiration, they were 80%, 18% and 2%, respectively. Although significant differences were noted between rates during deep inspiration and normal respiration, they were quite similar during normal respiration and breath-holding after quiet expiration ( P < 0.05). The values of V max were significantly higher during normal respiration compared to quiet expiration and during quiet expiration compared to deep inspiration ( P < 0.05). Conclusion The velocities and waveforms of hepatic veins varied during respiratory manoeuvres. The status of respiration must be taken into consideration whilst examining the hepatic vein waveforms and velocities with duplex Doppler US.

Value of duplex doppler ultrasonography in non-invasive assessment of children with chronic liver disease

to investigate the value of duplex Doppler ultrasonography (US) in the assessment of the hemodynamics of the portal and hepatic veins in a cohort of children with chronic liver disease (CLD) and to detect any relationship between the US changes, etiology and severity (or stage) of CLD. we prospectively enrolled 25 children with biopsy-proven CLD. Thirteen had cirrhosis (aged 8.9 ± 2.0 years) and 12 had chronic hepatitis (aged 9.3 ± 2.3 years). Gray scale and color-coded duplex Doppler US were performed for all, as well as 30 healthy age and sex-matched controls. Findings were correlated with clinical, laboratory and histopathological characteristics. prominent caudate lobe was detected in 100% of cirrhotics, but none of the chronic hepatitis or controls. Thickened lesser omentum and loss of the triphasic waveform of the hepatic vein were present in 69.2% and 53.8% of cirrhotics vs 33.3% and 8.3% of chronic hepatitis respectively. Portal vein flow velocity was significantly lower (P < 0.0001) and the congestion index was significantly higher (P < 0.005) in both patient groups compared to controls. Child-Pugh's staging showed a positive correlation with both abnormal hepatic vein waveform and direction of portal blood flow; and a negative correlation with both hepatic and portal vein flow velocities. No correlation with the etiology of CLD could be detected. duplex Doppler added to grayscale US can detect significant morphologic and portal hemodynamic changes that correlate with the severity (stage) of CLD, but not with etiology.

Abnormality of the hepatic vein waveforms in cirrhotic patients with portal hypertension and its prognostic implications

We investigated the prognostic significance of changes in the Doppler hepatic vein (HV) waveforms in cirrhotic patients with portal hypertension and the mechanisms of these changes. A total of 103 consecutive patients were included in this study and their HV waveforms were classified into four types: type I, triphasic waveform; type II, biphasic waveform; type III, biphasic waveform with reduced phasic oscillations; and type IV, a flat waveform. Type I was observed in 34, type II in 40, type III in 23, and type IV in six patients. The 5-year survival rates were 90%, 89%, 41%, and 0% in type I, II, III, and IV, respectively. Five variables including the Child-Pugh score, albumin, bilirubin, ascites, and HV waveform significantly correlated with the survival in a univariate analysis. A multivariate analysis only identified the HV waveform (type III and IV) to be an independent prognostic value. Even in Child-Pugh class B patients, the 5-year survival rate for type III or IV was as poor as 26% in comparison to 92% for type I or II. In contrast, in Child-Pugh class C patients, the 5-year survival rate for type I or II was as good as 63% in comparison to 25% for type III or IV. Furthermore, the changes in HV waveforms correlated with the extent of hepatic fibrosis, the increase in portal perfusion per liver volume, or the decrease in portal vascular resistance. Analyzing the HV waveforms was thus found to be a simple method for accurately assessing the prognosis in cirrhotic patients with portal hypertension.

A Doppler waveform index to characterize hepatic vein velocity pattern and evaluate hepatic fibrosis

