Abstract
Ultrasound is a remarkably powerful and versatile modality for pediatric imaging, without requiring exposure to radiation or sedatives. By providing information on blood flow, Doppler sonography can reveal details about normal physiology and disease processes not discernable from gray-scale anatomic images alone. However, in routine practice in many institutions Doppler remains underutilized, in part due to uncertainty of the meaning of changes in Doppler waveforms. In part I of this review, the basics of hemodynamics and how changes in blood flow affect the Doppler waveform are reviewed. Clinical applications in the investigation of hepatic disease are then discussed.
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References
Burns P (1995) Hemodynamics. In: Taylor K, Burns P, Wells P (eds) Clinical applications of doppler ultrasound. Raven, New York, pp 35–54
Taylor K, Holland S (1990) Doppler US part I: basic principles, instrumentation, and pitfalls. Radiology 174:297–307
Hedrick W, Hykes D, Starchman D (1995) Hemodynamics. In: Hedrick W, Hykes D, Starchman D (eds) Ultrasound physics and instrumentation. Mosby, St Louis, pp 126–161
Deane C (1997) Doppler ultrasound—measurement of bloodflow. In: Goldberg B, Merton D, Deane C (eds) An atlas of color flow imaging. Martin Dunitz, London, pp 47–66
Tortoli P, Michelassi V, Bambi G, et al (2003) Interaction between secondary velocities, flow pulsation and vessel morphology in the common carotid artery. Ultrasound Med Biol 29:407–415
Nagai Y, Helwegen J, Fleg J, et al (2001) Associations of aortic windkessel function with age, gender, and cardiovascular risk factors. Ultrasound Med Biol 27:1207–1210
Burns P (1995) Interpreting and analyzing the Doppler examination. In: Taylor K, Burns P, Wells P (eds) Clinical applications of Doppler ultrasound. Raven, New York, pp 55–98
Bude R, Rubin J (1999) Stenosis of the main artery supplying an organ: effect of end-organ vascular compliance on the post-stenotic peak systolic velocity. J Ultrasound Med 18:603–613
Bude R, Rubin J (1999) Effect of downstream cross-sectional area of an arterial bed on the resistive index and the early systolic acceleration. Radiology 212:732–738
Gallego C, Velasco M, Marcuello P, et al (2002) Congenital and acquired anomalies of the portal venous system. Radiographics 22:141–159
Siegel M (2002) Liver. In: Siegel M (ed) Pediatric sonography. Lippincott William and Wilkins, Philadelphia, pp 213–273
Patriquin H, Perreault G, Grignon A, et al (1990) Normal portal venous diameter in children. Pediatr Radiol 20:451–453
Weinreb J, Kumari S, Phillips G, et al (1982) Portal vein measurements by real-time sonography. AJR 139:497–499
Zimmerman P, Farooki S, Lu D, et al (2000) Doppler sonography of the hepatic vasculature. Appl Radiol 29:11–21
Paltiel H (2002) Pediatric abdominal aplications of color Doppler ultrasonography. Ultrasound Q 18:161–185
Abu-Yousef M (1992) Normal and respiratory variations of the hepatic and portal venous duplex Doppler waveforms with simultaneous electrocardiographic correlation. J Ultrasound Med 11:263–268
Kao S, Bell E, Brown B, et al (1996) Duplex Doppler sonography of changes in portal vein flow in healthy term newborn infants after feeding. J Ultrasound Med 15:121–125
Sato S, Ohnishi K, Sujita S, et al (1987) Splenic artery and superior mesenteric artery blood flow: nonsurgical Doppler ultrasound measurement in healthy subjects and patients with chronic liver disease. Radiology 164:347–352
Loberant N, Herskovits M, Barak M, et al (1999) Closure of the ductus venosus in premature infants: findings on real-time gray-scale, color-flow Doppler, and duplex Doppler sonography. AJR 172:227–229
Loberant N, Barak M, Gaitini D, et al (1992) Closure of the ductus venosus in neonates: findings on real-time gray-scale, color-flow Doppler, and duplex Doppler sonography. AJR 159:1083–1085
