Value Of Doppler Ultrasound Parameters Of Hepatic Artery In The Dlagnosis Of Liver Cirrhosis

BACKGROUND: Portal hypertension is a serious complication in patients with liver cirrhosis. The screening of portal hypertension is commonly carried to out to detect esophageal varices by endoscopic procedure. However, it cannot provide hemodynamic data on the portal circulation. On the other hand, portal pressure can be measured by hepatic vein catherization. However, it is difficult to use as a routine hemodynamic test because of its invasive and complex nature. Therefore, the need has arisen for a simple and noninvasive method that is able to supply the portal hemodynamic data.Accurate, noninvasive studies of hepatic blood flow are possible with duplex Doppler ultrasonography, which is generally performed to assess patency and direction of flow in portal and hepatic veins. This techinique is also useful to evaluate arterial flow, because resistance indexes (resistive and pulsatility indexs) can be calculated from systolic, diastolic, and mean blood flow velocity, are independent of the angle between the vessel and the ultrasound beam axis, and represent downstream arterial vasoconstriction.The recently developed Doppler ultrasound (US) technique seems to satisfy this need. Many researchers have found a significant reduction in portal venous velocity (PVV) in patients with cirrhosis compared with healthy subjects. With regard to hepatic arterial hemodynamics, findings in several studies suggest that analysis of hepatic arterial waveform obtained by Doppler US provides useful information to assess hepatic arterial vascularresistance. Sacerdoti et al have recently shown that patients with cirrhosis have increased hepatic arterial pulsatility index (HA-PI) compared with healthy subjects. Because pulsatility index reflects vascular impedance, this finding suggests that patients with cirrhosis have increased hepatic arterial vascular resistance. However, the accuracy of HA-PI in the diagnosis of cirrhosis has not been evaluated. Moreover, the value of simultaneous assessment of PVV and HA-PI in the diagnosis of cirrhosis and portal hypertension is not known.The aim of this prospective study was to define normal range of portal and hepatic arterial Doppler US parameters and to assess the sensitivity and specificity of these parameters in the diagnosis of liver cirrhosis.AIM OF THE STUDYBest cut-off value of hepatic arterial pulsatility index in the detection of cirrhosis.Sensitivity and specificity of US in the detection of cirrhosis Cost-effective analyze of US in the detection of cirrhosis.DESIGNThis is a prospective observational diagnostic test. Hepatic arterial pulsatility index will be measure at the level of crossing point of the hepatic artery, the gold standard is liver biopsy.SETTINGAll subjects will be identified in the departments of general surgery, RUI JIN Hospital, SHANGHAI SECOND MEDICAL UNIVERSITY,PATIENTS/PARTICIPANTSFrom July 2000 to April 2001, the possible cirrhotic patients and the subjects without liver disease admitted to our department will be considered for inclusion in the study.The following criteria will be used to select subjects: 1 Patients with a previous history of hepatitis.1 Patients of maldigestive syndrome with unknown reasons.2 Splenomegalie with unknown reasons.3 Patients with repeated unnormal liver function.SAMPLE SIZE ESTIMATIONSample of patients N1=(U?)25 P1 5 (1-P1) /?2Sample obstruction N2=(U?)2 5P2 5 (1 -P2) /?2P1: sensitivity P2: specificityAccording to the results of Tadashi Iwao[3] , the sensitivity and the specificity are 97% and 93%. The sample size is 56.DATA COLLECTIONHepatic arterial pulsatility index at level of right hepatic artery and anterior branch of right hepatic artery.QUALITY CONTROSAll measurements will be performed by one of the authors without information of patient characteristics.Liver biopsy is the gold standard.Blinded judgment: The researcher don't know the final diagnosis when he or she perform the US examination.STAT...