Specificity of splenic blood flow in liver cirrhosis.
The association between portal hypertension, splenomegaly and splenic hemodynamics has not been clearly defined until these days. Therefore, hemodynamics of splenic blood vessels and the role of spleen in portal hypertension were the aim of our study.


METHODS
Study included 44 patients with liver cirrhosis and splenomegaly and 25 healthy controls. Using color Doppler duplex ultrasonography, morphological and hemodynamic parameters of portal hypertension were analysed: liver and spleen diameters, presence of ascites, morphology of portal and splenic vein; portal and splenic vein flow velocity, hepatic and splenic artery velocity, arterial resistive and pulsatile Doppler indices.


RESULTS
In patients with liver cirrhosis, significant differences of venous flow in the liver and spleen were found, compared to the control group (p<0.05). Also, splenic vein flow was significantly faster than in the portal vein. On the contrary, in healthy controls, splenic vein flow was significantly slower than in the portal vein. Mean systolic splenic artery velocity in liver cirrhosis was considerably slower (51.07+/-11.91 cm/sec) than in the control group (58.50+/-13.31 cm/sec), while mean diastolic velocity in splenic artery (18.3+/-7.9 cm/sec) was approximate to the flow in the controls (19.76+/-5.58 cm/sec) (p>0.05). In patients with liver cirrhosis, mean systolic (51.07+/-11.91 cm/sec) and mean diastolic velocities (18.3+/-7.9 cm/sec) in the splenic artery were significantly faster than the mean systolic (42.58+/-14.54 cm/sec) and mean diastolic (12.07+/-5.59 cm/sec) velocities in hepatic artery (p<0.05). In patients with liver cirrhosis, mean resistive index (RI) of splenic artery was significantly lower (0.64+/-0.11) compared to mean RI of hepatic artery (0.72+/-0.08) (p<0.001). In healthy controls, mean RI of splenic artery was also significantly lower than mean RI of hepatic artery (p<0.001). In patients with liver cirrhosis, mean pulsatile index (PI) of splenic artery was significantly lower (1.24+/-0.47) than mean PI of hepatic artery (1.56+/-0.46) (p<0.01). In healthy controls, mean PI of spenic artery was significantly lower (1.17+/-0.36) than mean PI of hepatic artery (1.64+/-0.48) (p<0.001), as the result of high diastolic velocity in splenic artery.


CONCLUSIONS
We consider that high diastolic velocity in splenic artery is a specific phenomenon and may be a kind of modulated response to hypokinetic venous flow in portal hypertension.
Perisić
Mirjana D
MD
Institute of Digestive Diseases, Clinical Center of Serbia, Belgrade, Serbia and Montenegro. dusansa@drenik.net
Culafić
Dj M
DjM
Kerkez
M
M
D001783:Blood Flow Velocity; D016022:Case-Control Studies; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood; D008103:Liver Cirrhosis / Q000097:blood* / Q000209:etiology; D012016:Reference Values; D013152:Splanchnic Circulation; D013154:Spleen / Q000098:blood supply* / Q000000981:diagnostic imaging; D013157:Splenic Artery; D013162:Splenic Vein; D018616:Ultrasonography, Doppler, Duplex