title: Assessment of Portal Venous and Hepatic Artery Haemodynamic Variation in Non-Alcoholic Fatty Liver Disease (NAFLD) Patients.
abstract: BACKGROUND
  Non-Alcoholic Fatty Liver Disease (NAFLD) has various spectrums of liver diseases like isolated fatty liver, steatohepatitis and cirrhosis usually progressing in a linear fashion. In this process they are known to cause certain haemodynamic changes in the portal flow and hepatic artery flow.
  
  
  OBJECTIVE
  The aim of the study was to study these haemodynamic changes in patients with NAFLD and to correlate it with the disease severity.
  
  
  METHODS
  Ninety patients diagnosed to have NAFLD based on ultrasound abdomen (30 each in grade1, grade2 and grade3 NAFLD) and 30 controls (Normal liver on ultrasound abdomen) were subjected to portal vein and hepatic artery Doppler study. Peak maximum velocity (Vmax), Peak minimum velocity (Vmin), Mean flow velocity (MFV), and Vein pulsality index (VPI) of the portal vein and hepatic artery resistivity index (HARI) of the hepatic artery were the doppler parameters which were assessed. Liver span was also assessed both for the fatty liver and controls.
  
  
  RESULTS
  The mean Vmax, Vmin, MFV and VPI of the portal vein in patients with NAFLD was 12.23±1.74cm/sec, 9.31±1.45cm/sec, 10.76±1.48cm/sec, and 0.24±0.04 as compared to 14.05±2.43cm/sec, 10.01±2.27cm/sec, 12.23±2.47cm/sec, 0.3±0.08 in controls respectively. All these differences were statistically significant except for Vmin. The Mean HARI in patients with fatty liver was 0.65±0.06 when compared to controls of 0.75±0.06 (p=0.001). HARI (r-value of -0.517) had a better negative correlation followed by VPI (r-value of -0.44) and Vmax (r-value of -0.293) with the severity of NAFLD. MFV had a very weak negative correlation (r-value of -0.182) with the severity of NAFLD.
  
  
  CONCLUSIONS
  The Vmax, MFV, VPI and HARI were significantly less when compared to controls suggesting a reduced portal flow and an increased hepatic arterial flow in patients with NAFLD. Among the parameters, HARI correlated better with the severity of NAFLD followed by VPI.
authors.affiliation: Assistant Professor, Department of Radiology, Aarupadai Veedu Medical College and Hospital , Puducherry, Tamil Nadu, India .
authors.forename: Padhmini
authors.initials: P
authors.lastname: Balasubramanian
authors.affiliation: Associate Professor, Department of Medical Gastroenterology, Aarupadai Veedu Medical College and Hospital , Puducherry, Tamil Nadu, India .
authors.forename: Vinoth
authors.initials: V
authors.lastname: Boopathy
authors.affiliation: Senior Statistician, Sri Balaji Vidyapeeth University , Puducherry, Tamil Nadu, India .
authors.forename: Ezhumalai
authors.initials: E
authors.lastname: Govindasamy
authors.affiliation: Professor and Head of Department, Department of Radiology, Aarupadai Veedu Medical College and Hospital , Puducherry, Tamil Nadu, India .
authors.forename: Basavaiya Prabhu
authors.initials: BP
authors.lastname: Venkatesh
keywords: Hepatic artery resistivity index; Portal doppler; Portal vein pulsality index