Correlation between Endosonographic and Doppler Ultrasound Features of Portal Hypertension in Patients with Cirrhosis

Abstract

Purpose. Endoscopic ultrasound (EUS) permits the detailed visualization of clinically significant features of portal hypertension; however, it is an invasive procedure that is not widely available. The aim of this cross-sectional study was to determine whether a correlation exists between the features of portal hypertension detected using both Doppler ultrasound and EUS in subjects with liver cirrhosis. Materials and Methods. Analyzed cohort included 42 patients who underwent a detailed Doppler ultrasound focusing on the parameters of blood flow in the portal/splenic vein as well as an endoscopic/EUS procedure that included the assessment of the size and localization of “deep” varices. Results. The size of “deep” oesophageal varices detected with EUS exhibited no correlation with the parameters assessed by Doppler ultrasound. However, the size of the “deep” gastric varices detected using EUS correlated with the time averaged maximum velocity (Tmax as well as Vmin, Vmax) for the portal vein using Doppler ultrasound and exhibited a correlation with the Vmax and Tmax for the splenic vein. No significant correlation was determined between the diameter of the azygous vein and the thickness of the gastric wall when seen on EUS versus the parameters measured with Doppler ultrasound. Conclusion. EUS provides important information regarding the features of portal hypertension, and in the case of “deep” oesophageal varices exhibits a limited correlation with the parameters detected by Doppler ultrasound. Thus, despite its invasiveness, EUS is a method that provides a reliable and unique assessment of the features of portal hypertension in patients with liver cirrhosis.

A State-of-the-Art Review on the Evolving Utility of Endoscopic Ultrasound in Liver Diseases Diagnosis

“…The second advantage is the possibility to combine its images with those of the novel real-time elastography (RTE) that provide semi-quantitative measurements of liver parenchyma and focal lesion stiffness as documented by color images [ 5 ]. The third one is due to the fact that new-generation echoendoscopes are equipped with color, power, and pulsed Doppler, allowing identification of blood vessels, and evaluating portal hypertension, collateral vessels in portal hypertension, and intervening vessels during puncture [ 5 , 6 ]. The fourth one is the ability to obtain contrast-enhancement (CE) images, which improve the diagnostic performance in the case of focal lesions [ 7 ].…”

A Comprehensive Narrative Review on the Evolving Role of Endoscopic Ultrasound in Focal Solid Liver Lesions Diagnosis and Management

“…Additionally, given the transducer proximity to the organ of interest, EUS can easily identify intervening structures and vessels, thus minimizing the rate of EUS-related adverse events, if fine needle aspiration (FNA) is planned [3,4]. Other advantages include the EUS ability to provide real-time elastography (RTE) and real-time doppler and contrast-enhanced (CE) images, which improve the diagnostic performance in the focal lesion [5] by providing semi-quantitative measurements of focal lesion stiffness and the vascular component of the lesion as recognized by color images [6,7].…”

The Role of Endoscopic Ultrasound in Hepatology

“…[4][5][6] Moreover, newly emerging echoendoscopes are provid-ed with color, power and pulsed Doppler, enabling them to identify blood vessels and measure portal pressure in blood vessels. 7,8 Combined EUS with real-time elastography (RTE) can effectively measure stiffness of the liver parenchyma and focal lesions. 7 In addition, liver biopsy (LB) guided by EUS is safer with lower risks than the traditional percutaneous method.…”