title: Values of Doppler sonography predicts high risk variceal bleeding in patients with viral cirrhosis.
abstract: OBJECTIVE
  Gastrointestinal bleeding such as rupture of esophagogastric varices remains one of the leading causes of death in patients with liver cirrhosis. As a critical issue, assessment of the bleeding risk of esophageal varices is extremely important. In the present study, by determining the relationship between several parameters measured by pulsed Doppler sonography and the bleeding risk of esophageal varices assessed by upper endoscopy, we investigated what is the most valuable parameter as a supplement to the bleeding risk.
  
  
  METHODS
  A total of 158 patients with hepatitis virus-infected liver cirrhosis (56 positive for HBs antigen and 102 positive for HCV antibody) were studied. As controls, 171 normal subjects were used. The flow volumes of the portal trunk and the splenic vein, the Congestion Index, and the S/P ratio were measured by pulsed Doppler sonography. Based on upper endoscopic findings, we classified the patients into two groups based on bleeding risk of esophageal varices: high-risk and low-risk. Logistic regression analysis was employed to identify the most valuable parameter as a supplement to the bleeding risk.
  
  
  RESULTS
  The flow volume of the splenic vein, the Congestion Index, and the S/P ratio in cirrhotic patients with esophageal varices were significantly higher than those in normal subjects (P = 0.000). The mean flow volumes of the portal trunk and splenic vein and the mean of the S/P ratio in the high-risk group for bleeding of esophageal varices were significantly higher than those in the low-risk group (P = 0.000-0.005). Based on logistic regression analysis, the flow volume of the splenic vein was found to be the most valuable parameter for bleeding risk (P < 0.001).
  
  
  CONCLUSIONS
  The flow volume of splenic vein with pulsed Doppler sonography was the most valuable parameter for the bleeding risk of esophageal varices.
authors.affiliation: Laboratory Medicine, Teikyo University Mizonokuchi Hospital, Kanagawa 213-8507, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tsubaki
authors.forename: Shinpei
authors.initials: S
authors.lastname: Sato
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Fujikawa
authors.forename: Yumi
authors.initials: Y
authors.lastname: Kawashima
authors.forename: Eriko
authors.initials: E
authors.lastname: Kitazawa
authors.forename: Atsuko
authors.initials: A
authors.lastname: Takai
authors.forename: Kentarou
authors.initials: K
authors.lastname: Kikuchi
authors.forename: Toshio
authors.initials: T
authors.lastname: Morizane
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyakawa
mesh_terms: D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D016015:Logistic Models; D011168:Portal System / Q000503:physiopathology; D012039:Regional Blood Flow; D013162:Splenic Vein / Q000000981:diagnostic imaging; D018617:Ultrasonography, Doppler, Pulsed