Fugelseth D, Lindermann R, Liestol K, et al (1998) Postnatal closure of ductus venosus in preterm infants < 32 weeks. Early Hum Dev 53:163–169
Fugelseth D, Lindermann R, Liestol K, et al (1997) Ultrasonographic study of ductus venosus in healthy neonates. Arch Dis Child Fetal Neonatal Ed 77:F131–F134
Vade A, Lim-Dunham J, Iqbal N (2001) Imaging of the ductus venosus in neonates: from patency to closure. J Ultrasound Med 20:681–687
Desser T, Sze D, Jeffrey R (2003) Imaging and intervention in the hepatic veins. AJR 180:1583–1591
Brant W (2001) The core curriculum: ultrasound. Lippincott, Williams and Wilkins, Philadelphia
Jequier S, Jequier J, Henquinet S, et al (2000) Doppler waveform of hepatic veins in healthy children. AJR 175:85–90
Jequier S, Jequier J, Hanquinet S, et al (2002) Hepatic vein Doppler studies: variability of flow pattern in normal children. Pediatr Radiol 32:49–55
Patriquin H, Lafortune M (1995) Doppler sonography of the child’s abdomen. In: Taylor K, Burns P, Wells P (eds) Clinical applications of Doppler ultrasound. Raven, New York, pp 301–336
Stringer D, Krysl J, Manson D, et al (1990) The value of Doppler sonography in the detection of major vessel thrombosis in the neonatal abdomen. Pediatr Radiol 21:30–33
Dietrich C, Chichakli M, Hirche T, et al (2002) Sonographic findings of the hepatobiliary-pancreatic system in adult patients of cystic fibrosis. J Ultrasound Med 21:409–416
Wachsberg R, Bahramipour P, Sofocleous C, et al (2002) Hepatofugal flow in the portal venous system: pathophysiology, imaging findings, and diagnostic pitfalls. Radiographics 22:123–140
Westra S, Zaninovic A, Vargas J, et al (1995) The value of portal vein pulsatility on duplex sonograms as a sign of portal hypertension in children with liver disease. AJR 165:167–172
Kozaiwa K, Taliri H, Yoshimura N, et al (1995) Utility of duplex Doppler ultrasound in evaluating portal hypertension in children. J Pediatr Gastroenterol Nutr 21:215–219
Gorka W, Kagalwalla A, McParland B, et al (1996) Diagnostic value of Doppler ultrasound in the assessment of liver cirrhosis in children: histopathological correlation. J Clin Ultrasound 24:287–295
Tuney D, Aribal M, Ertem D, et al (1998) Diagnosis of liver cirrhosis in children based on colour Doppler ultrasonography with histopathological correlation. Pediatr Radiol 28:859–864
Gorg C, Seifart U, Zugmaier G (2004) Color Doppler sonographic signs of respiration-dependent hepatofugal portal flow. J Clin Ultrasound 32:62–68
deVries P, deHooge P, Hoekstra J, et al (1994) Blunted postprandial reaction of portal venous flow in chronic liver disease, assessed with duplex Doppler: significance for prognosis. J Hepatol 21:966–973
Freeney P (1989) Venography. In: Margulis A, Burhenne J (eds) Alimentary tract radiology. CV Mosby, St. Louis, pp 1951–1993
Zweibel W (1995) Sonographic diagnosis of hepatic vascular disorders. Semin Ultrasound CT MR 16:34–48
Patriquin H, Tessier G, Grignon A, et al (1985) Lesser omental thickness in normal children: baseline for detection of portal hypertension. AJR 145:693–696
Barakat M (2002) Doppler sonographic findings in children with idiopathic portal vein cavernous deformity and variceal hemorrhage. J Ultrasound Med 21:825–830
Kainberger F, Vergesslich K, Eilenberger M, et al (1990) Color-coded Doppler evaluation of cholecystic varices in portal hypertension. Pediatr Radiol 21:71–72
Rathi P, Soni A, Nanivadekar S, et al (1996) Gallbladder varices: diagnosis in children with portal hypertension on duplex sonography. J Clin Gastroenterol 23:228–231
DeGaetano A, Lafortune M, Patriquin H, et al (1995) Cavernous transformation of the portal vein: patterns of intrahepatic and splanchnic collateral circulation detected with Doppler sonography. AJR 165:1151–1155
Kim J, Lee Y, Kim S, et al (2001) Does umbilical vein catheterization lead to portal venous thrombosis? Prospective US evaluation in 100 neonates. Radiology 219:645–650
