Diagnostic Methods for Cirrhosis and Portal Hypertension: Imaging: Ultrasound and Doppler Ultrasonography

Chapter

Abstract

Ultrasonography (US) and Doppler US have been widely used to diagnose cirrhosis and portal hypertension (PH) for several decades. As an alternative to invasive methods to diagnose cirrhosis, many attempts have used US to assess hepatic fibrosis and its clinical complications. Because of its low cost, ease of use, and high patient compliance, it has become the most common and valuable diagnostic modality for detecting not only parenchymal disease but also anomalies in liver hemodynamics by Doppler imaging. Therefore, previous studies have evaluated several US indices using to identify cirrhosis, including nodular liver surface, blunted liver edge, coarse parenchymal echogenicity, atrophic change of right lobe, splenomegaly, and enlarged diameter of the splenic vein (SV). In addition, Doppler US indices, which have been commonly used for evaluating PH, include the measurement of portal and splenic venous blood velocity and flow as well as the resistance indices at the hepatic, splenic, renal, and superior mesenteric arteries. However, the objectivity of measurements of US and Doppler indices to diagnose cirrhosis and PH is compromised by interobserver variation and interequipment variability. Finally, US and Doppler US are of major value in diagnosing portal vein thrombosis and therefore in ruling out pre-hepatic portal hypertension. We review herein the role of various US tests used in the diagnosis of cirrhosis and PH, including grayscale and Doppler US.

Keywords

Ultrasonography Cirrhosis Portal hypertension Grayscale Doppler 

Abbreviations

DI

Damping index

HV

Hepatic vein

HVPG

Hepatic venous pressure gradient

PH

Portal hypertension

PI

Pulsatility index

PV

Portal vein

RI

Resistive index

SV

Splenic vein

US

Ultrasonography

References

  1. 1.
    Baik SK. Haemodynamic evaluation by Doppler ultrasonography in patients with portal hypertension: a review. Liver Int. 2010;30:1403–13.CrossRefPubMedGoogle Scholar
  2. 2.
    Kim MY, Jeong WK, Baik SK. Invasive and non-invasive diagnosis of cirrhosis and portal hypertension. World J Gastroenterol. 2014;20(15):4300.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Colli A, Fraquelli M, Andreoletti M, et al. Severe liver fibrosis or cirrhosis: accuracy of US for detection – analysis of 300 cases. Radiology. 2003;227:89–94.CrossRefPubMedGoogle Scholar
  4. 4.
    Shen L, Li JQ, Zeng MD, et al. Correlation between ultrasonographic and pathologic diagnosis of liver fibrosis due to chronic virus hepatitis. World J Gastroenterol. 2006;12:1292–5.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Aube C, Oberti F, Korali N, et al. Ultrasonographic diagnosis of hepatic fibrosis or cirrhosis. J Hepatol. 1999;30:472–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Moon KM, Kim G, Baik SK, et al. Ultrasonographic scoring system score versus liver stiffness measurement in prediction of cirrhosis. Clin Mol Hepatol. 2013;19:389–98.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Khan KN, Yamasaki M, Yamasaki K, et al. Proposed abdominal sonographic staging to predict severity of liver diseases – analysis with peritoneoscopy and histology. Dig Dis Sci. 2000;45:554–64.CrossRefPubMedGoogle Scholar
  8. 8.
    Needleman L, Kurtz AB, Rifkin MD, et al. Sonography of diffuse benign liver disease: accuracy of pattern recognition and grading. AJR Am J Roentgenol. 1986;146(5):1011.CrossRefPubMedGoogle Scholar
  9. 9.
    Chen CH, Lin ST, Yang CC, et al. The accuracy of sonography in predicting steatosis and fibrosis in chronic hepatitis C. Dig Dis Sci. 2008;53:1699–706.CrossRefPubMedGoogle Scholar
  10. 10.
    Kutcher R, Smith GS, Sen F, et al. Comparison of sonograms and liver histologic findings in patients with chronic hepatitis C virus infection. J Ultrasound Med. 1998;17(5):321.CrossRefPubMedGoogle Scholar
  11. 11.
    Baik SK, Kim JW, Kim HS, et al. Recent variceal bleeding: Doppler US hepatic vein waveform in assessment of severity of portal hypertension and vasoactive drug response. Radiology. 2006;240:574–80.CrossRefPubMedGoogle Scholar
  12. 12.
    Choi YJ, Baik SK, Park DH, et al. Comparison of Doppler ultrasonography and the hepatic venous pressure gradient in assessing portal hypertension in liver cirrhosis. J Gastroenterol Hepatol. 2003;18:424–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Merkel C, Sacerdoti D, Bolognesi M, et al. Doppler sonography and hepatic vein catheterization in portal hypertension: assessment of agreement in evaluating severity and response to treatment. J Hepatol. 1998;28:622–30.CrossRefPubMedGoogle Scholar
  14. 14.
    Zironi G, Gaiani S, Fenyves D, et al. Value of measurement of mean portal flow velocity by Doppler flowmetry in the diagnosis of portal hypertension. J Hepatol. 1992;16:298–303.CrossRefPubMedGoogle Scholar
  15. 15.
    Kim MY, Baik SK, Park DH, et al. Damping index of Doppler hepatic vein waveform to assess the severity of portal hypertension and response to propranolol in liver cirrhosis: a prospective nonrandomized study. Liver Int. 2007;27:1103–10.CrossRefPubMedGoogle Scholar
  16. 16.
    Nelson RC, Sherbourne GM, Spencer HB, et al. Splenic venous flow exceeding portal venous flow at Doppler sonography – relationship to portosystemic varices. Am J Roentgenol. 1993;161:563–7.CrossRefGoogle Scholar
  17. 17.
    Kim G, Cho YZ, Baik SK, et al. The accuracy of ultrasonography for the evaluation of portal hypertension in patients with cirrhosis: a systematic review. Korean J Radiol. 2015;16:314–24.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Jee MG, Baik SK, Park DH, et al. Interequipment variability of Doppler ultrasonographic indices in patients with liver cirrhosis. Korean J Hepatol. 2006;12:539–45.PubMedGoogle Scholar
  19. 19.
    Berzigotti A, Piscaglia F. Ultrasound in portal hypertension—part 1. Ultraschall Med. 2011;32:548–68. quiz 569–571CrossRefPubMedGoogle Scholar
  20. 20.
    Berzigotti A, Piscaglia F, Education E, et al. Ultrasound in portal hypertension—part 2—and EFSUMB recommendations for the performance and reporting of ultrasound examinations in portal hypertension. Ultraschall Med. 2012;33:8–32. quiz 30–31CrossRefPubMedGoogle Scholar
  21. 21.
    Baik SK, Park DH, Kim MY, et al. Captopril reduces portal pressure effectively in portal hypertensive patients with low portal venous velocity. J Gastroenterol. 2003;38:1150–4.CrossRefPubMedGoogle Scholar
  22. 22.
    Baik SK, Jee MG, Jeong PH, et al. Relationship of hemodynamic indices and prognosis in patients with liver cirrhosis. Korean J Intern Med. 2004;19:165–70.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Internal Medicine, Yonsei University, Wonju College of MedicineWonju Severance Christian HospitalWonjuRepublic of Korea

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