Comparison of Portal Vein Doppler Indices and Hepatic Vein Doppler Waveform in Patients with Nonalcoholic Fatty Liver Disease with Healthy Control

Abstract

Background: The purpose of the present study is to investigate the association of nonal-coholic fatty liver disease (NAFLD) with the doppler waveform pattern of hepatic veins and portal vein doppler indices. Objectives: This assay may be useful in evaluating the natural course of NAFLD and monitor treatment efficacy on follow-up. Patients and Methods: This case control study was performed in 31 patients with NAFLD and 31 normal healthy adults who served as the control group. The patients presented with elevated liver enzymes levels (ALT/AST) and hyperechogenic livers in the B-mode ultrasonography examination. Eleven patients had a liver biopsy. After an 8-hour fast, B-mode and duplex doppler ultrasonography were performed, and the waveform patterns of the right hepatic vein, portal vein diameter, grade of fatty liver, portal vein pulsatility index (VPI), and mean flow velocity (MFV) were measured. Results: VPI and MFV values were 0.42 ± 0.92 and 17.27 ± 5.34 cm/second, respectively, in the control group and 0.25 ± 0.50 and 12.82 ± 4.32 cm/second in patients with NAFLD (P < 0.01). The frequency of abnormal hepatic vein doppler waveform patterns (biphasic or monophasic) was significantly higher in patients with NAFLD (55.2%) versus control subjects (3.2%) (P < 0.001). There was no correlation between the degree of fat infiltration and VPI (P = 0.714), MFV (P = 0.911), or hepatic vein waveform pattern (P = 0.197). We found no correlation between liver enzyme levels and MFV or VPI. However, the rate of abnormal hepatic vein was higher in patients with enzyme levels that exceeded twice the normal value (P = 0.05). Conclusions: Patients with NAFLD have a high rate of abnormal hepatic vein doppler waveform patterns, and decreased VPI and MFV are suggestive of reduced vascular compliance in the liver. Elevated liver enzymes levels do not influence VPI or MFV, but patients with abnormal enzymes have higher rates of abnormal hepatic vein doppler waveform patterns.

Sonographic Evaluation of Liver Hemodynamic Indices in Overweight and Obese Dogs

“…However, statistical difference was found in MPV between ideal BSC and obese dogs and a decrease was observed with obesity. This result corroborates previous studies published in the medical literature . The reason for a decrease in MPV may be decreased vascular compliance, because of fatty deposition.…”

“…In human patients, abdominal sonography has high sensitivity and specificity in the diagnosis of fatty liver in asymptomatic overweight individuals who present with incidentally found abnormal liver enzyme activity . Doppler modality has been used widely for characterization and monitoring of fatty liver and other obesity‐related liver lesions in human patients . Previous studies showed that mean portal velocity (MPV) was statistically lower and abnormal pattern of the hepatic vein (HV) waveform was statistically higher in human patients with fatty liver infiltration compared to healthy individuals .…”

“…Doppler modality has been used widely for characterization and monitoring of fatty liver and other obesity‐related liver lesions in human patients . Previous studies showed that mean portal velocity (MPV) was statistically lower and abnormal pattern of the hepatic vein (HV) waveform was statistically higher in human patients with fatty liver infiltration compared to healthy individuals . Other studies found a significant inverse correlation between grade of fatty liver based on histology and hepatic artery resistivity index (HARI) and between grade of fatty liver and MPV .…”

Effects of Nonalcoholic Fatty Liver Disease on the Hepatic Vein and Artery

“…An alteration in pressure of the right atrium, hepatic parenchymal compliance or pressure differences during respiration in the thoracic or abdominal cavity affects the triphasic waveform pattern [17]. Parenchymal liver diseases like NAFLD, cirrhosis, or cardiac disease can cause biphasic or monophasic HVWP [3,4,9,16,18]. Pedersen et al found that abnormal HVWP can be seen in healthy populations, but with no further evaluation for liver disease [19].…”

“…The main features of the disease, with the exception of alcohol consumption, are fatty infiltration or lipid deposition in the hepatocytes in addition to elevated liver function tests [2][3][4]. Although NAFLD is accepted as a benign disease, it can progress to non-alcholic steatohepatitis, which is the advanced state of the disease, and can be complicated with liver fibrosis, cirrhosis, and even liver failure [4][5][6].…”