Neha Antil1, Binit Sureka2, Mahesh Kumar Mittal3, Amita Malik4, Bhupender Gupta5, Brij Bhushan Thukral6. 1. Postgraduate Resident, Department of Radiodiagnosis, VMMC & Safdarjung Hospital , New Delhi, India . 2. Senior Resident, Department of Radiodiagnosis, VMMC & Safdarjung Hospital , New Delhi, India . 3. Professor, Department of Radiodiagnosis, VMMC & Safdarjung Hospital , New Delhi, India . 4. Senior Specialist and Associate Professor, Department of Radiodiagnosis, VMMC & Safdarjung Hospital , New Delhi, India . 5. Professor, Department of Medicine, VMMC & Safdarjung Hospital , New Delhi, India . 6. Head of Department, Department of Radiodiagnosis, VMMC & Safdarjung Hospital , New Delhi, India .
Abstract
INTRODUCTION: Clinical assessment of chronic liver disease is done by Modified Child Pugh's and Model for end-stage liver disease scoring system. Measurement of hepatic venous pressure gradient (HVPG) and Upper GI Endoscopy are considered the gold standards for measurement of portal hypertension in cirrhotics. There is a need for non-invasive evaluation of portal hypertension. Ultrasonography with colour and spectral Doppler evaluation may be an effective, rapid and inexpensive alternative. AIM: To evaluate hepatic venous waveform, damping index, splenoportal index in patients of cirrhosis on Colour Doppler ultrasound, also predict severity of portal hypertension and presence of oesophageal varices. MATERIALS AND METHODS: Thirty patients of chronic liver disease were included in the study. Ultrasound and colour Doppler was done to look hepatic venous waveform pattern, Damping Index (DI), and Splenoportal Index (SPI). Contrast-enhanced Computed Tomography scan (CT) was done if renal function tests were normal, else endoscopy when the renal function tests were deranged to look for oesophageal varices. RESULTS: Twenty two (73.3%) patients had monophasic waveform. Biphasic and triphasic waveforms were seen in 4 (13.3%) cases. Twenty two patients (73.3%) had monophasic waveforms and majority of them were in class C. This distribution of hepatic vein waveform was statistically significantly with the Child Pugh's class (p<0.05). Twenty patients (66.7%) had value of Damping index more than >0.6 where majority of patients (18) belonged to class C and 2 in class B. There was a positive correlation between Child Pugh's total score and Damping index (r=0.614; p<0.05). There was weak positive correlation between splenoportal index and Child Pugh's score (r=0.269; p=0.15). CONCLUSION: Change in triphasic to monophasic waveform and DI >0.6 suggests severe liver dysfunction and is associated with severe portal hypertension. Hepatic venous waveform pressure changes, DI and SPI have no value in predicting presence of oesophageal varices.
INTRODUCTION: Clinical assessment of chronic liver disease is done by Modified Child Pugh's and Model for end-stage liver disease scoring system. Measurement of hepatic venous pressure gradient (HVPG) and Upper GI Endoscopy are considered the gold standards for measurement of portal hypertension in cirrhotics. There is a need for non-invasive evaluation of portal hypertension. Ultrasonography with colour and spectral Doppler evaluation may be an effective, rapid and inexpensive alternative. AIM: To evaluate hepatic venous waveform, damping index, splenoportal index in patients of cirrhosis on Colour Doppler ultrasound, also predict severity of portal hypertension and presence of oesophageal varices. MATERIALS AND METHODS: Thirty patients of chronic liver disease were included in the study. Ultrasound and colour Doppler was done to look hepatic venous waveform pattern, Damping Index (DI), and Splenoportal Index (SPI). Contrast-enhanced Computed Tomography scan (CT) was done if renal function tests were normal, else endoscopy when the renal function tests were deranged to look for oesophageal varices. RESULTS: Twenty two (73.3%) patients had monophasic waveform. Biphasic and triphasic waveforms were seen in 4 (13.3%) cases. Twenty two patients (73.3%) had monophasic waveforms and majority of them were in class C. This distribution of hepatic vein waveform was statistically significantly with the Child Pugh's class (p<0.05). Twenty patients (66.7%) had value of Damping index more than >0.6 where majority of patients (18) belonged to class C and 2 in class B. There was a positive correlation between Child Pugh's total score and Damping index (r=0.614; p<0.05). There was weak positive correlation between splenoportal index and Child Pugh's score (r=0.269; p=0.15). CONCLUSION: Change in triphasic to monophasic waveform and DI >0.6 suggests severe liver dysfunction and is associated with severe portal hypertension. Hepatic venous waveform pressure changes, DI and SPI have no value in predicting presence of oesophageal varices.
Authors: Soon Koo Baik; Jae Woo Kim; Hyun Soo Kim; Sang Ok Kwon; Young Ju Kim; Joong Wha Park; Seong Hyun Kim; Sei Jin Chang; Dong Ki Lee; Kwang Hyub Han; Soon Ho Um; Samuel S Lee Journal: Radiology Date: 2006-08 Impact factor: 11.105
Authors: Moon Young Kim; Soon Koo Baik; Dong Hun Park; Dae Wook Lim; Jae Woo Kim; Hyun Soo Kim; Sang Ok Kwon; Young Ju Kim; Sei Jin Chang; Samuel S Lee Journal: Liver Int Date: 2007-10 Impact factor: 5.828