Clinical Research Of Non-invasive Assessment Of Portal Hypertension And Esophageal Varices With Ultrasound

IntroductionsPortal hypertension is a severe complication of chronic liver diseases andcirrhosis. Portal hypertension is a contributing factor for the development of ascitesand hepatic encephalopathy and a direct cause of esophageal variceal and of bleedingrelated death. Esophageal variceal bleeding occurs at a yearly rate of15%-30%inpatients with large varices. And it is associated with a mortality of at least20%at6weeks. Even if HVPG and endoscopy play important roles in evaluating portalpressure and esophageal variceal, both examinations are invasive, low tolerated, andare less favorable for the follow-up of cirrhosis patients. So satisfactory replacementsfor HVPG and endoscopy must be found to better evaluate portal pressure andesophageal variceal.Objectives1) To assess whether intrahepatic circulation time analysis can be used to predictportal venous pressure severity. To compare the values of the parameters ofCEUS and CDFI in the evaluation of the portal hypertension.2) To assess whether intrahepatic circulation time analysis can be used toevaluate esophageal varices degree. To compare the values of the parametersof CEUS and CDFI in the evaluation of esophageal varices.3) To assess the capability of transabdominal ultrasound in exploring theesophageal varices under different functional status of esophagus. To assess the values of the color doppler grades by transabdominal ultrasound indiagnosis of EV grades.MethodsThis study takes the free portal pressure (FPP) and endoscopy as gold standards.The CEUS and CDFI parameters of liver were measured in patients. The correlationsbetween ultrasound parameters and FPP or endoscopy were analysed. The esophagealvarices were evaluated by transabdominal ultrasound and endoscopy under differentfunctional status of esophagus. The correlations between ultrasound color Dopplergrades and endoscopic grades were analysed.1) The CEUS and CDFI parameters of liver and free portal pressure weremeasured in31patients with hepatitis B virus–related liver disease. Pearsoncorrelation analysis was used to assess the correlation between the parametersof ultrasound and free portal pressure.2) The CEUS and CDFI parameters of liver and endoscopy were measured in36patients with hepatitis B virus–related liver disease. The correlation wasanalyzed between the parameters of ultrasound and esophageal varices.3) The esophageal varices were examined use transabdominal ultrasound andendoscopy in34patients with PHT under different functional status ofesophagus.The display rate of EV color Doppler signal under differentfunctional status of esophagus was analysed. Compared the relations betweencolor Doppler signal grades and the endoscopy grades of EV.Results1) The relations between the parameters of CEUS and FPP:The hepatic vein-hepatic artery (HV-HA) interval times were significantly shorter in the portal hypertension (PHT) group compared with those in the non-PHT group(8.26±1.94s and13.83±1.17s, respectively; p<0.001). The portal vein-hepatic artery(PV-HA) interval times were significantly longer in the PHT group compared withthose in the non-PHT group (13.13±2.25s and7.25±1.81s, respectively; p<0.001).Considering the whole patient population, there were statistically significantcorrelations between FPP and HV-HA interval time, PV-HA interval time (r=-0.900,p<0.001; r=0.808, p<0.001; respectively). Compared with the parameters of CDFI,the HV-HA interval time has more significant correlations with FPP.2) The diagnostic value of CEUS in assessing esophageal varices degree.HV-HA interval time, PV-HA interval time, and HAPI showed significantdifference between each two group(sP＜0.05).PVD has significant difference betweenserious group and moderate group or mild group(P＜0.05), but there was no differencbetween moderate group and mild group. PVV and HARI have no difference betweeneach two groups.HV-HA has high accuracy rate in diagnosis of serious EV, which has asensitivity and specificity of83%,76%with the cutoff equal8.63s.3) Transabdominal ultrasound evaluate EV in the state of swallowing.Compared with the supine positions, the right side up obligue position can be easyexploring the esophageal varices. EV color Doppler signal was seen in67%patientsunder esophagus rest state, while the signal was seen in87%patients under esophagusswallowing state. The EV color Doppler signal grade was correlation with EV gradediagnosed by endoscopy.Conclusions1) ICT measurement is correlated with FPP, which has potential capability toevaluate portal pressure by non-invasive method in patients with HBV-related liver disease.2) ICT measurement is correlated with EV degree, HV-HA has high accuracyrate in diagnosis of serious EV, which has a sensitivity and specificity of83%,76%with the cutoff equal8.63s.3) Swallowing can significantly increase the display rate of esophageal varices.The EV color Doppler signal grade under esohpageal relaxation state haspotential role in non-invasive assess EV for PHT patients follow up.