Correlation of MRI liver volume and Doppler sonographic portal hemodynamics with histologic findings in patients with chronic hepatitis C

Abstract

Purpose The purpose of this study was to correlate portal hemodynamics on sonography and liver volume on MRI with histologic findings in asymptomatic patients with chronic hepatitis C. Methods Portal blood flow in the left and right portal branches in 20 healthy volunteers and in 26 patients was measured using Doppler sonography during both fasting and postprandial states. Total liver and right‐and left‐lobe volumes were determined using MRI. The ratio between portal blood flow and liver volume determined the “portal flow index” of the right and left lobes. Results We observed a statistically significant difference (p < 0.01) between the volunteers and patients in the mean left‐lobe volume (352 ± 81 cm3 versus 544 ± 159 cm3) and in the mean left portal flow index (1.1 ± 0.2 ml/minute/cm3 versus 0.69 ± 0.2 ml/minute/cm3) as measured before the subjects ate. After a meal, the portal blood‐flow volume in the right lobe was similar in the 2 groups but in the left lobe was significantly lower in the patients (p = 0.0009). The left postprandial portal flow index was inversely correlated with the grade of liver fibrosis (r = 0.533). Conclusions The left‐lobe volume (positive predictive value, 83%; negative predictive value, 72%) and left postprandial portal flow index (positive predictive value, 86%; negative predictive value, 88%) are sensitive indicators of chronic hepatitis. The left postprandial portal flow index may be a useful test for differentiating patients with minimal or no fibrosis from patients with mild to severe fibrosis. © 2000 John Wiley & Sons, Inc. J Clin Ultrasound 28:461–468, 2000.

Can imaging modalities diagnose and stage hepatic fibrosis and cirrhosis accurately?

“…Despite general agreement that PV velocity is decreased in cirrhotic patients, the absolute values of portal flow velocity in both healthy subjects and patients with hepatic disease vary considerably and there is substantial overlap [23]. Further, PV velocity and PV flow have shown correlation with fibrosis stage in larger patient samples [33], but accuracy of measurement in single patients is not sufficient for exact fibrosis staging [37,38]. Portal blood flow is influenced by change in body position, respiration, timing of meals, exercise and cardiac output.…”

The prediction of liver disease status using Doppler observations of the hepatic and portal venous system compared with liver biopsy in patients with chronic hepatitis C

“…37 Further, portal vein velocity and portal vein flow have shown correlation with fibrosis stage in larger patient samples, 36 but the accuracy of measurement in single patients is not sufficient for exact fibrosis staging. 11,35 In the current study, the authors noted that there was a strong correlation between hepatic necroinflammatory changes with alterations in the hepatic vein flow pattern as well as portal vein undulations, with sensitivity of 82% (95% CI 65.1%-91.7%) and 75.6% (95% CI 59.4%-87.1%), specificity of 95% (95% CI 87%-98.4%) A very simple mathematical combination of sonographic and Doppler-derived measures to formulate a composite score to predict the known liver disease status of a patient with hepatitis C was statistically and clinically justified. It is recommended that these sonographic and Doppler-derived scores should be applied in clinical practice as alternative invasive liver-biopsy procedures to diagnose cirrhosis/ fibrosis/steatosis associated with hepatitis C infection.…”

Are Hepatic Portal Venous System Components Distributed Equally in the Liver? A Multidetector Computerized Tomography Study

“…In the inferior sections where the middle hepatic vein could not be observed clearly, the gallbladder itself and its fossa was accepted as the anatomical border (8,9). In the images obtained during the portal venous phase, starting from the dome of the liver, the area was calculated in sq mm (square millimeters) by the free ROI technique and then a 9mm thick subaxial section was taken; then the same procedure was repeated (Figure 1).…”