Ultraschall bei Pfortaderhochdruck – Teil 2 – und EFSUMB-Empfehlungen zur Durchführung und Dokumentation von Ultraschalluntersuchungen bei Pfortaderhochdruck

Abstract

Lernziele ! ▶ Kenntnisse über die Hauptindikationen und klinischen Informationen die mittels Sonografie auf dem Gebiet des Pfortaderhochdrucks gewonnen wurden, insbesondere in Bezug auf die prognostischen Aussagen und der Beurteilung der Behandlungen des Pfortaderhochdrucks.

Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy

“…US is typically the initial, first-line modality choice for the diagnosis and follow-up of portal hypertension[8,11]. Spectral and colour Doppler US can provide accurate and specific detection of certain portosystemic collaterals (recanalized paraumbilical vein, splenorenal collaterals, dilated left and short gastric veins), as well as, directionality of flow within the portal vein[8,11].…”

Clinical Evaluation and Prognosis

“…As for portal hypertension, splenomegaly is the most sensitive sign, but shows a low specificity, particularly in patients with HCV-related cirrhosis. Conversely, the presence of portocollateral circulation (paraumbilical vein, spontaneous splenorenal circulation, dilated left and short gastric veins) or of reversal of flow within the portal system is 100% specific, but both have low sensitivity in patients with compensated disease [25,26]. Several other signs of portal hypertension have been described [25,26], with the dilatation of the portal vein (diameter >13 mm) and the reduction of portal vein velocity (maximal and mean velocity of portal vein flow <16 cm/s and <10-12 cm/s, respectively) the most consistently reported across studies.…”

“…Conversely, the presence of portocollateral circulation (paraumbilical vein, spontaneous splenorenal circulation, dilated left and short gastric veins) or of reversal of flow within the portal system is 100% specific, but both have low sensitivity in patients with compensated disease [25,26]. Several other signs of portal hypertension have been described [25,26], with the dilatation of the portal vein (diameter >13 mm) and the reduction of portal vein velocity (maximal and mean velocity of portal vein flow <16 cm/s and <10-12 cm/s, respectively) the most consistently reported across studies. In a recent prospective study, the presence of any of the above-mentioned abnormalities in abdominal ultrasound associated with platelet count <150 × 10 3 /ml identified the subgroup of patients with advanced chronic liver disease/compensated cirrhosis in whom CSPH might be present; patients with completely normal ultrasound (US) assessment had a much lower prevalence of CSPH [27].…”

“…In a recent prospective study, the presence of any of the above-mentioned abnormalities in abdominal ultrasound associated with platelet count <150 × 10 3 /ml identified the subgroup of patients with advanced chronic liver disease/compensated cirrhosis in whom CSPH might be present; patients with completely normal ultrasound (US) assessment had a much lower prevalence of CSPH [27]. Some ultrasound signs also provide prognostic information; as previously stated, portosystemic collaterals indicate CSPH and are associated with a high prevalence of EV [25,26]. Furthermore, the appearance of new portosystemic collaterals during follow-up was associated with variceal formation and growth in one study, as did progressive spleen enlargement [25,26].…”

“…Some ultrasound signs also provide prognostic information; as previously stated, portosystemic collaterals indicate CSPH and are associated with a high prevalence of EV [25,26]. Furthermore, the appearance of new portosystemic collaterals during follow-up was associated with variceal formation and growth in one study, as did progressive spleen enlargement [25,26]. Finally, a small liver size, spleen size >14.5 cm, mean portal vein velocity <10 cm/s and loss of pulsatility of hepatic veins have been associated with a higher risk of death in patients with compensated cirrhosis.…”