Journal of clinical ultrasound : JCU · 2001
Color Doppler velocity profile assessment of portal hemodynamics in cirrhotic patients with portal hypertension: correlation with esophageal variceal bleeding.
Сравнительное исследованиеСтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Yin X Y, Lu M D, Huang J F, Xie X Y, Liang L J
Аннотация
PURPOSE: Using the color Doppler velocity profile (CDVP), we investigated portal hemodynamics and their relationship with esophageal variceal bleeding (EVB) in patients with cirrhosis and portal hypertension.
METHODS: The hemodynamics of the portal trunk, right anterior portal branch, and splenic vein were evaluated in 69 cirrhotic patients with portal hypertension and 46 healthy volunteers. The CDVP, a recently developed Doppler software, was used to measure blood flow velocity and flow volume; evaluate the spatial distribution of flow velocities in the cross-section of a vessel (velocity profile), as reflected by the profile parameter (n); and assess changes in flow volume over time (flow profile). The congestion index was calculated by dividing the cross-sectional area by the maximum cross-sectional velocity (CSVmax). The hemodynamic features were compared between patients without a history of EVB [EVB(-)] and those with a history of EVB [EVB(+)], and a logistic regression model was employed to identify factors associated with EVB.
RESULTS: Compared with the healthy group, the cirrhotic group had a significantly lower mean CSVmax in the portal trunk and right anterior portal branch (both p < 0.01), a significantly elevated mean flow volume in the splenic vein and portal trunk (both p < 0.01), a significantly elevated mean ratio of splenic vein flow volume to portal trunk flow volume (SV/PT) (p < 0.001), and a significantly greater mean congestion index in the portal trunk, right anterior portal branch, and splenic vein (all p < 0.01). In the cirrhotic group, there was a significantly higher incidence of a flat flow pattern in the right anterior portal branch and a phasic flow pattern in the splenic vein than in the healthy group (both p < 0.01). Among cirrhotic patients, the EVB(+) group had a significantly greater mean flow volume in the splenic vein (p < 0.01), greater mean SV/PT (p < 0.01), greater mean spleen size (p < 0.05), and lower mean portal trunk n value (p < 0.05) compared with the EVB(-) group. Logistic regression analysis revealed that the SV/PT and portal trunk n value were independent EVB-related factors.
CONCLUSIONS: The results suggest that portal hemodynamics in cirrhotic patients are characterized by passive congestion and increased blood flow. However, these 2 features had different preponderances in different parts of the portal venous system. Increased flow in the splenic vein may be the primary source of increased portal flow and may play a role in the development of EVB. The SV/PT and portal trunk n value may be valuable factors for predicting EVB.
METHODS: The hemodynamics of the portal trunk, right anterior portal branch, and splenic vein were evaluated in 69 cirrhotic patients with portal hypertension and 46 healthy volunteers. The CDVP, a recently developed Doppler software, was used to measure blood flow velocity and flow volume; evaluate the spatial distribution of flow velocities in the cross-section of a vessel (velocity profile), as reflected by the profile parameter (n); and assess changes in flow volume over time (flow profile). The congestion index was calculated by dividing the cross-sectional area by the maximum cross-sectional velocity (CSVmax). The hemodynamic features were compared between patients without a history of EVB [EVB(-)] and those with a history of EVB [EVB(+)], and a logistic regression model was employed to identify factors associated with EVB.
RESULTS: Compared with the healthy group, the cirrhotic group had a significantly lower mean CSVmax in the portal trunk and right anterior portal branch (both p < 0.01), a significantly elevated mean flow volume in the splenic vein and portal trunk (both p < 0.01), a significantly elevated mean ratio of splenic vein flow volume to portal trunk flow volume (SV/PT) (p < 0.001), and a significantly greater mean congestion index in the portal trunk, right anterior portal branch, and splenic vein (all p < 0.01). In the cirrhotic group, there was a significantly higher incidence of a flat flow pattern in the right anterior portal branch and a phasic flow pattern in the splenic vein than in the healthy group (both p < 0.01). Among cirrhotic patients, the EVB(+) group had a significantly greater mean flow volume in the splenic vein (p < 0.01), greater mean SV/PT (p < 0.01), greater mean spleen size (p < 0.05), and lower mean portal trunk n value (p < 0.05) compared with the EVB(-) group. Logistic regression analysis revealed that the SV/PT and portal trunk n value were independent EVB-related factors.
CONCLUSIONS: The results suggest that portal hemodynamics in cirrhotic patients are characterized by passive congestion and increased blood flow. However, these 2 features had different preponderances in different parts of the portal venous system. Increased flow in the splenic vein may be the primary source of increased portal flow and may play a role in the development of EVB. The SV/PT and portal trunk n value may be valuable factors for predicting EVB.