Alpern M, Rubin J, Williams D, et al (1987) Porta hepatis: duplex Doppler US with angiographic correlation. Radiology 162(1Pt1):53–56
Platt J, Rubin J, Ellis J (1995) Hepatic artery resistance changes in portal vein thrombosis. Radiology 196:95–98
Frider B, Marin A, Goldberg A (1989) Ultrasonographic diagnosis of portal vein cavernous transformation in children. J Ultrasound Med 8:445–449
DeLeve L, Shulman H, McDonald G (2002) Toxic injury to hepatic sinusoids: sinusoidal obstruction syndrome (veno-occlusive disease). Semin Liver Dis 22:27–41
Gentil-Kocher S, Bernard O, Brunelle F, et al (1988) Budd-Chiari syndrome in children: report of 22 cases. J Pediatr 113:30–38
Barakat M (2004) Unusual hepatic-portal-systemic shunting demonstrated by Doppler sonography in children with congenital hepatic vein ostial occlusion. J Clin Ultrasound 32:172–178
Bargallo X, Gilabert R, Nicolau C, et al (2003) Sonography of the caudate vein: value in diagnosing Budd-Chiari syndrome. AJR 181:1641–1645
McCarville M, Hoffer F, Howard S, et al (2001) Hepatic veno-occlusive disease in children undergoing bone-marrow transplantation: usefulness of sonographic findings. Pediatr Radiol 31:102–105
Lassau N, Leclere J, Auperin A, et al (1997) Hepatic veno-occlusive disease after myeloablative treatment and bone marrow transplantation: value of gray-scale and Doppler US in 100 patients. Radiology 204:545–552
von Herbay A, Frieling T, Haussinger D (2001) Association between duplex Doppler sonographic flow pattern in right hepatic vein and various liver diseases. J Clin Ultrasound 29:25–30
Kauffman W, Heslop H, Gronemeyer S, et al (1997) Hepatic arterial resistance index—an indicator of diffuse liver disease in children treated with bone marrow transplantation. Clin Radiol 52:903–906
Friedewald S, Molmenti E, DeJong M, et al (2003) Vascular and nonvascular complications of liver transplants: sonographic evaluation and correlation with other imaging modalities and findings at surgery and pathology. Ultrasound Q 19:71–85
Unsinn K, Freund M, Ellenmunter H, et al (2003) Spectrum of imaging findings after pediatric liver transplantation: Part 2, posttransplantation complications. AJR 181:1139–1144
Unsinn K, Freund M, Ellenmunter H, et al (2003) Spectrum of imaging findings after pediatric liver transplantation: Part I, posttransplantation anatomy. AJR 181:1133–1138
Ametani F, Itoh K, Shibata T, et al (2001) Spectrum of CT findings in pediatric patients after partial liver transplantation. Radiographics 21:53–63
Andronikou S, Millar A, Kader E, et al (2002) Anatomical considerations in the imaging of “reduced-size” liver transplantation in children. Pediatr Radiol 32:793–797
Westra S, Zaninovic A, Hall T, et al (1993) Imaging in pediatric liver transplantation. Radiographics 13:1081–1099
Nishida S, Kato T, Levi D, et al (2002) Effect of protocol Doppler ultrasonography and urgent revascularization on early hepatic artery thrombosis after pediatric liver transplantation. Arch Surg 137:1279–1283
DeGaetano A, Cotroneo A, Maresca G, et al (2000) Color Doppler sonography in the diagnosis and monitoring of arterial complications after liver transplantation. J Clin Ultrasound 28:373–380
Tzakis A, Gordon R, Shaw B, et al (1985) Clinical presentation of hepatic artery thrombosis after liver transplantation in the cyclosporine era. Transplantation 40:667–671
Garcia-Criado A, Gilabert R, Nicolau C, et al (2001) Early detection of hepatic artery thrombosis after liver transplantation by Doppler ultrasonography: prognostic implications. J Ultrasound Med 20:51–58
Hall T, McDiarmid S, Grant E, et al (1990) False-negative duplex Doppler studies in children with hepatic artery thrombosis after liver transplantation. AJR 154:573–575
Rollins N, Timmons C, Superina R, et al (1993) Hepatic artery thrombosis in children with liver transplants: false positive findings at Doppler sonogrpahy and arteriography in four patients. AJR 160:291–294
