title: Reliability of the estimation of total hepatic blood flow by Doppler ultrasound in patients with cirrhotic portal hypertension.
abstract: OBJECTIVE
  Hepatic blood flow (HBF) is best estimated by the Fick's method during indocyanine green constant infusion (ICG-HBF) on hepatic vein catheterization. We investigated the consistency and agreement of HBF measured by Doppler ultrasound (US-HBF) as compared with ICG-HBF in portal hypertensive patients with cirrhosis.
  
  
  METHODS
  In 50 patients observed for HVPG measurement (56% compensated; Child score 7 ± 2; HVPG 16.6 ± 6.0 mmHg; varices in 75%) US-HBF (Sequoia-512-Acuson; 4.5-7 MHz convex probe; US-HBF = hepatic artery blood flow+portal vein blood flow) and ICG-HBF (Fick's method after an equilibration period of at least 45 min of ICG bolus of 5 mg + constant rate infusion of 0.2 mg/min). Intraclass correlation coefficient (ICC) for consistency and absolute agreement between US-HBF and ICG-HBF were calculated.
  
  
  RESULTS
  Mean ICG-HBF and US-HBF were similar, being respectively 1004 ± 543 ml/min and 994 ± 494 ml/min (p = 0.661 vs. ICG-HBF). However, results in individual patients disclosed marked differences between the two methods (386 ± 415 ml/min) and showed only moderate consistency (ICC 0.456; p < 0.0001), absolute agreement (ICC 0.461; p < 0.0001) and linear correlation (R = 0.464; p < 0.0001). The discrepancy between the two methods was maximal in patients with poor liver function, high HBF by any technique and more arterialized liver circulation. Hepatic artery blood flow ≥40% of US-HBF indicated, with 90% specificity, a discrepancy ≥20% between US-HBF and ICG-HBF.
  
  
  CONCLUSIONS
  HBF estimations by Doppler-ultrasound and ICG are significantly correlated, but their discrepancy in individual cases is high. Estimation of HBF by Doppler-US should be considered unreliable in patients with poor hepatic function and large liver arterialization.
authors.affiliation: Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Spain; Centre de Diagnostic per l'Imatge, Hospital Clinic, Barcelona, Spain.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Berzigotti
authors.forename: Enric
authors.initials: E
authors.lastname: Reverter
authors.forename: Angeles
authors.initials: A
authors.lastname: García-Criado
authors.forename: Juan G
authors.initials: JG
authors.lastname: Abraldes
authors.forename: Federica
authors.initials: F
authors.lastname: Cerini
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: García-Pagán
authors.forename: Jaime
authors.initials: J
authors.lastname: Bosch
mesh_terms: D000368:Aged; D002404:Catheterization; D004396:Coloring Agents; D005260:Female; D006503:Hepatic Veins; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D007208:Indocyanine Green; D008102:Liver Circulation / Q000502:physiology*; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D018608:Ultrasonography, Doppler
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: HVPG; Hepatic veins; Non-invasive methods; Portal hypertension