Influence of the Spleen on Portal Haemodynamics: a Non-invasive Study with Doppler Ultrasound in Chronic Liver Disease and Haematological Disorders

Piscaglia, Fabio; Donati, Gabriele; Cecilioni, L.; Celli, Natascia; Stagni, B.; Pini, Paolo; Gaiani, Stefano; Gherlinzoni, Filíppo; Bolondi, Luigi

doi:10.1080/003655202760373452

Cited by 35 publications

(25 citation statements)

References 23 publications

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“…Various ultrasonographic (US) indexes, including spleen size, portal vein velocity (PVV), portal vein diameter, hepatic impedance indexes, splenic impedance indexes, and results of multi-detector computed tomographic esophagography, have been shown to be predictive of the severity of esophageal varices or risks of variceal bleeding in patients with cirrhosis. [17][18][19][20] However, no consistent results have been reported yet.…”

Section: Introductionmentioning

confidence: 77%

Prediction and screening of esophageal varices in cirrhotic patients using doppler US hemodynamic indices of portal system

Hekmatnia

Barikbin

Farghadani

et al. 2011

Gastroenterol Insights

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It is currently recommended that all patients with liver cirrhosis undergo upper gastrointestinal endoscopy (UGIE) to identify those who have esophageal varices (EV) that carry a high risk of bleeding and may benefit from prophylactic measures. In the future, this social and medical burden will increase due to the greater number of patients with chronic liver disease and their improved survival. The aim of this study was to assess the value of Doppler sonography for the prediction/screening of EV)in cirrhotic patients. In this twoyear prospective study, 50 patients with liver cirrhosis, referred to Al-Zahra hospital, were enrolled. Patients underwent detailed clinical examination, biochemistry tests (hematology, liver function tests), Gray-scale ultrasonography and Doppler sonography of hepatoportal system. Degree of esophageal varices was assessed at UGIE; Paquet's grades 0 -III were classified as group A (0-I; No or Mild EV) and group B (II-III; Moderate to severe EV). Three portal hemodynamic indices including liver vascular index, portal hypertension index, and congestive index was also measured. Degree of esophageal varices was assessed at UGIE. The relationship between the presence and degree of EVs with Doppler results were evaluated. Among 50 consecutive cirrhotic patients (41 males and 9 female, with mean age of 52.1(±16.2) year) were enrolled. 19 (38%) patients were placed in group A (No or mild EV), while 31(62%) had endoscopic evidences of moderate to severe esophageal varices (group B). Our study showed that among three portal hemodynamic indices we studied, only portal hypertension index has statistically significant correlation with degree of EVs confirmed by UGIE (P=0.029). Doppler ROC area under the curve was not significant but was near to be (AUC=0.64). Our data indicate that Doppler sonographic evaluations have no highly accurate predicting value for the presence of EV and its severity in patients with cirrhosis. However, we think Doppler study can be helpful for further investigation and finding more established and unchangeable information.

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Section: Introductionmentioning

confidence: 77%

Prediction and screening of esophageal varices in cirrhotic patients using doppler US hemodynamic indices of portal system

Hekmatnia

Barikbin

Farghadani

et al. 2011

Gastroenterol Insights

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“…Our study however, showed that the systolic velocity and the splenic artery resistance index (SA-RI) was higher in patients with significant fibrosis and cirrhosis. Salvatore et al showed that the SA-RI cut-off of 0.56 enabled the identification of patients with liver stiffness values >13kPa obtained by TE (value associated to the presence of cirrhosis) [42], and in two independent studies it was shown that SA-RI was significantly and selectively increased in patients with cirrhosis [25,43]. Binţinţan et al found that the SA-RI was higher in patients with oesophageal varices than in patients with no varices [44].…”

Section: Discussionmentioning

confidence: 99%

“…It can define the velocity and characteristics of blood flow within the portal system and the hepatic and splenic arteries [2,13]. Previous studies have shown that portal vein flow velocity [14,[15][16][17][18] and resistance index of the hepatic [1,14,[20][21][22] and splenic artery [21,[23][24][25][26] mirror the severity of portal hypertension in patients with cirrhosis. Given these observations, DUS is routinely used in the follow-up of patients with cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

Doppler ultrasonography combined with transient elastography improves the non-invasive assessment of fibrosis in patients with chronic liver diseases

et al. 2017

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Aims: Accurate clinical assessment of liver fibrosis is essential and the aim of our study was to compare and combine hemodynamic Doppler ultrasonography, liver stiffness by transient elastography, and non-invasive serum biomarkers with the degree of fibrosis confirmed by liver biopsy, and thereby to determine the value of combining non-invasive method in the prediction significant liver fibrosis. Material and methods: We included 102 patients with chronic liver disease of various etiology. Each patient was evaluated using Doppler ultrasonography measurements of the velocity and flow pattern at portal trunk, hepatic and splenic artery, serum fibrosis biomarkers, and transient elastography. These parameters were then input into a multilayer perceptron artificial neural network with two hidden layers, and used to create models for predicting significant fibrosis. Results: According to METAVIR score, clinically significant fibrosis (≥F2) was detected in 57.8% of patients. A model based only on Doppler parameters (hepatic artery diameter, hepatic artery systolic and diastolic velocity, splenic artery systolic velocity and splenic artery Resistance Index), predicted significant liver fibrosis with a sensitivity and specificity of75.0% and 60.0%. The addition of unrelated non-invasive tests improved the diagnostic accuracy of Doppler examination. The best model for prediction of significant fibrosis was obtained by combining Doppler parameters, non-invasive markers (APRI, ASPRI, and FIB-4) and transient elastography, with a sensitivity and specificity of 88.9% and 100%. Conclusion: Doppler parameters alone predict the presence of ≥F2 fibrosis with fair accuracy. Better prediction rates are achieved by combining Doppler variables with non-invasive markers and liver stiffness by transient elastography.

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“…It is now well documented that spleen size is in correlation with the grade of esophageal varices (22,41,42). Watanabe (43) calculated the splenic ratio (length x width x height of the spleen size on computed tomography), and showed that patients having a ratio over 963 cm 3 have esophageal varices, and that a high ratio may predict esophageal bleeding in patients with liver cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive assessment of portal hypertension in patients with alcoholic cirrhosis

Alempijević¹,

Sokic-Milutinovic²,

Miličić³

et al. 2012

Turk J Gastroenterol

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Influence of the Spleen on Portal Haemodynamics: a Non-invasive Study with Doppler Ultrasound in Chronic Liver Disease and Haematological Disorders

Cited by 35 publications

References 23 publications

Prediction and screening of esophageal varices in cirrhotic patients using doppler US hemodynamic indices of portal system

Prediction and screening of esophageal varices in cirrhotic patients using doppler US hemodynamic indices of portal system

Doppler ultrasonography combined with transient elastography improves the non-invasive assessment of fibrosis in patients with chronic liver diseases

Noninvasive assessment of portal hypertension in patients with alcoholic cirrhosis

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