Hepatic arterial flow volume and reserve in patients with cirrhosis: Use of intra-arterial Doppler and adenosine infusion

Kleber, Gerhard; Steudel, Norbert; Behrmann, Curd; Zipprich, Alexander; Hübner, Georg; Lotterer, E.; Fleig, Wolfgang E.

doi:10.1016/s0016-5085(99)70074-0

Cited by 79 publications

(79 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In chronic liver disease, the portal fraction of liver perfusion decreases as a result of the increase in intrahepatic vascular resistance, which is partially compensated by an increase in arterial inflow [28][29][30]. In cirrhosis, however, the increase in arterial perfusion is often not sufficient to maintain total liver perfusion owing to high extrahepatic portosystemic shunting [28,31].…”

Section: Influence Of Liver Function and Blood Flow On Image Appearancementioning

confidence: 99%

CT evaluations of focal liver reactions following stereotactic body radiotherapy for small hepatocellular carcinoma with cirrhosis: relationship between imaging appearance and baseline liver function

Sanuki

Takeda

Ohashi³

et al. 2010

BJR

View full text Add to dashboard Cite

ABSTRACT. This study aimed to assess the imaging appearances of focal liver reactions following stereotactic body radiotherapy (SBRT) for small hepatocellular carcinoma (HCC) and to examine relationships between imaging appearance and baseline liver function. We retrospectively studied 50 lesions in 47 patients treated with SBRT (30-40 Gy in 5 fractions) for HCC, who were followed up for more than 6 months. After SBRT, all patients underwent regular follow-ups with blood tests and dynamic CT scans. At a median follow-up of 18.1 months (range 6.2-43.7 months), all lesions but one were controlled. 3 density patterns describing focal normal liver reactions around HCC tumours were identified in pre-contrast, arterial and portal-venous phase scans: iso/iso/ iso in 4 patients (Type A), low/iso/iso in 8 patients (Type B) and low/iso (or high)/high in 38 patients (Type C). Imaging changes in the normal liver surrounding the treated HCC began at a median of 3 months after SBRT, peaked at a median of 6 months and disappeared 9 months later. Liver function, as assessed by the Child-Pugh classification, was the only factor that differed significantly between reactions to treatment showing ''non-enhanced'' (Type A and B) and ''enhanced'' (Type C) appearances in CT. Hence, liver tissue with preserved function is more likely to be well enhanced in the delayed phase of a dynamic contrast-enhanced CT scan. The CT appearances of normal liver seen in reaction to the treatment of an HCC by SBRT were therefore related to background liver function and should not be misread as recurrence of HCC.

show abstract

Section: Influence Of Liver Function and Blood Flow On Image Appearancementioning

confidence: 99%

CT evaluations of focal liver reactions following stereotactic body radiotherapy for small hepatocellular carcinoma with cirrhosis: relationship between imaging appearance and baseline liver function

Sanuki

Takeda

Ohashi³

et al. 2010

BJR

View full text Add to dashboard Cite

show abstract

“…Consequently, portal hypertension occurs in liver cirrhosis with increased vascular resistance (25). As the portal hypertension progresses, the total liver perfusion and the portal venous perfusion in liver cirrhosis progressively decreases with or without increased arterial flow (25,26). The decreased portal perfusion in liver cirrhosis could be partially compensated by an increase of arterial flow through the hepatic arterial buffer response that may be insufficient to compensate for the decreased portal vein flow up to the normal liver perfusion (27).…”

Section: Discussionmentioning

confidence: 99%

Quantitative evaluation of liver cirrhosis using T1 relaxation time with 3 tesla MRI before and after oxygen inhalation

