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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 extrahepatic APFs with indiscoverable focal lesions, confirmed by multimode imaging findings. (A) Color duplex US images of the portal system with normal internal diameter demonstrate typical arterial-like results with a continuous hepatopetal flow (a: right branch, b: left branch, c: sup. segmental brr., d: main trunk, e: superior mesenteric vein, f: splenic vein). (B) High-resistivity of multiple organs (a: triphase velocity tracing of abdominal aorta, b: triphase velocity tracing of hepatic artery, c: velocity tracing of intrahepatic artery with a high RI, d: hypertrophic left ventricular wall with aortic and mitral regurgitation). (C) Stronger enhancement of the affected superior mesenteric and splenic vein than that of the portal vein. (a: left branch, b: right posterior branch c: equal enhancement of superior mesenteric vein and its parallel running artery, d: stronger enhancement of the affected splenic vein than that of portal vein).
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f4-rado-46-03-198: Diffuse extrahepatic APFs with indiscoverable focal lesions, confirmed by multimode imaging findings. (A) Color duplex US images of the portal system with normal internal diameter demonstrate typical arterial-like results with a continuous hepatopetal flow (a: right branch, b: left branch, c: sup. segmental brr., d: main trunk, e: superior mesenteric vein, f: splenic vein). (B) High-resistivity of multiple organs (a: triphase velocity tracing of abdominal aorta, b: triphase velocity tracing of hepatic artery, c: velocity tracing of intrahepatic artery with a high RI, d: hypertrophic left ventricular wall with aortic and mitral regurgitation). (C) Stronger enhancement of the affected superior mesenteric and splenic vein than that of the portal vein. (a: left branch, b: right posterior branch c: equal enhancement of superior mesenteric vein and its parallel running artery, d: stronger enhancement of the affected splenic vein than that of portal vein).

Mentions: The right or left branch of the portal vein draining blood from the intrahepatic APF always had a hepatofugal flow, whereas that in the other lobe had a hepatopetal flow. The flow in the main trunk of the portal vein was always hepatopetal with a markedly decreased velocity in an intrahepatic APF patient but with a markedly increased velocity in an extrahepatic APF patient, whose flow directions in the two main branches of the portal vein were hepatopetal (Figures 2, 3A, 4A).


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 extrahepatic APFs with indiscoverable focal lesions, confirmed by multimode imaging findings. (A) Color duplex US images of the portal system with normal internal diameter demonstrate typical arterial-like results with a continuous hepatopetal flow (a: right branch, b: left branch, c: sup. segmental brr., d: main trunk, e: superior mesenteric vein, f: splenic vein). (B) High-resistivity of multiple organs (a: triphase velocity tracing of abdominal aorta, b: triphase velocity tracing of hepatic artery, c: velocity tracing of intrahepatic artery with a high RI, d: hypertrophic left ventricular wall with aortic and mitral regurgitation). (C) Stronger enhancement of the affected superior mesenteric and splenic vein than that of the portal vein. (a: left branch, b: right posterior branch c: equal enhancement of superior mesenteric vein and its parallel running artery, d: stronger enhancement of the affected splenic vein than that of portal vein).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f4-rado-46-03-198: Diffuse extrahepatic APFs with indiscoverable focal lesions, confirmed by multimode imaging findings. (A) Color duplex US images of the portal system with normal internal diameter demonstrate typical arterial-like results with a continuous hepatopetal flow (a: right branch, b: left branch, c: sup. segmental brr., d: main trunk, e: superior mesenteric vein, f: splenic vein). (B) High-resistivity of multiple organs (a: triphase velocity tracing of abdominal aorta, b: triphase velocity tracing of hepatic artery, c: velocity tracing of intrahepatic artery with a high RI, d: hypertrophic left ventricular wall with aortic and mitral regurgitation). (C) Stronger enhancement of the affected superior mesenteric and splenic vein than that of the portal vein. (a: left branch, b: right posterior branch c: equal enhancement of superior mesenteric vein and its parallel running artery, d: stronger enhancement of the affected splenic vein than that of portal vein).
Mentions: The right or left branch of the portal vein draining blood from the intrahepatic APF always had a hepatofugal flow, whereas that in the other lobe had a hepatopetal flow. The flow in the main trunk of the portal vein was always hepatopetal with a markedly decreased velocity in an intrahepatic APF patient but with a markedly increased velocity in an extrahepatic APF patient, whose flow directions in the two main branches of the portal vein were hepatopetal (Figures 2, 3A, 4A).

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