Doppler assessment of hepatic venous waves for predicting large varices in cirrhotic patients

Abstract

Background/Aim:Color Doppler examination of changes in hepatic venous waveforms is being evaluated as a means of prediction of severity of portal hypertension and presence of esophageal varices. Normal hepatic venous waveform shows a triphasic pattern. In cirrhosis, this pattern changes to a biphasic or monophasic pattern. We aimed to study the sensitivity of loss of normal hepatic venous waveforms in predicting large varices in a cross-sectional analysis.Materials and Methods:All patients, admitted or attending the outpatient department, with a diagnosis of cirrhosis were included in the study. All patients were subjected to oesophagogastroduodenoscopy and Color Doppler examination, and waveform patterns in hepatic vein were recorded. The sensitivity and specificity of changes in waveform in detecting large varices were studied.Results:A total of 51 cases were examined. Triphasic waves were seen in 4 (7.8%) cases, biphasic in 26 (51%) cases, and monophasic in 21 (41.2%) cases. Small varices were seen in 30 (58.8%) cases and large varices in 21 (41.2%) cases. The sensitivity of loss of the triphasic wave pattern in detecting significant varices (Grade 3 or 4) was very high (95.23%) and negative predictive value was also high (75%). Severity of liver disease as indicated by Child-Pugh and MELD scores did not correlate with changes in hepatic venous waveforms.Conclusion:Loss of triphasic hepatic venous waveform is highly sensitive in predicting significant varices in patients with cirrhosis.

Association of splenic MR elastographic findings with gastroesophageal varices in patients with chronic liver disease

“…Ultrasound parameters such as LS, SS, and spleen size have been widely investigated and reported to be reliable indicators of GEVs . Ultrasound methods are widely available and inexpensive but they are operator‐dependent and less sensitive, especially in obese patients.…”

“…In our opinion, MRE of the liver and spleen is welltolerated by almost all patients and should be implemented as part of a routine MRI examination. Ultrasound parameters such as LS, SS, and spleen size have been widely investigated and reported to be reliable indicators of GEVs (3)(4)(5)(6)(7)(8). Ultrasound methods are widely available and inexpensive but they are operator-dependent and less sensitive, especially in obese patients.…”

Non-invasive ultrasound-based diagnosis and staging of esophageal varices in liver cirrhosis. A systematic review of the literature published in the third Millenium

“…The classification of EV used by the authors of these studies was not homogenous and, therefore, it was difficult to compare the results; five studies used the 4 grades classification of EV [22][23][24][25][26], four used the 3 grades classification [8,[27][28][29], one study divided EV according to their size (small EV were considered those less than 5 mm while large EV had a size over 5 mm) [30] while one last study investigated only small EV according to the Beppu classification [31]. However, in the end, in order to increase the homogeneity of their final results, the same authors split the studied patients either in two groups (with EV vs. without EV or small EV vs. large EV) or in three groups (without EV vs. small EV vs. large EV).…”

“…The measurements are relatively easy to perform and are associated with a less pronounced interobserver variability compared with other Doppler parameters. The study of Joseph T [30] performed on 51 patients with liver cirrhosis, of which 30 with small EV and 21 with large EV, has shown that the disappearance of the triphasic flow pattern had a high Se (95.23%) and negative predictive value (NPV) (95.23%) for the detection of large EV. However the positive predictive value (PPV) (42.6%) and Sp (10%) for this parameter were low and it ultimatelly failed to correlate accurately with the size of EV.…”

“…The pattern of liver vein blood flow [30] and values of HARI or SAPI [24,27] do not provide reliable information about the presence of EV or risk of bleeding from EV and, for the moment, cannot be used in this respect.…”