Contrast Enhanced Ultrasound Is A Non-invasive Predictor Of Endoscopic Therapy In Decompensated Liver Cirrhosis

Objective:To study hepatic hemodynamics in patients with decompensated liver cirrhosis.To search the correlations of contrast-enhanced ultrasound (CEUS) parameters with rebleeding and portal hypertension.Methods:Data of 80 patients with portal hypertension who underwent CEUS,HVPG, sequentially,then receive endoscopy treatments. Describe the relationship between the CEUS parameters and Child-pugh,and HVPG, and the rebleeding and survival.Results:1) Main parameters of 34 patients with CEUS are as follows:hepatic artery arriving time (HAAT)=17±5S, hepatic artery time to peak (HATTP)=22±6S, portal vein arriving time (PVAT)=23±6S, portal vein time to peak (PVTTP)=33±8s, hepatic vein arriving time (HVAT)=27±7S, hepatic vein time to peak (HVTTP)=37±8s, hepatic artery-hepatic vein transit time (HA-HV AT)=10±4S, hepatic artery-hepatic vein time to peak transit time (HA-HV TTP)=14±5S, portal vein-hepatic vein transit time (PV-HV AT)=3±2S, portal vein-hepatic vein time to peak transit time (PV-HV TTP)=5±3s. Ultrasound diagnosis of 10 cases of portal vein thrombosis, while CEUS diagnosis of 16 cases of portal vein embolus, left embolus in 7 cases, and 8 cases of right bronchial embolus.2) There was no significant correlation between rebleeding after endoscopy treatments and HVPG, P=0.872.3)There was a statistically significant negative correlation between PV-HV AT and HVPG, r=-0.392.The area under the receiver operating characteristic curve (AUROC) was 0.973 for HVPG>20mmHg, and the sensitivity, specificity for an PV-HV AT cut-off value of 3s were 77.8%,50%; the sensitivity, specificity for an PV-HV AT cut-off value of 4s were 55.6%,75%; the sensitivity, specificity for an PV-HV AT cut-off value of 5s were 44.4%,100%, respectively. CEUS is a non-invasive method for estimating HVPG.4)PV-HV TTP has excellent relationship with early rebleeding after endoscopy treatments。Conclusions:1)Comparing with conventional ultrasound,CEUS is a safe, simple, noninvasive diagnostic measures, can find more portal vein embolus.2) Portal vein-hepatic vein transit time has significant relevance with HVPQ which is available in predicting liver cirrhosis esophagogastric varices varicosity hemorrhage risk.3) PV-HV TTP can be used as a noninvasive diagnostic markers for early prediction of rebleeding after endoscopic treatment.