Hepatology International

, Volume 6, Issue 2, pp 511–519 | Cite as

Delayed periportal enhancement: a characteristic finding on contrast ultrasound in idiopathic portal hypertension

  • Hitoshi MaruyamaEmail author
  • Taro Shimada
  • Hiroyuki Ishibashi
  • Masanori Takahashi
  • Hidehiro Kamesaki
  • Osamu Yokosuka
Original Article



Differentiation of idiopathic portal hypertension (IPH) from cirrhosis is not always easy because of their similar clinical features. This prospective study aimed to use contrast-enhanced ultrasound (US) in studying dynamic behavior of microbubble for characteristic enhancement features in IPH.


The study had 101 subjects: 8 IPH, 47 cirrhosis, and 36 controls, and additional ten cirrhosis for data validation. Contrast-enhanced US with perflubutane microbubble agent was performed in the early-phase (0–60 s) to compare hepatic enhancements among the three groups.


Onset time of enhancement in the hepatic artery was not different among the groups, but that in the portal vein was longer in cirrhosis (19.9 ± 5.2 s; p = 0.0014) and IPH (22.9 ± 5.0 s; p = 0.0007) than in controls (16.6 ± 3.4 s). As for parenchymal enhancement, all controls showed homogeneous enhancement, while all IPH showed delayed periportal enhancement. Cirrhosis had three patterns: 14 with homogeneous enhancement, 28 with diffuse heterogeneous enhancement, and 5 with IPH-like delayed periportal enhancement. Homogeneous enhancement was more frequent in controls than in cirrhosis/IPH (p < 0.0001), and delayed periportal enhancement was more frequent in IPH than in control/cirrhosis (p < 0.0001). The duration of intensity difference between hypoenhancement/delayed enhancement area and surrounding parenchyma which exceeded the half of the mean value of the maximum intensity difference (8.75 dB for IPH, 6.95 dB for cirrhosis) was longer in IPH (15.6 ± 6.9 s) than cirrhosis (10.2 ± 5.3 s; p = 0.0119). The data in cirrhosis were validated in the additional ten subjects.


Delayed periportal enhancement on the sonograms based on perflubutane microbubble agent may be a characteristic of IPH.


Idiopathic portal hypertension Cirrhosis Ultrasound Contrast agent 

Supplementary material

Supplementary material 1 (AVI 7912 kb)

Supplementary material 2 (AVI 8442 kb)


  1. 1.
    Schuppan D, Afdhal NH. Liver cirrhosis. Lancet 2008;371:838–851PubMedCrossRefGoogle Scholar
  2. 2.
    Hillaire S, Valla DC, Lebrec D. Non cirrhotic portal hypertension. Clin Liver Dis 1997;1:1223–1240CrossRefGoogle Scholar
  3. 3.
    Okuda K. Non-cirrhotic portal hypertension versus idiopathic portal hypertension. J Gastroenterol Hepatol 2002;17:S204–S213PubMedCrossRefGoogle Scholar
  4. 4.
    Ohnishi K, Saito M, Sato S, et al. Portal hemodynamics in idiopathic portal hypertension (Banti’s syndrome). Comparison with chronic persistent hepatitis and normal subjects. Gastroenterology 1987;92:751–758PubMedGoogle Scholar
  5. 5.
    Dhiman RK, Chawla Y, Vasishta RK, et al. Non-cirrhotic portal fibrosis (idiopathic portal hypertension): experience with 151 patients and a review of the literature. J Gastroenterol Hepatol 2002;17:6–16PubMedCrossRefGoogle Scholar
  6. 6.
    Hillaire S, Bonte E, Denninger M-H, et al. Idiopathic non-cirrhotic intrahepatic portal hypertension in the West: a re-evaluation in 28 patients. Gut 2002;51:275–280PubMedCrossRefGoogle Scholar
  7. 7.
    Futagawa S, Fukazawa M, Horisawa M, et al. Portographic liver changes in idiopathic noncirrhotic portal hypertension. AJR Am J Roentgenol 1980;134:917–923PubMedGoogle Scholar
  8. 8.
    Sarin SK, Kapoor D. Non-cirrhotic portal fibrosis: current concepts and management. J Gastroenterol Hepatol 2002;17:526–534PubMedCrossRefGoogle Scholar
  9. 9.
    Waguri N, Suda T, Kamura T, Aoyagi Y. Heterogeneous hepatic enhancement on CT angiography in idiopathic portal hypertension. Liver 2002;22:276–280PubMedCrossRefGoogle Scholar
  10. 10.
    Marelli C. Preliminary experience with NC100100, a new ultrasound contrast agent for intravenous injection. Eur Radiol 1999;9:S343–S346PubMedCrossRefGoogle Scholar
  11. 11.
    Burns PN, Wilson SR, Simpson DH. Pulse inversion imaging of liver blood flow: improved method for characterizing focal masses with microbubble contrast. Invest Radiol 2000;35:58–71PubMedCrossRefGoogle Scholar
  12. 12.
    Lencioni R, Piscaglia F, Bolondi L. Contrast-enhanced ultrasound in the diagnosis of hepatocellular carcinoma. J Hepatol 2008;48:848–857PubMedCrossRefGoogle Scholar
  13. 13.
    Maruyama H, Takahashi M, Ishibashi H, et al. Ultrasound-guided treatments under low acoustic power contrast harmonic imaging for hepatocellular carcinomas undetected by B-mode ultrasonography. Liver Int 2009;29:708–714PubMedCrossRefGoogle Scholar
  14. 14.
    Ishibashi H, Maruyama H, Takahashi M, Fujiwara K, Imazeki F, Yokosuka O. Assessment of hepatic fibrosis by analysis of the dynamic behavior of microbubbles during contrast ultrasonography. Liver Int 2010;30:1355–1363PubMedCrossRefGoogle Scholar
  15. 15.
    The Japan Society for Portal Hypertension. The General Rules for Study of Portal Hypertension. 2nd edn. 2004;91–92Google Scholar
  16. 16.
    Tsuneyama K, Ohba K, Zen Y, et al. A comparative histological and morphometric study of vascular changes in idiopathic portal hypertension and alcohol fibrosis/cirrhosis. Histopathology 2003;43:55–61PubMedCrossRefGoogle Scholar
  17. 17.
    Nelson TR, Pretorius DH. Three-dimensional ultrasound imaging. Ultrasound Med Biol 1998;24:1243–1270PubMedCrossRefGoogle Scholar
  18. 18.
    Maruyama H, Ishibashi H, Takahashi M, Imazeki F, Yokosuka O. Effect of signal intensity from the accumulated microbubbles in the liver for differentiation of idiopathic portal hypertension from liver cirrhosis. Radiology 2009;252:587–594PubMedCrossRefGoogle Scholar

Copyright information

© Asian Pacific Association for the Study of the Liver 2011

Authors and Affiliations

  • Hitoshi Maruyama
    • 1
    Email author
  • Taro Shimada
    • 1
  • Hiroyuki Ishibashi
    • 1
  • Masanori Takahashi
    • 1
  • Hidehiro Kamesaki
    • 1
  • Osamu Yokosuka
    • 1
  1. 1.Department of Medicine and Clinical OncologyChiba University Graduate School of MedicineChibaJapan

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