Quantitative analysis of Doppler waveform of hepatic veins for assessment of hepatic functional reserve.
OBJECTIVE
The Doppler waveform of hepatic veins in healthy humans is a triphasic waveform (two negative waves and one positive). Recent studies emphasize the role of Doppler ultrasonography in the evaluation of liver cirrhosis. The analysis of the Doppler waveform of hepatic veins might be a useful and non-invasive method to assess hepatic functional reserve and the amount of the liver to be excised.


METHODS
In 30 patients scheduled for hepatectomy, we performed quantitative analysis of the Doppler waveform of hepatic veins and correlated the Pulsatility Index (PI) and Resistance Index (RI) with ICG clearance values and histologic findings of resected liver specimens in order to ascertain the clinical utility of this method.


RESULTS
The mean (+/-SE) values of PI and RI were 1.31 +/- 0.10 and 0.82 +/- 0.03, respectively, and both values are diminished according to the severity of cirrhosis and very closely correlated with fibrosis of the liver-reflected hepatic consistency (PI: r = -0.611, p = 0.0010; RI: r = -0.647, p = 0.0005). They were also correlated with ICG clearance values to some extent, but several discrepant cases were observed. In four of the discrepant cases (ICGR15 < or = 10%, but PI and RI <mean values), less invasive resections were performed than preoperatively proposed.


CONCLUSIONS
These results suggested the usefulness of the analysis of the Doppler waveform of hepatic veins as an easy, non-invasive and reliable method for determining hepatic functional reserve and the amount of the liver to be excised.
Oshima
Kenji
K
Department of Surgery II, Nagoya University, Graduate School of Medicine, Nagoya, Japan. knj.big-island@ac.cyberhome.ne.jp
Kaneko
Tetsuya
T
Kawase
Yoshihisa
Y
Nakao
Akimasa
A
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005355:Fibrosis; D006498:Hepatectomy; D006503:Hepatic Veins / Q000000981:diagnostic imaging*; D006801:Humans; D008099:Liver / Q000473:pathology; D008111:Liver Function Tests / Q000379:methods*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011446:Prospective Studies; D011673:Pulsatile Flow; D018617:Ultrasonography, Doppler, Pulsed