Portal Pressure Monitoring Research Articles

Endoscopic ultrasound for the diagnosis and treatment of primary hepatocellular carcinoma.

Chronic liver disease has emerged as a significant global concern, with primary hepatocellular carcinoma (HCC) representing a critical consequence of this disease. However, early detection of HCC remains challenging in clinical practice. Recently, there has been a growing interest in applying endoscopic ultrasound (EUS) as a diagnostic tool for gastrointestinal diseases. Nevertheless, using EUS to diagnose and treat HCC is uncommon. In this review we described the diagnostic and therapeutic applications of EUS in primary HCC and evaluated its clinical significance. The diagnostic procedures primarily involve EUS-guided fine-needle biopsy or aspiration, assessment of metastatic lymph nodes and portal vein thrombosis, portal pressure monitoring, and portal vein blood collection. Treatment mainly includes EUS-guided tumor ablation, brachytherapy, injectable chemotherapy, and managing variceal hemorrhage related to portal hypertension.

Portal pressure monitoring-state-of-the-art and future perspective.

Portal hypertension is a serious symptom of chronic liver diseases, which can lead to many critical complications, such as the formation of varices related to upper digestive bleeding, ascites, infection, hepatic encephalopathy, renal failure, and even death. As a result, portal pressure monitoring has important prognostic and clinical implications. The hepatic venous pressure gradient measurement, a gold-standard method applied to monitor portal pressure, is invasive and only available in experienced centers. Over the past decade, noninvasive methods aimed at monitoring the portal pressure have been increasingly investigated, including serum markers, radiological features, ultrasound elastography, doppler and contrast-enhanced ultrasonography. In this study, we focused on both invasive and noninvasive methods for portal pressure monitoring and explored their roles in clinical setting. The advantages and limitations of various techniques for future research are also discussed.

Changes in Liver and Spleen Stiffness by Virtual Touch Quantification Technique after Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices and Exacerbation of Esophageal Varices: A Preliminary Study.

To assess liver stiffness (LS) and spleen stiffness (SS) values measured by virtual touch quantification (VTQ) technique in the monitoring of portal pressure and their usefulness for the prediction of the exacerbation of esophageal varices (EV) in patients with gastric varices undergoing balloon-occluded retrograde transvenous obliteration (B-RTO). The LS, SS, and hepatic venous pressure gradient (HVPG) were measured in 20 patients both before and after B-RTO. The change in each parameter between the two groups (EV exacerbation and non-exacerbation groups) was compared by analysis of variance. The efficacy of the parameters for the prediction of the exacerbation of EV was analyzed using a receiver operating characteristic (ROC) curve analysis. 9 patients (40.9 %) exhibited an exacerbation of EV within 24 months after B-RTO. Significant changes were observed in the HVPG and SS after B-RTO between the two groups (EV exacerbation group vs. non-exacerbation group: HVPG before 12.7 ± 4.4 mmHg vs. 11.0 ± 4.4 mmHg; HVPG after 19.6 ± 6.0 mmHg vs. 13.6 ± 3.1 mmHg P = 0.003; SS before 3.40 ± 0.50 m/s vs. 3.20 ± 0.51 m/s; SS after 3.74 ± 0.53 m/s vs. 3.34 ± 0.43 m/s P = 0.016). However, no significant changes in LS were observed between the two groups. The area under the ROC curves of elevation in HVPG and SS for the prediction of the exacerbation of EV after B-RTO were 0.833 and 0.818, respectively. Elevation of the HVPG and SS measured by VTQ after B-RTO was useful for the prediction of the exacerbation of EV.