Garcia-Criado A, Gilabert R, Salmeron J, et al (2003) Significance of and contributing factors for a high resistive index on Doppler sonography of the hepatic artery immediately after surgery: prognostic implications for liver transplant recipients. AJR 181:831–838
Platt J, Yutzy G, Bude R, et al (1997) Use of Doppler sonography for revealing hepatic artery stenosis in liver transplant recipients. AJR 168:4730–4730
Dodd GD, Memel D, Zajko A, et al (1994) Hepatic artery stenosis and thrombosis in transplant recipients: Doppler diagnosis with resistive index and systolic acceleration time. Radiology 192:657–661
Funaki B, Rosenblum J, Leef J, et al (1995) Portal vein stenosis in children with segmental liver transplants: treatment with percutaneous transhepatic venoplasty. AJR 165:161–165
Ko E, Kim T, Kim P, et al (2003) Hepatic vein stenosis after living donor liver transplantation: evaluation with Doppler US. Radiology 229:806–810
Jequier S, Jequier J, Hanquinet S, et al (2003) Orthotopic liver transplants in children: change in hepatic venous Doppler wave pattern as an indicator of acute rejection. Radiology 226:105–112
Britton P, Lomas D, Coulden R, et al (1992) The role of hepatic vein Doppler in diagnosing acute rejection following paediatric liver transplantation. Clin Radiol 45:228–232
Brunelle F, Chaumont P (1984) Hepatic tumors in children: ultrasonic differentiation of malignant from benign lesions. Radiology 150:695–699
Van Campenhout I, Patriquin H (1992) malignant microvasculature in abdominal tumors in children: detection with Doppler US. Radiology 183:445–448
Bates S, Keller M, Ramos I, et al (1990) Hepatoblastoma: detection of tumor vascularity with duplex Doppler US. Radiology 176:505–507
Paltiel H, Patriquin H, Keller M, et al (1992) Infantile hepatic hemangioma: Doppler US. Radiology 182:735–742
Kassarjian A, Zurakowski D, Dubois J, et al (2004) Infantile hepatic hemangiomas: clinical and imaging findings and their correlation with therapy. AJR 182:785–795
Boon L, Burrows P, Paltiel H, et al (1996) Hepatic vascular anomalies in infancy: a twenty-seven-year experience. J Pediatrics 129:346–354
Bodner G, Peer S, Karner M, et al (2002) Nontumorous vascular malformations in the liver: color Doppler ultrasonographic findings. J Ultrasound Med 21:187–197
McInroy B, Zajko A, Pinna A (1998) Biliary necrosis due to hepatic involvement with hereditary hemorrhagic telangiectasia. AJR 170:413–415
Jabra A, Taylor G (1991) Ultrasound diagnosis of congenital intrahepatic portosystemic shunt. Pediatr Radiol 21:529–530
Valls E, Ceres L, Urbaneja A, et al (2000) Color Doppler sonography in the diagnosis of neonatal intrahepatic portosystemic shunts. J Clin Ultrasound 28:42–46
Buscarini E, Buscarini L, Arruzzoli S, et al (1994) Hepatic vascular malformations in hereditary hemorrhagic telangiectasia: imaging findings. AJR 163:1105–1110
Murray C, Yoo S, Babyn P (2003) Congenital extrahepatic portosystemic shunts. Pediatr Radiol 33:614–620
Hackworth C, Leef J, Rosenblum J, et al (1998) Transjugular intrahepatic portosystemic shunt creation in children: initial clinical experience. Radiology 206:109–114
Lafortune M, Patriquin H (1990) Doppler sonography of the liver and splanchnic veins. Semin Intervent Radiol 7:27–37
Patriquin H, Lafortune M, Weber A, et al (1987) Surgical portosystemic shunts in children: assessment with duplex Doppler US. Work in progress. Radiology 165:25–28
Middleton W, Teefey S, Darcy M (2003) Doppler evaluation of transjugular intrahepatic portosystemic shunts. Ultrasound Q 19:56–70
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Coley, B.D. Pediatric applications of abdominal vascular Doppler imaging: Part I. Pediatr Radiol 34, 757–771 (2004). https://doi.org/10.1007/s00247-004-1228-2
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DOI: https://doi.org/10.1007/s00247-004-1228-2