Kim

Park

Kim³

et al. 2012

Magnetic Resonance Imaging

View full text Add to dashboard Cite

Purpose: To quantify liver T1 relaxation times before and after oxygen inhalation in patients with and without liver cirrhosis using a 3 Tesla (T) MRI. Materials and Methods:Institutional Review Board approval and written informed consent were obtained. Ninety-two noncirrhotic patients and 87 patients with hepatitis B viral liver cirrhosis (72 Child-Pugh class A and 15 Child-Pugh class B or C) underwent MRI with a 3.0T system before and after the supply of 100% oxygen at a rate of 15 L/min by means of a nonrebreather ventilation mask for 3 min. T1 maps were acquired using threedimensional spoiled gradient echo sequences with two different flip angles (2 and 14 ) and a fixed TR/TE (2.54 ms/0.95 ms). Liver T1 values were obtained using a T1 processing tool (MapIT software). The mean baseline T1 values of three groups (control, Child-Pugh class A, and Child-Pugh class B/C) were compared using an analysis of variance test. Liver T1 value before and after oxygenation was compared using a paired t-test for each group.Results: The baseline liver T1 value was significantly higher in the control group (941 6 136 ms) than in ChildPugh A (858 6 143 ms) and Child-Pugh B/C (783 6 164 ms) group (P < 0.001 and P < 0.0001). The reduction in the liver T1 value after oxygen inhalation was significant in the control group (P ¼ 0.012) but not significant in Child-Pugh class A (P ¼ 0.079) and Child-Pugh class B/C (P ¼ 0.752). Conclusion:The baseline liver T1 relaxation time was significantly different between the patients with and without liver cirrhosis. The shortening effect of oxygen on the liver T1 value was significant in the control group but not in the cirrhotic patients.

show abstract

“…Most authors have reached an agreement on the notion that the increase of intrahepatic vascular resistance leads to a decrease of the portal fraction of liver perfusion [4,5] . This decreased portal perfusion is partially compensated by an increase of arterial flow, with the total liver perfusion being reduced in cirrhotic patients [4,10,11] . More importantly, since the changes of the hepatic microcirculation in cirrhosis influence the progression of the disease, such a technique would be of greater value in hepatology.…”

Section: Discussionmentioning

confidence: 99%

“…This change may be explained by the results obtained with multiple indicator dilution techniques in human cirrhosis or rat cirrhotic liver. The increased microvascular resistance in the cirrhotic liver reduces capillary blood flow; the reduction in capillary blood flow is compensated by liver arterialization, increasing the capillary perfusion [4,10,11] . In addition, we observed that MTT and PS measured by the perfusion CT tended to change significantly in patients with decompensated cirrhosis (Table 2).…”

Section: Groupmentioning

confidence: 99%

Assessment of the hepatic microvascular changes in liver cirrhosis by perfusion computed tomography

Chen¹,

Zeng²,

Huo³

et al. 2009

WJG

View full text Add to dashboard Cite

AIM:To assess the hepatic microvascular parameters in patients with liver cirrhosis by perfusion computed tomography (CT). METHODS:Perfusion CT was performed in 29 patients without liver disease (control subjects) and 39 patients with liver cirrhosis, including 22 patients with compensated cirrhosis and 17 patients with decompensated cirrhosis, proved by clinical and laboratory parameters. CT cine-scans were obtained over 50 s beginning with the injection of 50 mL of contrast agent. Hepatic microvascular parameters, mean transit time (MTT) and permeability surface area product (PS) were obtained with the Perfusion 3 software (General Electric, ADW 4.2). RESULTS:The overall differences of MTT and PS between control subjects, patients with compensated cirrhosis and those with decompensated cirrhosis were statistically significant (P = 0.010 and P = 0.002, respectively). MTT values were 15.613 ± 4.1746 s, 12.592 ± 4.7518 s, and 11.721 ± 4.5681 s for the three groups, respectively, while PS were 18.945 ± 7.2347 mL/min per 100 mL, 22.767 ± 8.3936 mL/min per 100 mL, and 28.735 ± 13.0654 mL/min per 100 mL. MTT in decompensated cirrhotic patients were significantly decreased compared to controls (P = 0.017), whereas PS values were remarkably increased (P = 0.001). CONCLUSION:The hepatic microvascular changes in patients with liver cirrhosis can be quantitatively assessed by perfusion CT. Hepatic microvascular parameters (MTT and PS), as measured by perfusion CT, were significantly altered in decompensated cirrhosis.

show abstract

Hepatic arterial flow volume and reserve in patients with cirrhosis: Use of intra-arterial Doppler and adenosine infusion

Cited by 79 publications

References 31 publications

CT evaluations of focal liver reactions following stereotactic body radiotherapy for small hepatocellular carcinoma with cirrhosis: relationship between imaging appearance and baseline liver function

CT evaluations of focal liver reactions following stereotactic body radiotherapy for small hepatocellular carcinoma with cirrhosis: relationship between imaging appearance and baseline liver function

Quantitative evaluation of liver cirrhosis using T1 relaxation time with 3 tesla MRI before and after oxygen inhalation

Assessment of the hepatic microvascular changes in liver cirrhosis by perfusion computed tomography

Contact Info

Product

Resources

About