Hemodynamic analysis of esophageal varices in patients with liver cirrhosis using color Doppler ultrasound

Li, Fenghua; Hao, Jing; Xia, Jianguo; Liu, Hongli; Fang, Hua

doi:10.3748/wjg.v11.i29.4560

Cited by 42 publications

(47 citation statements)

References 24 publications

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“…Previous Doppler ultrasound-based studies have found no signiˆcant diŠerence in V PV among variceal grades (e.g., small vs. large varices or F1 vs. F2 vs. F3 varices). 29,32 We speculate this discrepant nding is due to the diŠerent precision of the 2 measurement modalities. Doppler ultrasound can measure ‰ow in the PV and may be cheaper and more widely available than PC-MRI.…”

Section: Magnetic Resonance In Medical Sciencesmentioning

confidence: 96%

MR-based Measurements of Portal Vein Flow and Liver Stiffness for Predicting Gastroesophageal Varices

Morisaka

Ichikawa

Sano

et al. 2013

MRMS

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Objectives: We evaluated ‰ow parameters measured by phase-contrast magnetic resonance (MR) imaging (PC-MRI) of the portal venous system and liver stiŠness measured by MR elastography (MRE) to determine the usefulness of these methods in predicting gastroesophageal varices (GEV) in patients with chronic liver disease (CLD).Methods: In patients with CLD and controls, we performed PC-MRI on the portal (PV) and superior mesenteric veins; calculated mean velocity (V, cm/s), cross-sectional area (S, mm 2 ), and ‰ow volume (Q, mL/min); and determined markers of liverˆbrosis (liver stiŠ-ness [kPa]) and aspartate aminotransferase (AST) platelet ratio index [APRI]). We visually assessed GEV and development of collateral pathways of the PV on routine contrast-enhanced dynamic MR imaging and compared patient characteristics, ‰ow parameters, liver stiŠness markers, and visual analysis among 3GEV groups, those with mild, severe, or no GEV with reference to endoscopicˆndings.Results: Child-Pugh grade, V PV , S PV , liver stiŠness, APRI, and visually identiˆed GEV (visible GEV) diŠered signiˆcantly among the 3 groups (Pº0.05). We investigated V PV , S PV , liver stiŠness, and visible GEV as independent markers to distinguish patients with and without GEV and examined V PV and visible GEV to predict severe GEV. Visible GEV showed low sensitivity (14 to 30z) and high speciˆcity (98z) for predicting GEV in patients with CLD. A subgroup analysis that excluded cases with collateral pathway demonstrated slightly improved diagnostic performance of V PV and liver stiŠness.Conclusions: Portal vein ‰ow parameters and liver stiŠness can be useful markers for predicting GEV in patients with CLD.

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Section: Magnetic Resonance In Medical Sciencesmentioning

confidence: 96%

MR-based Measurements of Portal Vein Flow and Liver Stiffness for Predicting Gastroesophageal Varices

Morisaka

Ichikawa

Sano

et al. 2013

MRMS

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“…It was widely used to explore the relationship between EV hemodynamics associated with portal hypertension and liver cirrhosis [8,9] . Main characteristics of portal hypertension like a decrease in portal flow velocity or an increase in portal vein diameter are detectable by this means [10,11] .…”

Section: Wwwwjgnetcommentioning

confidence: 99%

Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients

Tarzamni¹,

Somi²,

Farhang³

et al. 2008

WJG

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AIM:To evaluate portal hypertension parameters in liver cirrhosis patients with and without esophageal varices (EV). METHODS:A cohort of patients with biopsy confirmed liver cirrhosis was investigated endoscopically and with color Doppler ultrasonography as a possible noninvasive predictive tool. The relationship between portal hemodynamics and the presence and size of EV was evaluated using uni-and multivariate approaches. RESULTS:Eighty five consecutive cirrhotic patients (43 men and 42 women) were enrolled. Mean age (± SD) was 47.5 (± 15.9). Portal vein diameter (13.88 ± 2.42 vs 12.00 ± 1.69, P < 0.0005) and liver vascular index (8.31 ± 2.72 vs 17.8 ± 6.28, P < 0.0005) were found to be significantly higher in patients with EV irrespective of size and in patients with large varices (14.54 ± 1.48 vs 13.24 ± 2.55, P < 0.05 and 6.45 ± 2.78 vs 10.96 ± 5.05, P < 0.0005, respectively), while portal vein flow velocity (13.25 ± 3.66 vs 20.25 ± 5.05, P < 0.0005), congestion index (CI) (0.11 ± 0.03 vs 0.06 ± 0.03, P < 0.0005), portal hypertensive index (2.62 ± 0.79 vs 1.33 ± 0.53, P < 0.0005), and hepatic (0.73 ± 0.07 vs 0.66 ± 0.07, P < 0.001) and splenic artery resistance index (RI) (0.73 ± 0.06 vs 0.62 ± 0.08, P < 0.0005) were significantly lower. A logistic regression model confirmed spleen size (P = 0.002, AUC 0.72) and portal hypertensive index (P = 0.040, AUC 0.79) as independent predictors for the occurrence of large esophageal varices (LEV). CONCLUSION:Our data suggest two independent situations for beginning endoscopic evaluation of compensated cirrhotic patients: Portal hypertensive index > 2.08 and spleen size > 15.05 cm. These factors may help identifying patients with a low probability of LEV who may not need upper gastrointestinal endoscopy.

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“…In prior studies it has been suggested that hemodynamics of the left gastric vein appears to be superior to those of the portal vein in predicting patients with cirrhosis who are at a higher risk of bleeding [20]. However, it was not shown that it is superior to portal vein in detecting the presence of esophageal varices.…”

Section: Resultsmentioning

confidence: 82%

Portal Vein Doppler: A Tool for Non-Invasive Prediction of Esophageal Varices in Cirrhosis

Shastri

Kulkarni

Patell

et al. 2014

JCDR

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Background and Objectives: Esophageal varices (EV), a major complication of liver cirrhosis, can lead to life threatening gastrointestinal (GI) bleeding. Esophagogastroduodenoscopy (EGD) is the gold standard for diagnosis and management of esophageal varices. However, it is not always available in resourceconstrained settings.This study was aimed at evaluating portal vein indices (PVI) using Doppler on ultrasound abdomen, which is more widely available, as tools to predict the presence of EV.

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Hemodynamic analysis of esophageal varices in patients with liver cirrhosis using color Doppler ultrasound

Cited by 42 publications

References 24 publications

MR-based Measurements of Portal Vein Flow and Liver Stiffness for Predicting Gastroesophageal Varices

MR-based Measurements of Portal Vein Flow and Liver Stiffness for Predicting Gastroesophageal Varices

Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients

Portal Vein Doppler: A Tool for Non-Invasive Prediction of Esophageal Varices in Cirrhosis

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