PURPOSE: To objectively evaluate examiner's performance in abdominal ultrasonography using body phantom and adjustment of an equipment. MATERIALS AND METHODS: Twenty four radiology residents (six per year of training) independently performed upper abdominal ultrasonography of an ABDFAN phantom, which is similar to human anatomy. Duration of each examination was measured. By consensus, three experienced abdominal radiologists evaluated the management of ultrasonographic equipment (annotation of scan area, depth control, gain and time-gain compensation control, focus control, and occurrence of artifact) and the acquisition of 15 standard images. They scored 5 points per item, for a total of 100 points. RESULTS: The mean score for management of ultrasonographic equipment was 19.17, and 62.50 for acquisition of standard images. The total mean score was 81.67. A significant difference in the total mean score was observed between first grade residents, with a score of 64.17, and other residents, with a score over 85. Mean examination time was 10.9 minutes. In management of ultrasonographic equipment, annotation of the scan area received a lower score of 1.04 points. In the acquisition of standard images, the mean score for an intercostal scan of the right hepatic lobe, including the right hepatic vein, was lowest, at 1.88, whereas those for transverse scan of the right hepatic lobe and of the pancreas were highest, at 5 points. CONCLUSION: As the total mean score by residents, except for first grade residents, was over 85, the assessment items presented in this study can be used as objective criteria in the test for accreditation of ultrasound practices.
Accreditation* ; Compensation and Redress ; Consensus ; Hepatic Veins ; Humans ; Pancreas ; Ultrasonography*

The authors have studied the findings of radionuclear scanning, inferior vena cavography and ultrasonographyin 2 cases of Budd-chiari Sundrome experienced diffuse inhomogeneous uptake throughout enlarged liver without colddefects. Slightly increased activity in the central portion of liver in case I and markedly increased activity inthe caudate lobe in case II were observed. In inferior vena cavography, the dilated hepatic veins formingintrahepatic collaterals were seen in enlarged caudate lobe. Marked stenosis of I.V.C. at the level of confluenceto right atrium, intraluminal thrombosis of I.V.C., partial obstruction of hepatic veins by thrombi at theconfluent portion and systemic collaterals were noted in case I. In case II, abrupt conical obstruction of I.V.C.at the orgin of hepatic segment, which is consistent with membrane or web. was seen. Prominent systemiccollaterals were developed through the serpinginous margedly dilated azygos and hemiazygos veins, and splenorenalshunt. In ultrasonography, diffuse narrowing and obstruction of hepatic veins at eh confluent level by echogenicnodules were seen in 2 cases. Prominent intrahepatic venous collaterals were observed in case II.
Budd-Chiari Syndrome ; Constriction, Pathologic ; Heart Atria ; Hepatic Veins ; Hepatomegaly ; Liver ; Membranes ; Thrombosis ; Ultrasonography ; Veins

Doppler ultrasonography of the hepatic vasculature is an integral part of evaluating precirrhotic and cirrhotic patients. While the reversal of the portal venous flow is a well-recognized phenomenon, other flow patterns, although not as easily understood, may play an important role in assessing the disease status. This article discusses the different characteristic flow patterns observed from the portal vein, hepatic artery, and hepatic vein in patients with liver cirrhosis or related complications and procedures. Knowledge of these different flow patterns provides additional information that may reinforce the diagnosis of cirrhosis, help in staging, and offer prognostic information for determining the direction of therapy. Doppler ultrasonography is invaluable when liver transplantation is being considered and aids in the diagnosis of cirrhosis and portal hypertension.
Diagnosis ; Fibrosis* ; Hepatic Artery ; Hepatic Veins ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Liver Transplantation ; Portal Vein ; Ultrasonography, Doppler ; Ultrasonography, Doppler, Color

BACKGROUND/AIMS: Clinical validation is required to determine whether Doppler measurements are comparable before and after administering ultrasound contrast agent (USCA). The purpose of this study is to explore whether the use of USCA affects spectral Doppler analysis in recipients of liver transplantation (LT). METHODS: For this study, 36 patients were examined using Doppler ultrasonography (US) along with a contrast-enhanced US for surveillance of vascular complications after LT. The following spectral Doppler US parameters were measured before and after administration of USCA: peak systolic velocity, end-diastolic velocity, resistive index, and systolic acceleration time of the graft hepatic artery; peak flow velocity of the graft portal vein; and peak flow velocity and venous pulsatility index of the graft hepatic vein. RESULTS: The mean peak systolic and end-diastolic velocities of the hepatic artery and the peak flow velocity of the portal and hepatic veins were increased after intravenously administration of the USCA, ranging from 10% to 13%. However, the changes were not statistically significant (P=0.097, 0.103, 0.128, and 0.190, respectively). There were no significant differences in other measured parameters, including the resistive index (P=0.205) and systolic acceleration time (P=0.489) of the hepatic artery and venous pulsatility index (P=0.494) of the hepatic vein. CONCLUSIONS: The measured velocities of graft hepatic vessels tended to increase after administration of USCA, but without statistical significance. The comparison of serial Doppler parameters with or without injection of USCA is valid during Doppler surveillance in recipients of LT.
Acceleration ; Contrast Media* ; Doppler Effect ; Hepatic Artery ; Hepatic Veins ; Humans ; Liver Transplantation* ; Liver* ; Microbubbles ; Portal Vein ; Transplants ; Ultrasonography* ; Ultrasonography, Doppler

