Diagnostic value of Doppler ultrasound in the assessment of liver cirrhosis in children: Histopathological correlation

Abstract

We have correlated flow abnormalities in the hepatic vasculature with histological findings in the liver to determine the accuracy of Doppler ultrasound in the diagnosis of liver cirrhosis in children. Eighteen children admitted for evaluation of unknown liver disease were examined prospectively and blindly with Doppler ultrasound prior to liver biopsy. Biopsy specimens showed established cirrhosis in 9 of 18, early cirrhosis in 5 of 18, and no cirrhosis in 4 of 18 children. Doppler studies were also performed on 20 control subjects. The portal vein velocity was decreased (p < 0.0005) and the arterio‐portal velocity ratio was increased (p < 0.0005) in the established cirrhosis cohort relative to the controls. For the criteria of the established cirrhosis cohort, the sensitivities of the loss of the reverse flow component in the hepatic veins, the arterio‐portal velocity ratio being greater than 3.0, the portal vein velocity being less than 20 cm/s, and the existence of focal flow acceleration in the hepatic veins were 100%, 78%, 67%, and 44%, respectively. The specificity of all of these criteria was 100%. The indicators were not useful in the diagnosis of early cirrhosis. © 1996 John Wiley & Sons, Inc.

Intérêt de l’échographie dans le diagnostic de la cirrhose en milieu tropical

“…Le ralentissement du flux portal a été rapporté par plusieurs auteurs [13,18,34]. Pour Iwao et al [13], une valeur de la vitesse à 12 cm/s a une sensibilité et une spécificité respectivement de 97 et 93 %.…”

“…L'ultrasonographie, examen non invasif, de réalisation facile, occupe une place importante dans le diagnostic de la cirrhose et a fait l'objet de plusieurs études [1,2,7,[10][11][12][13][14][15][16][17][18][19].…”

“…L'échographie doppler (couleur et pulsé) est actuellement un examen fondamental dont l'intérêt consiste à apprécier la vitesse, le sens, le volume du flux sanguin portal, l'index de résistance de l'artère hépatique et à rechercher d'autres signes d'HTP [2,8,13,18,19,[21][22][23][24][25][26].…”

Kenneth Taylor, MD, PhD

“…Although established cirrhosis can be recognized by a number of well-established sonographic and color Doppler features (Gorka et al 1996), the challenge for the next century must be improved characterization of diffuse liver disease. The USA is facing an epidemic of hepatitis C. Only 5% of the total cases present have been detected to date.…”

Noninvasive diagnosis of the degree of hepatic fibrosis using ultrasonography in patients with chronic liver disease due to hepatitis C virus

“…These parameters can be evaluated using Duplex‐Doppler ultrasonography, which is easy to perform, has a low cost and provides valuable information regarding liver parenchyma and hepatic vessels. In fact, Duplex‐Doppler ultrasonography has shown its clinical usefulness in the diagnosis of portal hypertension and liver cirrhosis (LC) in both adults and the paediatric age group; and also in assessing the response of these patients to drugs [13–24]. However, some researchers did not find this manoeuvre to be of significant use [25, 26].…”