Earlier hepatic vein transit-time measured by contrast ultrasonography reflects intrahepatic hemodynamic changes accompanying cirrhosis.
OBJECTIVE
Non-invasive diagnosis of cirrhosis by transit-time analysis of an ultrasound contrast agent has been reported, even though the mechanism by which contrast arrives to the hepatic vein earlier in cirrhosis than in normal controls is unknown. The aim of this study is to assess whether the earlier appearance of contrast in the hepatic vein depends on intrahepatic or extrahepatic causes.


METHODS
There were 15 participants: six volunteers, three patients with hepatitis, and six with cirrhosis. The contrast agent was given intravenously, and transit-time analysis of the hepatic artery, portal vein and hepatic vein was performed. The time-acoustic intensity curves in the three vessels were analyzed by an image and cineloop display and quantification software package.


RESULTS
The hepatic artery and portal vein arrival times were not significantly different among the three groups. On the other hand, hepatic vein arrival times were significantly earlier in cirrhosis (median 18 seconds) compared with arrival times in hepatitis patients (median 30 seconds, P < 0.001) and in healthy volunteers (median 31 seconds, P < 0.001). These results give support to a previous pilot study and indicate that most of the time delay in hepatic vein arrival time between cirrhosis and the other groups originated from intrahepatic circulation abnormalities.


CONCLUSIONS
This study confirms that the earlier appearance of contrast in the hepatic vein observed in cirrhosis is due to intrahepatic, and not extrahepatic, hemodynamic changes.
Sugimoto
Hiroyuki
H
Department of Surgery II, Nagoya University School of Medicine, Tsurumai-cho 65, Showa-ku, Nagoya 466-8550, Japan. sugi@med.nagoya-u.ac.jp
Kaneko
Tetsuya
T
Hirota
Masashi
M
Tezel
Ekmel
E
Nakao
Akimasa
A
D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000502:physiology; D006503:Hepatic Veins / Q000000981:diagnostic imaging* / Q000502:physiology*; D006801:Humans; D008102:Liver Circulation / Q000502:physiology*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000502:physiology; D018617:Ultrasonography, Doppler, Pulsed
D003287:Contrast Media