PURPOSE: The anastomosis of hepatic artery to recipient vessel has a major role in a liver transplantation, so its occlusion is the most important cause of failure of liver transplantations. We made the study to reveal the peculiarities in pediatric liver transplantations compared with adult cases. METHODS: From January 1999 to September 2005, we performed 99 cases of pediatric liver transplantation. The mean age at operation was 4.17 years of age. The hepatic vein and portal vein are anastomosed by the general surgeons and then the hepatic artery is anastomosed by the plastic surgeons. The Doppler ultrasonography and computed tomography were used for postoperative checkup for hepatic artery patency. RESULTS: There were no immediate complications, but hepatic arterial occlusion was developed in 3 cases (2.8%). In pediatric patients, the anastomosis of hepatic artery is more difficult than adults because of the rapid respiratory and pulse rate, the small vascular diameter, and the large gap of diameter difference between the recipient and the donor vessels. CONCLUSION: We could confirm that pediatric liver transplantations are relatively safe but long learning curve was needed.
Adult ; Child* ; Heart Rate ; Hepatic Artery* ; Hepatic Veins ; Humans ; Learning Curve ; Liver Transplantation* ; Liver* ; Portal Vein ; Tissue Donors ; Ultrasonography, Doppler

BACKGROUND/AIMS: Portal hypertension occurs as a consequence of liver cirrhosis and is responsible for serious complications such as variceal bleeding, ascites and hepatic encephalopathy. The hepatic venous pressure gradient (HVPG) is the gold standard for assessment of portal hypertension. However, use of the HVPG is limited by being an invasive test. This prospective study evaluated whether the parameters identified by the non-invasive Doppler ultrasonography reflect the HVPG and could potentially be used for the assessment of the severity of portal hypertension in patients with liver cirrhosis. METHODS: HVPG and Doppler ultrasonographic parameters, including the damping index (DI) of the hepatic vein waveform, the portal venous velocity and flow, the splenic venous velocity and flow, the pulsatility and the resistive index of the hepatic, splenic and renal arteries were measured in 114 patients with liver cirrhosis and compared. RESULTS: The DI of the Doppler hepatic vein waveform was significantly correlated with the grade of the HVPG, i.e. with a higher HVPG, an increase in the DI was observed (p<0.01). The other Doppler parameters did not correlate with the HVPG grade. CONCLUSIONS: The results of this study showed that the DI measurements of the hepatic vein waveform by Doppler ultrasonography might provide a noninvasive assessment of the severity of portal hypertension.
Ascites ; Hemorrhage ; Hepatic Encephalopathy ; Hepatic Veins ; Humans ; Hypertension, Portal ; Liver ; Liver Cirrhosis ; Prospective Studies ; Renal Artery ; Ultrasonography, Doppler ; Venous Pressure

This study was performed to identify the relationships between hepatic vein (HV) measurements, including flow velocity and waveform, using pulsed-wave (PW) Doppler ultrasonography, and the severity of tricuspid regurgitation (TR) in dogs. The study included 22 dogs with TR and 7 healthy dogs. The TR group was subdivided into 3 groups according to TR jet profile obtained by echocardiography. The hepatic venous waveform was obtained and classified into 3 types. A variety of HV measurements, including the maximal velocities of the atrial systolic, systolic (S), end ventricular systolic, and diastolic (D) waves and the ratio of the S- and D- wave velocities (S/D ratio), were acquired. TR severity was significantly correlated with the S- (r = −0.380, p = 0.042) and D- (r = 0.468, p = 0.011) wave velocities and the S/D ratio (r = −0.747, p < 0.001). Receiver operating characteristic curve analysis revealed the highest sensitivity and specificity for the S/D ratio (89% and 75%, respectively) at a threshold of 0.97 with excellent accuracy (AUC = 0.911, p < 0.001). In conclusion, PW Doppler ultrasonography of the HV can be used to identify the presence of significant TR and to classify TR severity in dogs.
Animals ; Dogs* ; Echocardiography ; Hepatic Veins* ; ROC Curve ; Sensitivity and Specificity ; Tricuspid Valve Insufficiency* ; Ultrasonography, Doppler

