Qualitative hepatic venous Doppler sonography versus portal flowmetry in predicting the severity of esophageal varices in hepatitis C cirrhosis.

OBJECTIVE: The purpose of this study was to compare the diagnostic accuracy of simple recognition of hepatic vein waveform abnormalities using Doppler sonography with portal Doppler flowmetry for the noninvasive assessment of esophageal varices in patients with hepatitis C cirrhosis. SUBJECTS AND METHODS: Fifty patients with biopsy-proven liver cirrhosis caused by hepatitis C who were being examined for possible liver transplantation were studied prospectively with Doppler sonography by a single observer. Hepatic vein waveforms were classified as normal triphasic, abnormal biphasic, monophasic, and those with loss of the reverse-flow component. Portal flow indicators included the maximum values of portal flow velocity, portal vein flow volume, diameter of the portal vein, and congestion index. For the purposes of this study, we simplified the endoscopic grading of varices by classifying F1 and F2 varices as small and F3 as large. None of the patients had clinical or echocardiographic signs of failure of the right side of the heart.
RESULTS: Sensitivity for the detection of large varices was 92% for monophasic waves, 76% for waves with loss of the reverse flow component, and 62% for biphasic waves. Overall specificity was 100%. Portal vein diameter and congestion index were higher (p < .02) and portal vein velocity was lower (p < .05) in patients with varices than in patients without varices, but these indicators were not useful in determining the size of varices. Portal vein flow volume did not differ in the presence of varices or ascites and was independent of the morphology of the hepatic vein wave.
CONCLUSION: Simple recognition of patterns seen in hepatic vein waveform morphology in patients with liver cirrhosis caused by hepatitis C is superior to portal Doppler flowmetry for predicting the size of esophageal varices.