Title: Doppler Sonography for Surrogate Markers of Gastro-Oesophageal Varices in Chronic Liver Disease
Authors: V.S. Sudhakaran, N.J. John
DOI: https://dx.doi.org/10.18535/jmscr/v7i1.83
Abstract
Introduction: Gastro-oesophageal varices lead to a major cause of morbidity and mortality in CLD with Portal Hypertension requiring repeated endoscopies for diagnosis and follow up. Sonographic surrogate markers for varices are being searched for and evaluated to aid in diagnosis and follow up.
Aim of the work: To determine the accuracy of primary Doppler indices of hepatic artery, splenic artery, middle hepatic vein, superior mesenteric artery and calculated complex Doppler parameters in diagnosis of oesophageal varices.
Patients and Methods: 96 cases of CLD underwent Doppler sonography of portal venous system, hepatic arteries and hepatic veins. Conventional Doppler parameters, liver congestion index, liver vascular index and portal hypertension index were noted. Patients underwent endoscopy for detecting and grading varices. The Doppler findings were correlated with endoscopy findings.
Results: PSV, RI and PI values alone of splenic artery, hepatic artery and SMA do not correspond to presence or absence of varices. Liver congestive index, liver vascular index and portal hypertension index and wave forms in middle hepatic vein show correlation with presence or absence of varices.
Conclusions: Liver congestion index >0.145 cm x s, liver vascular index < 12 cm/s, portal hypertension index >0.021s/cm and monophasic/biphasic wave form in middle hepatic vein can be used as sonographic surrogate markers for presence of gastro-oesophageal varices in portal hypertension.
Keywords: Chronic Liver Disease, gastro-oesophageal varices, Doppler Sonography, Liver congestion index, liver vascular index and portal hypertension index, Middle hepatic vein wave form.
References
- Tchelepi H, Ralls PW, Radin R, Grant E. Sonography of diffuse liver disease. J Ultrasound Med 2002;21:1023–1032.
- Iranpour P, Lall C, Houshyar R, Helmy M, Yang A, Choi JI, et al. Altered Doppler flow patterns in cirrhosis patients: an overview. Ultrasonography. 2016 Jan;35(1):3-12.
- Paquet KJ. Prophylactic endoscopic sclerosing treatment of the esophageal wall in varices: a prospective controlled randomized trial. Endoscopy 1982;14:4–5
- Grace ND, Groszmann RJ, Garcia-Tsao G, Burroughs AK, Pagliaro L, Makuch RW, Bosch J, Stiegmann GV, Henderson JM, DeFranchis R, Wagner JL, Conn HO, Rodes J. Portal hypertension and variceal bleeding: an AASLD single topic symposium. Hepatology 1998;28:868–880.
- D’Amico G, Garcia-Tsao G, Cales P, Escorsell A, Nevens F, Cestari R, Caletti G, Zoli M. Diagnosis of portal hypertension: how and when. In: DeFranchis R. ed. Portal Hypertension III. Proceedings of the Third Baveno International Consensus Workshop on Definitions, Methodology and Therapeutic Strategies. Oxford: Blackwell Science, 2001: 36–64.
- Dean Alexander McNaughton, MD • Monzer M. Abu-Yousef, MD. Doppler US of the Liver Made Simple. RadioGraphics 2011; 31:161–18
- Iwao T, Toyonaga A, Oho K, Tayama C, Masumoto H, Sakai T, Sato M, Tanikawa K. Value of Doppler ultrasound parameters of portal vein and hepatic artery in the diagnosis of cirrhosis and portal hypertension. Am J Gastroenterol. 1997 Jun;92(6):1012-7.
- Piscaglia F, Donati G, Serra C, Muratori R, Solmi L, Gaiani S, Gramantieri L, BolondiL. Value of splanchnic Doppler ultrasound in the diagnosis of portal hypertension. Ultrasound Med Biol. 2001 Jul;27(7):893-9.
- Moriyasu F, Nishida O, Ban N, Nakamura T, Sakai M, Miyake T, Uchino H. "Congestion index" of the portal vein. AJR Am J Roentgenol. 1986 Apr;146(4):735-9.
- Berzigotti A, Gilabert R, Abraldes JG, Nicolau C, Bru C, Bosch J, García-Pagan JC. Noninvasive prediction of clinically significant portal hypertension and esophageal varices in patients with compensated liver cirrhosis. Am J Gastroenterol. 2008 May;103(5):1159-67
- Plestina S, Pulanic R, Kralic M, Plestina S, Samarzija M. Color Doppler ultrasonography is reliable in assessing the risk of esophageal variceal bleeding in patients with liver cirrhosis. Wien Klin Wochenschr 2005; 117: 711-717.