title: Macro- and microcirculation patterns of intrahepatic blood flow changes in patients with hereditary hemorrhagic telangiectasia.
abstract: OBJECTIVE
  To evaluated vascular dynamic processes in the liver of hereditary hemorrhagic telangiectasia (HHT) patients by ultrasound (US) considering quantitative analytic methods.
  
  
  METHODS
  The imaging features on US and contrast-enhanced ultrasound (CEUS) in 18 patients diagnosed with HHT were retrospectively analyzed. Regarding CEUS, real-time contrast harmonic imaging and sulfur hexafluoride-filled microbubbles were used.
  
  
  RESULTS
  HVaMs were identified in all 18 patients. By US, the two major Caselitz criteria could be detected in 55.6% patients. "Color spots" were detected in 72.2% of the cases. Respecting sonographic grading criteria by Buscarini, grade 3 could be demonstrated most frequent (40%). By CEUS, all the patients showed quick and early hyperenhancement during the arterial phase. Significant lowest time to peak (TTP) and highest area under the curve (AUC) values were identified in the hepatic artery (TTP: 69.8%; AUC: 100%) and highest TTP and lowest AUC in the hepatic parenchyma and the portal vein.
  
  
  CONCLUSIONS
  For the first time we analyzed CEUS findings of a group of HHT patients regarding macro- and microcirculation. Our data demonstrate significant differences in TTP and AUC values in the four selected regions: hepatic artery, shunt region, portal vein and hepatic parenchyma.
authors.affiliation: Roland C Schelker, Christina Hart, Wolfgang Herr, Department of Internal Medicine III, Hematology and Oncology, University Hospital of Regensburg, 93051 Regensburg, Germany.
authors.forename: Roland C
authors.initials: RC
authors.lastname: Schelker
authors.affiliation: Roland C Schelker, Christina Hart, Wolfgang Herr, Department of Internal Medicine III, Hematology and Oncology, University Hospital of Regensburg, 93051 Regensburg, Germany.
authors.forename: Ana P
authors.initials: AP
authors.lastname: Barreiros
authors.affiliation: Roland C Schelker, Christina Hart, Wolfgang Herr, Department of Internal Medicine III, Hematology and Oncology, University Hospital of Regensburg, 93051 Regensburg, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Hart
authors.affiliation: Roland C Schelker, Christina Hart, Wolfgang Herr, Department of Internal Medicine III, Hematology and Oncology, University Hospital of Regensburg, 93051 Regensburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herr
authors.affiliation: Roland C Schelker, Christina Hart, Wolfgang Herr, Department of Internal Medicine III, Hematology and Oncology, University Hospital of Regensburg, 93051 Regensburg, Germany.
authors.forename: Ernst-Michael
authors.initials: EM
authors.lastname: Jung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006439:Hemodynamics; D006499:Hepatic Artery / Q000002:abnormalities*; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008297:Male; D045423:Microbubbles; D008833:Microcirculation; D008875:Middle Aged; D011169:Portal Vein / Q000002:abnormalities*; D012189:Retrospective Studies; D013459:Sulfur Hexafluoride / Q000008:administration & dosage; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000295:instrumentation / Q000379:methods; D055815:Young Adult
chemical_list: D003287:Contrast Media; D013459:Sulfur Hexafluoride
keywords: Contrast-enhanced ultrasound; Hereditary hemorrhagic telangiectasia; Intrahepatic shunts; Time-intensity-curve