title: Hepatic Venous Waveform, Splenoportal and Damping Index in Liver Cirrhosis: Correlation with Child Pugh's Score and Oesophageal Varices.
abstract: BACKGROUND
  Clinical assessment of chronic liver disease is done by Modified Child Pugh's and Model for end-stage liver disease scoring system. Measurement of hepatic venous pressure gradient (HVPG) and Upper GI Endoscopy are considered the gold standards for measurement of portal hypertension in cirrhotics. There is a need for non-invasive evaluation of portal hypertension. Ultrasonography with colour and spectral Doppler evaluation may be an effective, rapid and inexpensive alternative.
  
  
  OBJECTIVE
  To evaluate hepatic venous waveform, damping index, splenoportal index in patients of cirrhosis on Colour Doppler ultrasound, also predict severity of portal hypertension and presence of oesophageal varices.
  
  
  METHODS
  Thirty patients of chronic liver disease were included in the study. Ultrasound and colour Doppler was done to look hepatic venous waveform pattern, Damping Index (DI), and Splenoportal Index (SPI). Contrast-enhanced Computed Tomography scan (CT) was done if renal function tests were normal, else endoscopy when the renal function tests were deranged to look for oesophageal varices.
  
  
  RESULTS
  Twenty two (73.3%) patients had monophasic waveform. Biphasic and triphasic waveforms were seen in 4 (13.3%) cases. Twenty two patients (73.3%) had monophasic waveforms and majority of them were in class C. This distribution of hepatic vein waveform was statistically significantly with the Child Pugh's class (p<0.05). Twenty patients (66.7%) had value of Damping index more than >0.6 where majority of patients (18) belonged to class C and 2 in class B. There was a positive correlation between Child Pugh's total score and Damping index (r=0.614; p<0.05). There was weak positive correlation between splenoportal index and Child Pugh's score (r=0.269; p=0.15).
  
  
  CONCLUSIONS
  Change in triphasic to monophasic waveform and DI >0.6 suggests severe liver dysfunction and is associated with severe portal hypertension. Hepatic venous waveform pressure changes, DI and SPI have no value in predicting presence of oesophageal varices.
authors.affiliation: Postgraduate Resident, Department of Radiodiagnosis, VMMC & Safdarjung Hospital , New Delhi, India .
authors.forename: Neha
authors.initials: N
authors.lastname: Antil
authors.affiliation: Senior Resident, Department of Radiodiagnosis, VMMC & Safdarjung Hospital , New Delhi, India .
authors.forename: Binit
authors.initials: B
authors.lastname: Sureka
authors.affiliation: Professor, Department of Radiodiagnosis, VMMC & Safdarjung Hospital , New Delhi, India .
authors.forename: Mahesh Kumar
authors.initials: MK
authors.lastname: Mittal
authors.affiliation: Senior Specialist and Associate Professor, Department of Radiodiagnosis, VMMC & Safdarjung Hospital , New Delhi, India .
authors.forename: Amita
authors.initials: A
authors.lastname: Malik
authors.affiliation: Professor, Department of Medicine, VMMC & Safdarjung Hospital , New Delhi, India .
authors.forename: Bhupender
authors.initials: B
authors.lastname: Gupta
authors.affiliation: Head of Department, Department of Radiodiagnosis, VMMC & Safdarjung Hospital , New Delhi, India .
authors.forename: Brij Bhushan
authors.initials: BB
authors.lastname: Thukral
keywords: Colour Doppler ultrasound; Hepatic vein