OBJECTIVETo explore the characteristics of the portal vein hemodynamics and the correlation with the portal vein pressure.

METHODSThere were 41 cases of hepatic cirrhosis complicating portal hypertension. The liver function was graded Child-Pugh A+B in 31 cases and Child-Pugh C in 10 cases. The inner-diameter and blood stream speed of the portal vein (PV), the spleen vein (SV) and the superior mesentery vein (SMV) were measured by the color Doppler ultrasonography. The vascular acreage and blood flow volume were calculated. The portal vein pressure was directly measured during the operation. Thirty-two healthy people and 26 patients with chronic hepatitis B (CHB) served as controls in this study.

RESULTSThe inner-diameter of the three veins was obviously wider and the blood flow speed was slower in two portal hypertension groups than in CHB and normal groups (P<0.01). In Child C group, the speed was the slowest. The speed of SV and SMV in two hypertension groups did not show any significant difference (P>0.05). In Child A+B group, the blood flow volume of the three veins was larger than that in normal and CHB groups (P<0.01 or P<0.05). The volume of PV was less in Child C group than Child A+B group (P<0.01), but the volume of SV and SMV was not obviously different (P>0.05). In Child A+B group, the portal vein pressure (Ppv) had a close correlation with the portal vein width, blood flow quantitation (Qpv), and blood stream volume (Qsv) of the spleen vein.

CONCLUSIONSThe Qpv in Child A+B grade can be measured by the color Doppler ultrasonography technique, and the portal vein pressure can be monitored easily by the equation of Ppv=1.8951+0.0011Qpv.

Adult ; Blood Flow Velocity ; Female ; Hemodynamics ; Humans ; Hypertension, Portal ; physiopathology ; Male ; Mesenteric Veins ; physiopathology ; Middle Aged ; Portal Pressure ; physiology ; Portal Vein ; physiopathology ; Splenic Vein ; physiopathology ; Ultrasonography, Doppler, Color

BACKGROUND/AIMS: We compared the cirrhosis-prediction accuracy of an ultrasonographic scoring system (USSS) combining six representative sonographic indices with that of liver stiffness measurement (LSM) by transient elastography, and prospectively investigated the correlation between the USSS score and LSM in predicting cirrhosis. METHODS: Two hundred and thirty patients with chronic liver diseases (187 men, 43 women; age, 50.4+/-9.5 y, mean+/-SD) were enrolled in this prospective study. The USSS produces a combined score for nodularity of the liver surface and edge, parenchyma echogenicity, presence of right-lobe atrophy, spleen size, splenic vein diameter, and abnormality of the hepatic vein waveform. The correlations of the USSS score and LSM with that of a pathological liver biopsy (METAVIR scoring system: F0-F4) were evaluated. RESULTS: The mean USSS score and LSM were 7.2 and 38.0 kPa, respectively, in patients with histologically overt cirrhosis (F4, P=0.017) and 4.3 and 22.1 kPa in patients with fibrotic change without overt cirrhosis (F0-F3) (P=0.025). The areas under the receiver operating characteristic (ROC) curves of the USSS score and LSM for F4 patients were 0.849 and 0.729, respectively. On the basis of ROC curves, criteria of USSS > or =6: LSM > or =17.4 had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 89.2%:77.6%, 69.4%:61.4%, 86.5%:83.7%, 74.6%:51.9% and 0.83:0.73, respectively, in predicting F4. CONCLUSIONS: The results indicate that this USSS has comparable efficacy to LSM in the diagnosis of cirrhosis.
Adult ; Area Under Curve ; *Elasticity Imaging Techniques ; Female ; Hepatic Veins/physiopathology ; Humans ; Liver Cirrhosis/pathology/*ultrasonography ; Male ; Middle Aged ; Odds Ratio ; Predictive Value of Tests ; Prospective Studies ; ROC Curve ; Severity of Illness Index ; Spleen/anatomy & histology ; Splenic Vein/physiology

Hepatic myelopathy is a rare complication of chronic liver disease that is associated with extensive portosystemic shunts. The main clinical feature of hepatic myelopathy is progressive spastic paraparesis in the absence of sensory or sphincter impairment. Early and accurate diagnosis of hepatic myelopathy is important because patients with early stages of the disease can fully recover following liver transplantation. Motor-evoked potential studies may be suitable for the early diagnosis of hepatic myelopathy, even in patients with preclinical stages of the disease. Here we describe two patients who presented with spastic paraparesis associated with a spontaneous splenorenal shunt and without any previous episode of hepatic encephalopathy. One patient experienced improved neurologic symptoms after liver transplantation, whereas the other patient only received medical treatment, which did not prevent the progression of spastic paraparesis.
Adult ; Disease Progression ; Evoked Potentials, Motor/physiology ; Hepatitis B, Chronic/complications/diagnosis ; Hepatitis C, Chronic/complications/diagnosis ; Humans ; Liver Cirrhosis/*complications/diagnosis ; Liver Transplantation ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Paraparesis, Spastic/etiology/pathology ; Renal Veins/*radiography ; Spinal Cord Diseases/*diagnosis/etiology/radiography ; Splenic Vein/*radiography ; Tomography, X-Ray Computed ; Vascular Fistula/*radiography