title: Doppler assessment of hepatic venous waves for predicting large varices in cirrhotic patients.
abstract: OBJECTIVE
  Color Doppler examination of changes in hepatic venous waveforms is being evaluated as a means of prediction of severity of portal hypertension and presence of esophageal varices. Normal hepatic venous waveform shows a triphasic pattern. In cirrhosis, this pattern changes to a biphasic or monophasic pattern. We aimed to study the sensitivity of loss of normal hepatic venous waveforms in predicting large varices in a cross-sectional analysis.
  
  
  METHODS
  All patients, admitted or attending the outpatient department, with a diagnosis of cirrhosis were included in the study. All patients were subjected to oesophagogastroduodenoscopy and Color Doppler examination, and waveform patterns in hepatic vein were recorded. The sensitivity and specificity of changes in waveform in detecting large varices were studied.
  
  
  RESULTS
  A total of 51 cases were examined. Triphasic waves were seen in 4 (7.8%) cases, biphasic in 26 (51%) cases, and monophasic in 21 (41.2%) cases. Small varices were seen in 30 (58.8%) cases and large varices in 21 (41.2%) cases. The sensitivity of loss of the triphasic wave pattern in detecting significant varices (Grade 3 or 4) was very high (95.23%) and negative predictive value was also high (75%). Severity of liver disease as indicated by Child-Pugh and MELD scores did not correlate with changes in hepatic venous waveforms.
  
  
  CONCLUSIONS
  Loss of triphasic hepatic venous waveform is highly sensitive in predicting significant varices in patients with cirrhosis.
authors.affiliation: Department of Medical Gastroenterology, Medical College, Thiruvananthapuram, Kerala, India. drthomasjos@yahoo.com.in
authors.forename: Thomas
authors.initials: T
authors.lastname: Joseph
authors.forename: Mukunda
authors.initials: M
authors.lastname: Madhavan
authors.forename: Krishnadas
authors.initials: K
authors.lastname: Devadas
authors.forename: Vinayakumar K
authors.initials: VK
authors.lastname: Ramakrishnannair
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012039:Regional Blood Flow / Q000502:physiology; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult