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Fluctuating portal velocity tracing with rhythmicity: ultrasonic differential diagnosis and clinical significance.

Meng Q, Lv L, Yang B, Fu N, Lu G - Radiol Oncol (2012)

Bottom Line: The waveform of the velocity tracing for the portal vein of CTS patients, especially its intrahepatic branches, showed a typical hump-like shape with or without a transitory hepatofugal tracing.The PW results displayed an increase in the retrograde phase of the hepatic venous flow with increased velocities in the two phases.Portal velocity tracings should be evaluated during routine detecting for APF or CTS, especially in patients with gastrointestinal upsets.

View Article: PubMed Central - PubMed

Affiliation: Department of Ultrasound.

ABSTRACT

Background: To evaluate the usefulness of the routine sonographic evaluation of the pattern of fluctuate portal velocity tracings and the hepatic veins for the diagnosis of arterioportal fistula (APF) and cardiogenic trans-sinusoidal shunting (CTS). MATERIALS AND METHODS.: Color Doppler flow imaging and pulsed-wave Doppler (PW) examinations of the portal vein were performed in 282 subjects. The waveforms of the velocity tracings in the portal main trunk and its branches were determined to infer APF or CTS. Suspected cases of APFs or CTSs were always confirmed by echocardiography, contrast-enhanced ultrasound, computed tomography, or digital subtraction angiography findings. The portal maximum velocity (V(max)), minimum velocity(V(min)), V(max)/V(min), arterial peak systolic velocity and resistance index, and venous reverse and forward velocities were used to estimate their haemodynamics.

Results: The waveform of the velocity tracing for the draining portal vein of APF was typically arterial-like or diphase, as indicated by a systolic hepatofugal dwarf peak and a diastolic hepatopetal low flat shape. The flow in the affected portal vein was always hepatofugal in an intrahepatic patient, whereas a hepatopetal flow was observed in an extrahepatic APF patient. The waveform of the velocity tracing for the portal vein of CTS patients, especially its intrahepatic branches, showed a typical hump-like shape with or without a transitory hepatofugal tracing. The PW results displayed an increase in the retrograde phase of the hepatic venous flow with increased velocities in the two phases.

Conclusions: Portal velocity tracings should be evaluated during routine detecting for APF or CTS, especially in patients with gastrointestinal upsets.

No MeSH data available.


Related in: MedlinePlus

US findings for a typical intrahepatic APF. (A) The dilated draining left portal vein. (B) The arterial-like velocity tracing of the draining portal vein with a continuous hepatofugal flow. (C) The turbulent area of APF. (D) The velocity tracing of a feeding artery with fast flow and a low RI.
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f2-rado-46-03-198: US findings for a typical intrahepatic APF. (A) The dilated draining left portal vein. (B) The arterial-like velocity tracing of the draining portal vein with a continuous hepatofugal flow. (C) The turbulent area of APF. (D) The velocity tracing of a feeding artery with fast flow and a low RI.

Mentions: An echo-free focal lesion in continuity with a markedly hypertrophied feeding artery and a dilated draining portal vein, which showed a fast and turbulent flow during the CDFI and PW examinations, (Figure 2) was considered a direct indication of APF. The affected portal vein occasionally showed no enlargement with indiscoverable focal lesions. The waveform of its velocity tracing was typically arterial-like or diphase, as indicated by a systolic hepatofugal dwarf peak and a diastolic hepatopetal low flat shape (Figure 3A).


Fluctuating portal velocity tracing with rhythmicity: ultrasonic differential diagnosis and clinical significance.

Meng Q, Lv L, Yang B, Fu N, Lu G - Radiol Oncol (2012)

US findings for a typical intrahepatic APF. (A) The dilated draining left portal vein. (B) The arterial-like velocity tracing of the draining portal vein with a continuous hepatofugal flow. (C) The turbulent area of APF. (D) The velocity tracing of a feeding artery with fast flow and a low RI.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3472948&req=5

f2-rado-46-03-198: US findings for a typical intrahepatic APF. (A) The dilated draining left portal vein. (B) The arterial-like velocity tracing of the draining portal vein with a continuous hepatofugal flow. (C) The turbulent area of APF. (D) The velocity tracing of a feeding artery with fast flow and a low RI.
Mentions: An echo-free focal lesion in continuity with a markedly hypertrophied feeding artery and a dilated draining portal vein, which showed a fast and turbulent flow during the CDFI and PW examinations, (Figure 2) was considered a direct indication of APF. The affected portal vein occasionally showed no enlargement with indiscoverable focal lesions. The waveform of its velocity tracing was typically arterial-like or diphase, as indicated by a systolic hepatofugal dwarf peak and a diastolic hepatopetal low flat shape (Figure 3A).

Bottom Line: The waveform of the velocity tracing for the portal vein of CTS patients, especially its intrahepatic branches, showed a typical hump-like shape with or without a transitory hepatofugal tracing.The PW results displayed an increase in the retrograde phase of the hepatic venous flow with increased velocities in the two phases.Portal velocity tracings should be evaluated during routine detecting for APF or CTS, especially in patients with gastrointestinal upsets.

View Article: PubMed Central - PubMed

Affiliation: Department of Ultrasound.

ABSTRACT

Background: To evaluate the usefulness of the routine sonographic evaluation of the pattern of fluctuate portal velocity tracings and the hepatic veins for the diagnosis of arterioportal fistula (APF) and cardiogenic trans-sinusoidal shunting (CTS). MATERIALS AND METHODS.: Color Doppler flow imaging and pulsed-wave Doppler (PW) examinations of the portal vein were performed in 282 subjects. The waveforms of the velocity tracings in the portal main trunk and its branches were determined to infer APF or CTS. Suspected cases of APFs or CTSs were always confirmed by echocardiography, contrast-enhanced ultrasound, computed tomography, or digital subtraction angiography findings. The portal maximum velocity (V(max)), minimum velocity(V(min)), V(max)/V(min), arterial peak systolic velocity and resistance index, and venous reverse and forward velocities were used to estimate their haemodynamics.

Results: The waveform of the velocity tracing for the draining portal vein of APF was typically arterial-like or diphase, as indicated by a systolic hepatofugal dwarf peak and a diastolic hepatopetal low flat shape. The flow in the affected portal vein was always hepatofugal in an intrahepatic patient, whereas a hepatopetal flow was observed in an extrahepatic APF patient. The waveform of the velocity tracing for the portal vein of CTS patients, especially its intrahepatic branches, showed a typical hump-like shape with or without a transitory hepatofugal tracing. The PW results displayed an increase in the retrograde phase of the hepatic venous flow with increased velocities in the two phases.

Conclusions: Portal velocity tracings should be evaluated during routine detecting for APF or CTS, especially in patients with gastrointestinal upsets.

No MeSH data available.


Related in: MedlinePlus