Duplex Doppler ultrasound of the hepatic artery in patients with acute alcoholic hepatitis.
BACKGROUND
Acute alcoholic hepatitis (AAH) is a clinical diagnosis associated with increased hepatic artery diameter and flow. Duplex Doppler ultrasound (DDU) has been shown to accurately measure arterial flow in both liver and kidney transplant patients. The authors conducted a blinded, controlled study to evaluate the accuracy of measuring hepatic artery parameters with DDU in diagnosing AAH.


METHODS
Duplex Doppler ultrasound was performed by an investigator, blinded to group makeup, on 22 consecutive hospital inpatients with the clinical diagnosis of AAH. The diagnosis of AAH was based on specific criteria, including the following: recent alcohol abuse, hyperbilirubinemia, prolonged prothrombin time, leukocytosis, hepatomegaly, hepatic bruit, and marked redistribution of isotope on 99mTc-sulfur colloid liver-spleen scan. Controls were 12 cirrhotic patients without AAH and 17 healthy volunteers. Duplex Doppler ultrasound measurements were obtained most consistently from the proximal right hepatic artery. Measured parameters included the following: peak systolic velocity (PSV); resistive index = (PSV - end diastolic velocity [EDV])/PSV; pulsatility index = (PSV - EDV)/mean velocity; and hepatic artery diameter.


RESULTS
The mean hepatic artery diameter was significantly larger in patients with AAH (3.55 +/- 0.72 mm) than in patients with cirrhosis (2.75 +/- 0.69 mm; p = 0.003) and healthy controls (2.68 +/- 0.69 mm; p = 0.001). The mean PSV was significantly higher in patients with AAH (187 +/- 52 cm/s) compared with cirrhotic (67 +/- 51 cm/s) and healthy (66 +/- 51 cm/s) controls (p = 0.0001). The mean resistive index was lower in AAH patients (0.60 +/- 0.11) compared with cirrhotic (0.69 +/- 0.10; p value was not significant) and healthy controls (0.72 +/- 0.11; p = 0.004). The mean pulsatility index was lower in AAH patients (1.04 +/- 0.47) compared with cirrhotic (1.36 +/- 0.45; p value was not significant) and healthy controls (1.53 +/- 0.45; p = 0.01).


CONCLUSIONS
In the appropriate clinical setting, an elevated hepatic artery diameter or PSV measurement is suggestive of AAH. Duplex Doppler ultrasound offers a noninvasive test to assist in the diagnosis of AAH.
Han
Steven-Huy B
SH
Division of Gastrointestinal and Liver Diseases, School of Medicine, University of Southern California, Los Angeles, CA, USA. shbhan@ucla.edu
Rice
Susan
S
Cohen
Stanley M
SM
Reynolds
Telfer B
TB
Fong
Tse-Ling
TL
D000208:Acute Disease; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006519:Hepatitis, Alcoholic / Q000000981:diagnostic imaging*; D006801:Humans; D008102:Liver Circulation / Q000502:physiology; D008104:Liver Cirrhosis, Alcoholic / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow / Q000502:physiology; D018616:Ultrasonography, Doppler, Duplex; D014655:Vascular Resistance / Q000502:physiology