Noninvasive Analysis of Portal Pressure by Contrast-Enhanced Sonography in Patients With Cirrhosis

Abstract

Objectives Free portal pressure measurement is a reliable method for assessment of portal pressure in patients with cirrhosis. Intrahepatic circulatory time analysis of a sonographic contrast agent can assess liver fibrosis and its severity. The purposes of this pilot study were to assess the correlation between the intrahepatic circulatory time and free portal pressure and to assess whether intrahepatic circulatory time analysis can be used to predict portal venous pressure severity. Methods The intrahepatic circulatory time and free portal pressure were measured in 31 patients with hepatitis B virus–related liver disease. Pearson correlation analysis was used to assess the correlation between the intrahepatic circulatory time and free portal pressure. Results The hepatic vein–hepatic artery interval times were significantly shorter in the portal hypertension group than the non–portal hypertension group (mean ± SD, 8.26 ± 1.94 and 13.83 ± 1.17 seconds, respectively; P < .001). The portal vein–hepatic artery interval times were significantly longer in the portal hypertension group than the nonportal hypertension group (13.13 ± 2.25 and 7.25 ± 1.81 seconds; P < .001). Considering the whole patient population, there were statistically significant correlations between free portal pressure and the hepatic vein–hepatic artery interval time (r = −0.900; P < .001) and portal vein–hepatic artery interval time (r = 0.808; P < .001). In patients with portal hypertension, there was a statistically significant correlation between free portal pressure and the hepatic vein–hepatic artery interval time (r = −0.804; P = .009) and a weak correlation between free portal pressure and the portal vein–hepatic artery interval time (r = 0.506; P = .036). Conclusions Intrahepatic circulatory time measurement is correlated with free portal pressure and has the potential capability to evaluate portal pressure noninvasively in patients with hepatitis B virus–related liver disease.

Usefulness of Contrast-Enhanced Ultrasonography for Predicting Esophageal Varices in Patients with Hepatitis B Virus (HBV)-Related Cirrhosis

“…The HV–HA index had been used in many studies to correct the differences of participants’ blood circulation time [20,21,26]. As expected, the AUROCs of HV–HA was larger than that of HVAT (0.883 vs. 0.838 for assessing presence of EV and 0.915 vs. 0.840 for assessing high-risk EV).…”

“…PSI was the difference between the peak signal intensity in the liver parenchyma and baseline intensity; moreover, TTP was defined as the time interval between injection and liver parenchyma peak time [18,21]. To lessen the impact of variations in the blood circulation time, HV–HA (HVAT minus HAAT) and PV–HA (PVAT minus HAAT) were calculated [20,21]. The time from 10% to 90% of liver parenchyma peak signal intensity was expressed as the rise time [22].…”

“…Compared with contrast-enhanced CT and contrast-enhanced MRI, CEUS is low cost [15,16], repeatable, safer, and can be controlled by operators in real-time during the measurements. Moreover, previous studies have demonstrated that hepatic dynamic CEUS features are correlated with severity of chronic liver diseases (CLD) [17], degree of liver fibrosis [18], and portal pressure [19,20]. In patients with cirrhosis, the occurrence of EV is a consequence of portal hypertension (PH).…”

Ultrasonography for Noninvasive Assessment of Portal Hypertension

“…The interval time between vessels is a representative parameter for microbubble hemodynamics and shows close correlation with portal pressure, between free portal pressure and hepatic vein–hepatic artery interval time (r=−0.804, p=0.009) or the portal vein–hepatic artery interval time (r=0.506, p=0.036) 27. More recent studies have demonstrated original parameters for portal pressure; the first study proposed “regional hepatic perfusion” using SonoVue, which correlated with HVPG (r=0.279, p=0.041) and hyperdynamic syndrome markers 28.…”

New Developments in the Treatment of Hepatic Tumors

“…However, it is sometimes difficult to use conventional measurements to diagnose well-compensated cirrhosis. The behavior of the microbubbles in sonographic contrast medium in the portal vein may reflect hemo dynamic changes due to hepatic fibrosis [1]. In this comparative study, patients were divided into two groups (noncirrhotic and cirrhotic) according to the histological findings of the resected specimens.…”