To describe a Doppler waveform index representing the hepatic vein flow velocity pattern and to examine its relationship to the degree of hepatic fibrosis. Doppler waveforms were obtained in 66 patients scheduled for percutaneous liver needle biopsy and categorized as normal (with a retrograde flow phase) or abnormal (without retrograde flow). Waveforms were also characterized using a hepatic vein waveform index (HVWI): (maximum - minimum velocity)/(maximum velocity). Biopsy specimens were graded for fibrosis. There was a highly significant decrease in HVWI with increasing fibrosis score in the biopsy (p < 0.001, Jonckheere trend test). The biopsy showed cirrhosis in 14 of 29 patients (48%) with absent retrograde flow and 5 of 37 patients (14%) with a normal flow pattern. Using HVWI as the criterion, cirrhosis was present in 13 of 21 (62%) patients with HVWI < 0.75, in 6 of 31 (19%) patients with 0.75 < HVWI < 1.50, and in none of 14 (0%) patients with HVWI > 1.50. HVWI is inversely correlated to the degree of liver fibrosis and may be more efficient than the presence or absence of retrograde flow in diagnosing and grading hepatic fibrosis.

Damping index of Doppler hepatic vein waveform to assess the severity of portal hypertension and response to propranolol in liver cirrhosis: a prospective nonrandomized study

Alterations in the Doppler hepatic vein (HV) waveform are associated with cirrhosis and portal hypertension. We prospectively evaluated the correlation between the extent of abnormal Doppler HV waveforms expressed as damping index (DI) and the hepatic venous pressure gradient (HVPG) and response to propranolol in patients with cirrhosis. In 76 patients with cirrhosis (69 men and seven women), both DI of Doppler HV waveform and HVPG were measured, and the relationship between them was analysed. DI was calculated by the minimum velocity/maximum velocity of the HV waveform. An HVPG>12 mmHg was defined as severe portal hypertension. In a subgroup of 19 patients receiving propranolol, changes in both DI and HVPG were evaluated after propranolol administration for 3 months. One author (S. K. B.) performed all DI of Doppler HV waveform studies. Abnormal HV waveforms were seen in 66 of 76 patients (86.8%). DI significantly correlated with the grade of HVPG, i.e. with higher HVPG increased DI was observed (P<0.01). By logistic regression analysis, DI>0.6 was significantly more likely to be severe portal hypertension (odds ratio: 14.19, 95% confidence interval: 4.07-49.55). Receiver-operating characteristic curve according to the value of 0.6 of DI showed a sensitivity of 75.9% and a specificity of 81.8% for the presence of severe portal hypertension. In 19 patients of the propranolol subgroup, change of DI following propranolol treatment also significantly correlated with that of HVPG (P<0.01). Damping index of the HV waveform by Doppler ultrasonography might be a non-invasive supplementary tool in evaluating the severity of portal hypertension and in responding to propranolol in patients with liver cirrhosis.

Sonographic Differences in Venous Return Between Piggyback Versus Caval Interposition in Adult Liver Transplantations

The piggyback technique (PT) is being used more frequently than caval interposition (CI) in adult orthotopic liver transplants (OLT). It is unclear whether PT alters venous return compared with CI, therefore leading to postoperative complications. The aim of our study was to analyze our experience with PT and CI by comparing ultrasound results of hepatic vein flow on the first postoperative day. Patients and Methods This retrospective analysis of consecutive OLTs performed between 2002 and 2005 included data from a single blinded radiologist who reviewed all postoperative day 1 ultrasound examinations. The hepatic vein waveforms were scored as all phasic, all flat, or partially phasic/flat. Results During the study period, we performed, 465 OLT among which 270 had available ultrasound examinations. The etiologies of liver disease were similar between the PT and CI cohorts, hepatitis C and alcoholic liver disease accounted for more than 60%. Two hundred eight (77%) had undergone PT and 62 (23%) CI. Among the PT, 60% were phasic, 31.1% were partially phasic/flat, and 8% were flat. When a CI was performed, 56.5% were phasic, 35.5% were partially phasic/flat, and 8% were flat. Conclusions There was no significant difference between PT and CI with regard to an effect on hepatic vein waveforms on the first operative day. Therefore, there do not appear to be early hemodynamic benefits of performing CI versus PT anastamoses of OLTs. Further studies may be needed to determine whether long-term sequelae follow the piggyback technique.