Basic Science Liver

Basic Science Liver

Determination of normal portal vein congestive index on ultrasound scan among adults in Zaria, Nigeria

Background: Portal hypertension is a major abnormality of the portal venous system and it is a commonly encountered clinical condition with multiple causes and several sequelae. The need for an imaging parameter that will aid its early diagnosis cannot be overemphasized, bearing in mind that portal pressure monitoring devices are not available in most tertiary hospitals in Nigeria. This prospective study was aimed at using ultrasound to determine the normal Portal Vein Congestive Index among adults in Zaria, Nigeria. Patients and Methods: The study was conducted over a period of 6 months spanning 15 th November 2011 to 14 th May 2012 at the Radiology Department of Ahmadu Bello University Teaching Hospital, Zaria. Following an overnight fast by the 186 eligible participants, the portal vein diameter, cross sectional area and flow velocity were obtained using ultrasound Doppler equipment (Mindray diagnostic ultrasound system, Model DC-3, 2010-2012, Nanshan, Shenzen, PR China). B-Mode gray-scale for the assessment of dimensions, and Duplex Doppler Ultrasound Scan techniques for interrogation of the flow pattern and velocity. These parameters were then used to obtain the congestive index of the subjects. Results: The portal vein hemodynamic parameters were as follows mean (SD): Cross sectional area, 1.097 cm 2 (0.203) (ranged 0.89-1.30); mean flow velocity, 15.44 cm/s (2.628) (ranged 12.80-18.10); and congestive index, 0.0722 cmS (0.0135) (ranged 0.0587-0.0857). All measurements in males were significantly higher than those in females (P < 0.001); and the portal vein congestive index increased significantly with age (P = 0.006).Conclusion: Reference values of normal congestive index of the portal vein have been established and may be used for the assessment of patients with liver diseases or portal hypertension in this environment.

Surgical Ligation of Extrahepatic Shunt under Guidance of Doppler Ultrasound, Portography, and Portal Pressure Monitoring

A 54-year-old man with chronic hepatitis C was admitted to our hospital because of a disturbance of consciousness and hyperammonemia. Abdominal angiography revealed a portosystemic shunt between the superior mesenteric vein and inferior vena cava. Endoscopic examination showed no varix. As interventional treatment was unsuccessful, surgical ligation of the shunt was performed. After surgery, portography revealed a huge shunt. Before ligation, the portal pressure, portal flow speed, and volume at the umbilical portion were 24 H2O. 5.6 cm/s and 203 ml/min, respectively. Finally the shunt was ligated. The portal flow speed and volume increased for 14 days following surgery and then stabilized. No varices were observed postoperatively. Doppler ultrasound, portography, and portal pressure monitoring can be used to reveal haemodynamic changes in the portal system and justify surgical ligation of portosystemic shunt.

A comparison of islet autotransplantation with allotransplantation and factors elevating acute portal pressure in clinical islet transplantation

Acute portal pressure rise is occasionally observed during intraportal islet infusion, especially in islet autotransplantation (IAT) where tissue purification is rarely applied. In this paper we investigate factors associated with acute portal pressure rise, a known risk factor for portal vein thrombosis. Retrospective data was collected on 15 islet autotransplant and 122 allogeneic islet transplant subjects. Non-purified pancreatic cells were transplanted in islet autotransplants, and purified islet cells were transplanted in allogeneic transplants. Portal pressure was documented throughout the islet infusion. The total numbers of transplanted islets were significantly smaller in autotransplants than allografts, although the packed cell volume in autotransplants was larger. Autoislet infusion, with a larger packed cell volume, caused higher transient portal venous pressures than allogeneic islet transplant. Univariate analysis and multivariate linear regression revealed that packed cell volume and the number of transplanted cells were significant risk factors for acute portal pressure rise in both autotransplants and allogeneic transplants. Non-purified IAT has a higher risk for acute portal pressure rise than allogeneic islet transplantation, and the rise is associated with the packed cell volume and the number of transplanted cells. Minimization of packed cell volume and cautious monitoring of portal pressure are important to avoid potential complications of portal hypertension.

Splenic artery occlusion for small-for-size syndrome: Better late than never but early is the best

Splenic artery occlusion for small-for-size syndrome: Better late than never but early is the best

Influence of thyroid status on hepatic alpha 1-adrenoreceptor responsiveness.