BACKGROUND/AIMS: We identified reports in the literature regarding the diagnostic accuracy of hepatic vein arrival time (HVAT) measured by contrast-enhanced ultrasonography (CEUS) to assess hepatic fibrosis in cirrhosis. METHODS: The Ovid MEDLINE, Embase, and Cochrane databases were searched for all studies published up to 23 July 2015 that evaluated liver status using CEUS and liver biopsy (LB). The QUADAS-II (quality assessment of diagnostic accuracy studies-II) was applied to assess the internal validity of the diagnostic studies. Selected studies were subjected to a meta-analysis with MetaDisc 1.4 and RevMan 5.3. RESULTS: A total of 12 studies including 844 patients with chronic liver disease met our inclusion criteria. The overall summary sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of the HVAT measured by CEUS for the detection of cirrhosis compared to LB were 0.83 (95% confidence interval [CI], 0.77 to 0.89), 0.75 (95% CI, 0.69 to 0.79), 3.45 (95% CI, 1.60 to 7.43), and 0.28 (95% CI, 0.10 to 0.74), respectively. The summary diagnostic odds ratio (random effects model) was 15.23 (95% CI, 3.07 to 75.47), the summary receiver operator characteristics area under the curve was 0.74 (standard error [SE]=0.14), and the index Q was 0.69 (SE=0.11). CONCLUSIONS: Based on a systematic review, the measurement of HVAT by CEUS exhibited an increased accuracy and correlation for the detection of cirrhosis.
Biopsy ; Fibrosis* ; Hepatic Veins* ; Humans ; Liver ; Liver Diseases ; Odds Ratio ; Sensitivity and Specificity ; Ultrasonography*

PURPOSE: To assess the value of contrast-enhanced color Doppler ultrasonography(US) in the detection of ves-sels related to hepatocellular carcinoma(HCC). MATERIALS AND METHODS: Between July 1997 and April 2000, 76 HCCs in 70 patients (50 men and 20 women; mean age, 57.8 years) were confirmed histologically or clinically. Tumor site and size at gray scale US, and afferent, intratumoral and efferent color signals at precontrast and postcontrast color Doppler US were deter-mined. Afferent signals were classified as basket or penetrating type, and intratumoral signals as spotty, linear or mixed. Efferent signals were categorized as signal to portal vein or signal to hepatic vein, and postcontrast color signal changes as focal, general or marginal spotty type. We also measured the color percentage of intra-tumoral signals as seen during precontrast and postcontrast study. RESULTS: The detection rate changed from 41(53.9%) to 60(78.9%) in cases with afferent signals, from 50(65.8%) to 64(84.2%) in those with intratumoral signals, and from 6(7.9%) to 9(11.8%) in those with efferent signals. Overall, 74(97.4%) cases showed positive findings at postcontrast color Doppler US. The most common enhancing pattern was general, occurring in 33(43.4%) cases. The color percentage of intratumoral signals increased from an average of 8.2% to 34.9%. The detection rate of intratumoral signals from tumors less than 3 cm in diameter increased from 56.8% to 100%, and that of deeply-located tumor-related signals (17 cas-es) increased from 47.1% to 94.1%. CONCLUSION: The use of contrast enhanced color Doppler US increased the detection rate of afferent, intratumoral, and efferent signals, especially that of intratumoral signals from tumors less than 3 cm in diameter and signals from deeply located tumors. In addition, the modality can aid the diagnosis of HCC by evaluating tumor dynamics.
Diagnosis ; Female ; Hepatic Veins ; Humans ; Liver Neoplasms ; Male ; Portal Vein ; Ultrasonography, Doppler, Color*

Membranous obstruction of the hepatic inferior vena cava(MOVC)is one of the common causes of Budd-Chiari syndrome. The aim of this study is to ascertain and compare the characteristic sonographic and CT findings of Budd-Chiari syndrome caused by MOVC. We studied 10 patients of Budd-Chiari syndrome caused by MOVC through sonography and CT. MOVC was confirmed by operation and/or inferior vena cavography. The cases included 9 men and one woman. With sonography. IVC obstruction was diagnosed in 9 cases. The cause of IVC obstruction was web in 5 cases and fibrous cord in 3 cases. The cause was unspecified in on case. Obliteration of the hepatic veins and intrahepatic collateral vessels were delineated in 9 cases. With color doppler sonography, the directions of blood flow of the hepatic veins through the intervenous communication were fairly well demonstrated in all 5 cases. With CT, IVC obstruction was diagnosed in 7 cases. The obliteration of the hepatic segment of the IVC were segmental in 6 cases and diffuse in one case. Ct demonstrated communicating vessels between the hepatic veins in 3 cases. Furthermore. Systemic collateral vessls(azygos and hemiazygos veins. Veins along the abdominal wall, and internal mammary veins)were demonstrated in all cases. Liver cirrhosis was combined in all cases and hepatoma developed in 4 cases. Sonography is useful to detect the MOVC and to demonstrate hepatic venous obstruction and intrahepatic collateral vessels. Color doppler sonography is easily performed to show the direction of the blood flow through interconnecting vessels. CT shows the obliterated segment of the IVC clearly and multiple prominent systemic coliaterals. In conclusion, and Budd-Chiai syndrome caused by MOVC is accurately diagnosed by combined color doppler sonography and CT.
Abdominal Wall ; Budd-Chiari Syndrome* ; Carcinoma, Hepatocellular ; Female ; Hepatic Veins ; Humans ; Liver Cirrhosis ; Male ; Ultrasonography ; Veins ; Vena Cava, Inferior*