Recent Variceal Bleeding: Doppler US Hepatic Vein Waveform in Assessment of Severity of Portal Hypertension and Vasoactive Drug Response

To prospectively evaluate both the correlation between abnormal Doppler ultrasonography (US) hepatic vein waveforms and the hepatic venous pressure gradient (HVPG) and the response to drug treatment in patients with cirrhosis. Ethics committee approval and informed consent of patients and control subjects were obtained. In 78 patients with cirrhosis (70 men, eight women; mean age, 49.4 years +/- 9.7 [standard deviation]) and a history of variceal bleeding, both the hepatic vein waveform--as measured with Doppler US--and the HVPG were measured, and the relationship between them was analyzed. Hepatic vein Doppler waveforms were classified as triphasic, biphasic, or monophasic. Severe portal hypertension was defined as an HVPG of more than 15 mm Hg. In a subgroup of 21 patients, changes in hepatic vein waveform and HVPG were evaluated after intravenous administration of 2 mg of terlipressin. Statistical analyses were performed with Spearman rank correlation, logistic regression analysis, and cross tabulation. Abnormal hepatic vein waveforms were seen in 72 patients (92%). Forty-four patients (56%) had biphasic waveforms, 28 (36%) had monophasic waveforms, and six (8%) had triphasic waveforms. A positive correlation was found between the extent of abnormalities in hepatic vein waveforms and the increase in HVPG (P < .05). Monophasic waveforms were associated with severe portal hypertension, with a sensitivity of 74% and a specificity of 95%. Twenty patients in the terlipressin subgroup had abnormal baseline waveforms; the baseline waveform improved in 18 patients in association with the HVPG reduction after injection of terlipressin. Doppler US hepatic vein waveform assessment is useful in the noninvasive evaluation of the severity of portal hypertension and the response to vasoactive drugs in patients with portal hypertension and variceal bleeding.

The Significance of Hepatic Vein Outflow Volume in Hepatic Outflow Insufficiency of Living Right Liver Graft Evaluated by Doppler Ultrasound

The color Doppler ultrasound has been used to evaluate hepatic vein (HV) outflow insufficiency based on flow velocity and waveforms. In our experience, some cases with flat waveforms are clinically asymptomatic. The parameters of HV flow velocity and waveforms are not always correlated with clinical problems. So, we proposed that total HV flow volume (HVFV) may be a more reliable index. From August 2001 to July 2003, 31 cases among 48 adult-to-adult living related transplants of a right liver graft had one HV anastomosis. HV velocity, waveforms, and HVFV were compared both before and after transplantation. We set the minimal HVFV ratio at 80% based on the original HVFV before graft retrieval. There was no significant difference in HVFV before liver graft retrieval between the 2 groups, but there was a significant change after transplantation. There were no cases of HV insufficiency among group A patients (>80%), whose HVFV ranged from 397 to 1181 mL/min with ratios from 75% to 180% (mean 115%). In group B, there were 4 complicated cases with prolonged severe ascites (<80%) with HVFV ratios from 56% to 76% (mean 66%). Fisher exact test showed a great significance ( P < .001). Thus the preliminary criteria of 80% minimal HVFV ratio allows detection of HV insufficiency for further interventional management.

Hepatic vein Doppler waveform in patients with diffuse fatty infiltration of the liver

Objective: To determine the incidence of abnormal hepatic vein Doppler waveform in patients with diffuse fatty infiltration of the liver (FIL). Materials and methods: In this prospective study, 40 patients with diffuse FIL and 50 normal healthy adults who served as control group underwent hepatic vein (HV) Doppler ultrasonography. The patients with the diagnosis of FIL were 23 men (57.5%) and 17 women aged 30–62 years (mean age ± S.D., 42 ± 12 years). Subjects in the control group were 27 men (54%) and 23 women aged 34–65 years (mean age ± S.D., 45 ± 14 years). The diagnosis of FIL was confirmed with computed tomography density measurements. The waveforms of HV were classified into three groups: regular triphasic waveform, biphasic waveform without a reverse flow, and monophasic or flat waveform. Etiological factors for FIL were diabetes mellitus (DM), hyperlipidemia and obesity (body mass index > 25). Serum lipid profile was obtained from all the patients with FIL. Results: Seventeen of the 40 patients (43%) with FIL had an abnormal HV Doppler waveform, whereas only one of the 50 (2%) healthy subjects had an abnormal waveform. The difference in the distribution of normal Doppler waveform pattern between the patients and the control group was significant ( P < 0.001). No differences were found in the behaviour of the hepatic vein Doppler waveform in relation to the different etiologic factors for FIL ( P > 0.05). There was not any correlation between the degree of fat infiltration and the hepatic vein waveform pattern ( P = 0.60). Conclusion: Patients with fatty liver has a high rate of an abnormal hepatic vein Doppler waveform pattern which can be biphasic or monophasic. We could not find a relation between the etiological factors for FIL and the occurrence of an abnormal HV Doppler waveform.