The present work aimed to elucidate the influence of thyroid functional status on the alpha 1-adrenoreceptor-induced activation of hepatic metabolic functions. The experiments were performed in either a nonrecirculating liver perfusion system featuring continuous monitoring of portal pressure, PO2, pCa, and pH, or isolated hepatocytes from euthyroid, hyperthyroid, and hypothyroid rats. Hypothyroidism decreased the alpha 1-adrenergic stimulation of respiration, glycogen breakdown, and gluconeogenesis. These effects were accompanied by a decreased intracellular Ca2+ mobilization corroborating that those processes are regulated by the Ca(2+)-dependent branch of the alpha 1-adrenoreceptor signaling pathway. Moreover, in hyperthyroid rats the alpha 1-adrenergic-induced increase in cytosolic Ca2+ was enhanced, and glucose synthesis or mobilization was not altered. The thyroid status influenced neither the alpha 1-adrenergic stimulation of vascular smooth muscle contraction nor the alpha 1-agonist-induced intracellular alkalinization and protein kinase C (PKC) activation. Thus the distinct impairment of the Ca(2+)-dependent branch of the alpha 1-adrenoreceptor signaling pathway by thyroid status provides a useful tool to investigate the role played by each signaling pathway, Ca2+ or PKC, in controlling hepatic functions.

Assessment of the Risk of Bleeding From Esophageal Varices by Continuous Monitoring of Portal Pressure

Portal pressure was monitored by means of an indwelling hepatic vein balloon catheter in patients with alcoholic cirrhosis and bleeding varices to determine the safety and feasibility of the technique and its value in predicting recurrence of bleeding. Forty patients were enrolled. Central venous access could not be achieved in 4 patients (10%). Hepatic vein catheterization was accomplished in the remaining 36 patients. Fourteen patients were either later found to have nonalcoholic liver disease or had already received treatment that excluded them from the protocol. The remaining 22 patients, who were treated with blood and fluid replacement, were monitored for up to 72 hours. Portal pressure was greater than 11 mm Hg in all patients (normal, less than 5 mm Hg) and did not change significantly over the 3 days of study. Portal pressure was significantly higher in the 9 patients who continued to bleed or rebled compared with the 13 patients who remained stable. The lowest pressure associated with continued bleeding or rebleeding was 16 mm Hg. Continuous monitoring of portal pressure in patients with bleeding esophageal varices due to alcoholic cirrhosis is safe and feasible and permits rapid stratification of the risk of continued bleeding or early rebleeding.

Assessment of the risk of bleeding from esophageal varices by continuous monitoring of portal pressure

Portal pressure was monitored by means of an indwelling hepatic vein balloon catheter in patients with alcoholic cirrhosis and bleeding varices to determine the safety and feasibility of the technique and its value in predicting recurrence of bleeding. Forty patients were enrolled. Central venous access could not be achieved in 4 patients (10%). Hepatic vein catheterization was accomplished in the remaining 36 patients. Fourteen patients were either later found to have nonalcoholic liver disease or had already received treatment that excluded them from the protocol. The remaining 22 patients, who were treated with blood and fluid replacement, were monitored for up to 72 hours. Portal pressure was > 11 mm Hg in all patients (normal, < 5 mm Hg) and did not change significantly over the 3 days of study. Portal pressure was significantly higher in the 9 patients who continued to bleed or rebled compared with the 13 patients who remained stable. The lowest pressure associated with continued bleeding or rebleeding was 16 mm Hg. Continuous monitoring of portal pressure in patients with bleeding esophageal varices due to alcoholic cirrhosis is safe and feasible and permits rapid stratification of the risk of continued bleeding or early rebleeding.

Mesenteric Venous Thrombosis and Small-Bowel Infarction Following Infusion of Vasopressin into the Superior Mesenteric Artery

