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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

Diffuse intrahepatic APFs with indiscoverable focal lesion, confirmed by multimode imaging findings. (A) Color duplex US images of the intrahepatic branches of the portal vein with normal internal diameter shown as typical arterial-like (a: left branch) or diphase velocity (b: right branch) tracings, as indicated by a systolic hepatofugal dwarf peak and a diastolic hepatopetal low flat shape, and that of the enlarged intrahepatic branches of the hepatic artery, which shows high-velocity flow and low resistivity index (c: left branch, d: right branch). (B) Dynamic CEUS scans show that microbubbles arrived at the affected portal vein and at its parallel running artery in the early arterial phase 7–10 s after SonoVue injection (a: left branch, b: right branch), with the affected portal vein markedly enhanced by the microbubbles during the arterial phase (c: left branch, d: right branch) and which became more echogenic than its surrounding parenchyma until the hepatic veins were stained (e: left branch, f: right branch). (C) The contrast-enhanced CT images show an earlier enhancement of the affected portal vein than that of the superior mesenteric vein during the arterial phase (a: right anterior branch, b: right posterior branch, c: left branch, d: the enhancement of the superior mesenteric artery but no enhancement of its parallel running vein). (D) DSA reveals the opacification of the portal vein following its parallel running artery but no visible fistula during the early arterial phase (a: opacification of hepatic artery, b: opacification of peripheric portal vein, c: opacification of left and right branches of portal vein, d: opacification of superior mesenteric and splenic vein).
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f3-rado-46-03-198: Diffuse intrahepatic APFs with indiscoverable focal lesion, confirmed by multimode imaging findings. (A) Color duplex US images of the intrahepatic branches of the portal vein with normal internal diameter shown as typical arterial-like (a: left branch) or diphase velocity (b: right branch) tracings, as indicated by a systolic hepatofugal dwarf peak and a diastolic hepatopetal low flat shape, and that of the enlarged intrahepatic branches of the hepatic artery, which shows high-velocity flow and low resistivity index (c: left branch, d: right branch). (B) Dynamic CEUS scans show that microbubbles arrived at the affected portal vein and at its parallel running artery in the early arterial phase 7–10 s after SonoVue injection (a: left branch, b: right branch), with the affected portal vein markedly enhanced by the microbubbles during the arterial phase (c: left branch, d: right branch) and which became more echogenic than its surrounding parenchyma until the hepatic veins were stained (e: left branch, f: right branch). (C) The contrast-enhanced CT images show an earlier enhancement of the affected portal vein than that of the superior mesenteric vein during the arterial phase (a: right anterior branch, b: right posterior branch, c: left branch, d: the enhancement of the superior mesenteric artery but no enhancement of its parallel running vein). (D) DSA reveals the opacification of the portal vein following its parallel running artery but no visible fistula during the early arterial phase (a: opacification of hepatic artery, b: opacification of peripheric portal vein, c: opacification of left and right branches of portal vein, d: opacification of superior mesenteric and splenic vein).

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)

Diffuse intrahepatic APFs with indiscoverable focal lesion, confirmed by multimode imaging findings. (A) Color duplex US images of the intrahepatic branches of the portal vein with normal internal diameter shown as typical arterial-like (a: left branch) or diphase velocity (b: right branch) tracings, as indicated by a systolic hepatofugal dwarf peak and a diastolic hepatopetal low flat shape, and that of the enlarged intrahepatic branches of the hepatic artery, which shows high-velocity flow and low resistivity index (c: left branch, d: right branch). (B) Dynamic CEUS scans show that microbubbles arrived at the affected portal vein and at its parallel running artery in the early arterial phase 7–10 s after SonoVue injection (a: left branch, b: right branch), with the affected portal vein markedly enhanced by the microbubbles during the arterial phase (c: left branch, d: right branch) and which became more echogenic than its surrounding parenchyma until the hepatic veins were stained (e: left branch, f: right branch). (C) The contrast-enhanced CT images show an earlier enhancement of the affected portal vein than that of the superior mesenteric vein during the arterial phase (a: right anterior branch, b: right posterior branch, c: left branch, d: the enhancement of the superior mesenteric artery but no enhancement of its parallel running vein). (D) DSA reveals the opacification of the portal vein following its parallel running artery but no visible fistula during the early arterial phase (a: opacification of hepatic artery, b: opacification of peripheric portal vein, c: opacification of left and right branches of portal vein, d: opacification of superior mesenteric and splenic vein).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f3-rado-46-03-198: Diffuse intrahepatic APFs with indiscoverable focal lesion, confirmed by multimode imaging findings. (A) Color duplex US images of the intrahepatic branches of the portal vein with normal internal diameter shown as typical arterial-like (a: left branch) or diphase velocity (b: right branch) tracings, as indicated by a systolic hepatofugal dwarf peak and a diastolic hepatopetal low flat shape, and that of the enlarged intrahepatic branches of the hepatic artery, which shows high-velocity flow and low resistivity index (c: left branch, d: right branch). (B) Dynamic CEUS scans show that microbubbles arrived at the affected portal vein and at its parallel running artery in the early arterial phase 7–10 s after SonoVue injection (a: left branch, b: right branch), with the affected portal vein markedly enhanced by the microbubbles during the arterial phase (c: left branch, d: right branch) and which became more echogenic than its surrounding parenchyma until the hepatic veins were stained (e: left branch, f: right branch). (C) The contrast-enhanced CT images show an earlier enhancement of the affected portal vein than that of the superior mesenteric vein during the arterial phase (a: right anterior branch, b: right posterior branch, c: left branch, d: the enhancement of the superior mesenteric artery but no enhancement of its parallel running vein). (D) DSA reveals the opacification of the portal vein following its parallel running artery but no visible fistula during the early arterial phase (a: opacification of hepatic artery, b: opacification of peripheric portal vein, c: opacification of left and right branches of portal vein, d: opacification of superior mesenteric and splenic vein).
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