Non-pulsatile hepatic and portal vein waveforms in patients with liver cirrhosis: concordant and discordant relationships.

The relationship between hepatic vein waveform and portal vein waveform (HVW and PVW) was evaluated in 54 healthy subjects and 148 patients with liver cirrhosis and portal hypertension using spectral Doppler ultrasound recordings. In all healthy subjects, the HVW was triphasic and the PVW was slightly pulsatile. 51 of 148 patients (34.5%) had flat non pulsatile HVW with a significantly higher incidence in Child C vs Child A patients (48.9% vs 20.7%, respectively; p<0.01) while 56 of 148 patients (37.8%) had flat PVW, also with significantly higher incidence in Child C vs Child A patients (46.7% vs 25.9%, respectively; p<0.05). Of the 86 patients having flat waves (HVW or PVW), only 21 (24.4%) had concordant flat waves (flat both HVW and PVW) while discordance was detected in the remaining 75.6% patients. Only 22 patients (14.9%) had a triphasic HVW but with broad spectrum and absent window in 20 (90.9%) and significantly lower pre-systolic:systolic (PS) ratio (Vmax of the pre-systolic retrograde wave/Vmax of the systolic antegrade wave) compared with healthy subjects (0.23+/-0.1 vs 0.42+/-0.18, respectively; p<0.001). In conclusion, spectral broadening with window absence and dampening of the retrograde pre-systolic wave mark are the earliest changes in HVW in cirrhotic patients even in the presence of a triphasic pattern. The transmission of hepatic vein pulsatility is not a major factor responsible for portal vein pulsatility.

Non pulsatile hepatic and portal vein waveforms in patients with liver cirrhosis: concordant and disconcordant relationships

Non pulsatile hepatic and portal vein waveforms in patients with liver cirrhosis: concordant and disconcordant relationships

Hepatic vein waveforms: A novel index for predicting prognosis and parenchymal alteractions of liver cirrhosis

Hepatic vein waveforms: A novel index for predicting prognosis and parenchymal alteractions of liver cirrhosis

Hepatic vein Doppler waveform changes in early stage (Child-Pugh A) chronic parenchymal liver disease.

Doppler waveform changes can be found in chronic parenchymal liver disease, especially in the late stages. We investigated the contribution of Doppler ultrasound in diagnosing early-stage chronic parenchymal liver disease. In this prospective study, 30 patients who had been diagnosed with chronic liver disease (Child-Pugh class A) and 30 healthy subjects were studied. The diagnosis was confirmed with histopathologic examinations of biopsy specimens in 17 patients. The Doppler US examination of hepatic veins was performed in all the patients and healthy subjects. The Doppler US pattern was classified into three groups according to the Doppler signal characteristics: (1) type 0, triphasic waveform, the presence of a short phase of reversed flow, (2) type I, decreased amplitude of the phasic oscillations without the short phase of reversed flow, and (3) type II, complete flat waveform. Normal hepatic vein waveforms (type 0) were found in 8 patients (26.66%) and abnormal hepatic waveforms (type I + type II) in 22 patients (73.33%). The results of Doppler ultrasonography were correlated with the diagnosis of early-stage chronic parenchymal liver disease (Child-Pugh class A). In all the subjects of the control group, the Doppler waveform of hepatic veins showed the triphasic pattern (type 0). In the statistical evaluation using Fisher's exact test we observed that there was a significant difference (p < 0.05) between the control group and the patient group with respect to the presence of abnormal (type I + type II) Doppler waveform. The diagnostic accuracy in the patients who had biopsy was 76.47% and that in the patients who did not was 69.23%.