HomeRadiologyVol. 102, No. 2 PreviousNext Diagnostic RadiologyMesenteric Venous Thrombosis and Small-Bowel Infarction Following Infusion of Vasopressin into the Superior Mesenteric ArteryWilliam A. Renert, Kenneth F. Button, Stuart L. Fuld, William J. CasarellaWilliam A. Renert, Kenneth F. Button, Stuart L. Fuld, William J. CasarellaAuthor Affiliations Department of Radiology Columbia-Presbyterian Medical Center622 W. 168th St. New York, N. Y. 10032William A. RenertKenneth F. ButtonStuart L. FuldWilliam J. CasarellaPublished Online:Feb 1 1972https://doi.org/10.1148/102.2.299MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractExsanguinating esophageal varices which could not be stopped by a Sengstaken-Blakemore tube were controlled by the constant infusion of vasopressin into the superior mesenteric artery. At autopsy, the varices and small mesenteric veins were thrombosed, and there was segmental infarction of the small intestine. Intermittent infusion of vasopressin, portal pressure monitoring, and serial serum lactic acid determinations might be helpful in preventing this complication of an extremely valuable procedure.Article HistoryAccepted: July 1971Published in print: Feb 1972 FiguresReferencesRelatedDetailsCited ByInflammatory Disorders of the Small Intestine5 December 2012Journal of Vascular and Interventional Radiology, Vol. 14, No. 5Medical Clinics of North America, Vol. 86, No. 6Gastroenterology Clinics of North America, Vol. 29, No. 2CardioVascular and Interventional Radiology, Vol. 22, No. 4Journal of Vascular and Interventional Radiology, Vol. 9, No. 5Journal of the American Academy of Dermatology, Vol. 31, No. 1Cardiovascular and Interventional Radiology, Vol. 12, No. 4Intensive Care Medicine, Vol. 14, No. 5Acta Radiologica, Vol. 28, No. 4Research In Experimental Medicine, Vol. 184, No. 4Digestive Diseases and Sciences, Vol. 26, No. S7Gastrointestinal Radiology, Vol. 6, No. 1PharmacoangiographySeminars in Roentgenology, Vol. 16, No. 1Vasopressin: The missing agent in neonatal necrotizing enterocolitis—A hypothesisIrish Journal of Medical Science, Vol. 149, No. 1Clinical Radiology, Vol. 31, No. 1Digestive Diseases and Sciences, Vol. 24, No. 5Gastroenterology, Vol. 77, No. 3Current Problems in Diagnostic Radiology, Vol. 8, No. 3The American Journal of Digestive Diseases, Vol. 23, No. 11Gastroenterology, Vol. 74, No. 5Effect of vasopressin on mesenteric blood flow determined by the clearance of radioxenonJournal of Surgical Research, Vol. 20, No. 3The American Journal of Surgery, Vol. 131, No. 4Gastroenterology, Vol. 71, No. 5Surgical Clinics of North America, Vol. 56, No. 6The American Journal of Digestive Diseases, Vol. 20, No. 12Gynecologic Oncology, Vol. 3, No. 4Gastroenterology, Vol. 69, No. 1The American Journal of Surgery, Vol. 128, No. 2The American Journal of Surgery, Vol. 127, No. 6Angiology, Vol. 25, No. 1Gut, Vol. 14, No. 1Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 102, No. 2 Metrics Altmetric Score PDF download

Determination of Normal Portal Vein Parameters on Triplex Ultrasound Scan Among Adults in Zaria, Nigeria

Background: There are many causes of the portal vein (PV) disease and these include portal hypertension (PHT), PV thrombosis, PV gas and PV stenosis/obstruction. PHT is a common clinical presentation of portal venous disease with multiple causes and several sequelae. There is a need for an imaging parameter that will aid early diagnosis of PHT since portal pressure monitoring devices are not available in most tertiary hospitals in Nigeria. Aims and Objectives: To determine the normal values of PV parameters using triplex ultrasound (US) among adults in Zaria, Nigeria. Settings and Design: This prospective study was conducted over a period of 6 months between November 2011 and May 2012 at the Radiology Department of Ahmadu Bello University Teaching Hospital, Zaria. Materials and Methods: Following an overnight fast, US scan was performed on 186 eligible participants. The diameter, cross-sectional area (CSA) and flow velocity of the PV were obtained. Results: The PV parameters obtained were as follows (mean ± standard deviation): PV diameter, 1.09 ± 0.22 cm (range: 0.87-1.31); CSA, 1.10 ± 0.203 cm 2 (range: 0.89-1.30) and mean flow velocity, 15.44 ± 2.63 cm/s (range: 12.80-18.10). All the measurements in males were significantly higher than those in females ( P Conclusion: The normal values of PV parameters have been established in adult subjects in Zaria. These values will serve as a reference to detect abnormalities of dimensions and flow velocities in the PV, thus enabling quantitative evaluation of patients with suspected PV disease.