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Grading of Portal Hypertension with Doppler Ultrasound
Findings in this study of patients
with portal hypertension and 100 control subjects were analysed for any
indicators that might allow grading of this condition or explanation of why
some patients develop varices while others develop refractory ascites. All
patients had ultrasound imaging prior to transjugular intrahepatic portosystemic
shunt placement, with portal and portosystemic pressures measured at the
time of the procedure. Measurement of the inner diameter of the portal vein
was taken at a midpoint between the confluence and the portal bifurcation
and the splenic vein diameter was measured at a level left of the aorta.
Splenic blood flow and portal vein blood flow and congestion index were
calculated (see formula) and the resistive index of the main right intrahepatic
branch of the hepatic artery was measured To ensure consistency of measurements,
patients were fasted overnight. Measurements were taken with suspended
respiration, sample volume size matched vessel diameter and a Doppler angle
between 30º and 60º was maintained. The duplex ultrasound variables
were highly sensitive for diagnosing portal hypertension. A congestive index
> 0.1 showed a sensitivity of 95%. A portal vein diameter >1.25cm or
portal vein velocity <21cm/sec gave a sensitivity and specificity of 80%
for portal hypertension.There was a weak correlation between vessel size
and blood flow measurements with pressure but the sinificance was not high
enough to enable grading of portal hypertension or replace direct pressure
measurement. This could be due to the development of collateral pathways.
None of the ultrasound variables were significantly different for the two
patient subgroups (bleeding varices and refractory ascites).Congestive Index
= PV cross-sectional area ÷(PV velocity ÷ 2)
PV = portal vein
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