Impact of splenic circulation: non-invasive microbubble-based assessment of portal hemodynamics
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The objective was to examine the effect of splenic circulation using a microbubble agent to assess the severity of portal hypertension.
This prospective study consisted of 91 subjects (63.0 ± 12.6 years, 30–86; 60 males, 31 females), 62 cirrhosis and 29 controls, who underwent both Doppler ultrasound and contrast-enhanced ultrasound with a perflubutane microbubble agent. Two microbubble-based parameters for splenic circulation, the minimum circulation time (MCT, s) and the peak enhancement time (PET, s), were assessed with respect to the hepatic venous pressure gradient (HVPG) and other clinical findings.
The MCT and PET showed significant differences between cirrhosis (5.7 ± 1.8; 14.6 ± 3.0) and controls (4.0 ± 1.9, p < 0.0001; 8.9 ± 2.3, p < 0.0001), respectively. However, only PET offered positive correlations with wedged hepatic venous pressure (r = 0.4648, p = 0.0001) and HVPG (r = 0.4573, p = 0.0001). The area under the receiver operating characteristics curve to identify HVPG ≥ 10 mmHg, and 12 mmHg was 0.76 and 0.76, respectively.
The microbubble-based non-invasive assessment of the splenic circulation is effective to identify the severity of portal hypretension presumably by reflecting congestion of splenic venous flow due to increased portal venous pressure.
• There is a potential link between splenic circulation and portal hypertension.
• Microbubble-based assessment of splenic circulation is predictive of the severity of portal hypertension.
• Interobserver variability was sufficient in the assessment of splenic enhancement sonograms.
KeywordsPortal hypertension Spleen Hepatic venous pressure gradient Contrast-enhanced ultrasound
Hepatic venous pressure gradients
Minimum circulation time
Peak enhancement time
Wedged hepatic venous pressure
The scientific guarantor of this publication is Hitoshi Maruyama. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study, performed at one institution.