Dogan Yuksel, Soylu Aliye, Kilickesmez Ozgur, Demirtas Tuna, Kilickesmez Kadriye Orta, Dogan Sebahat Nacar, Eren Gulay, Sevindir Isa, Yasar Nurgul, Poturoglu Sule, Sonmez Kenan
Department of Cardiology, Bakirkoy Dr, Sadi Konuk Education and Research Hospital, Istanbul, Turkey.
Cardiovasc Ultrasound. 2010 Jul 21;8:28. doi: 10.1186/1476-7120-8-28.
Congestive hepatomegaly might be the first sign for pulmonary hypertension. Apparent diffusion coefficient (ADC) value obtained with quantitative diffusion-weighted magnetic resonance imaging (DW-MRI) is affected by liver fibrosis and perfusion. We aimed to evaluate the diagnostic value of DW-MRI in cooperation with biochemical markers, ultrasonography (US) and echocardiography (TTE) in determining the degree of hepatic congestion secondary to pulmonary hypertension (PHT).
35 patients with PHT and 26 control subjects were included in the study. PHT was diagnosed if pulmonary artery systolic pressure (PASP) was measured above 35 mmHg with TTE. Study group was classified into mild and moderate PHT. DW-MRI was performed with b-factors of 0, 500 and 1000 sec/mm(2). Mean ADC, ADC-II (Average of the ADC values of right lobe anterior and posterior segments), US, TTE and blood biochemical parameters of both groups were compared.
There exists a positive correlation between liver size and the diameters of vena cava inferior, right atrium, right hepatic vein(RHV), mid-hepatic vein(MHV), left hepatic vein(LHV) (p < 0.01). There was a positive correlation between PASP and RHV, MHV, LHV. The patients had lower ejection fractions (p < 0.01) and higher LDH (p < 0.01) and ALP (p < 0.05) levels than the control group. The ADC values of the patients with moderate PASP were higher than those with a mild PASP (p < 0.05). Mean ADC was higher in patients with moderate PHT compared to control group (p = 0.009). There was a positive correlation between PASP and ADC values of right lobe posterior segment of the liver (p < 0.05). The ADC-II and mean ADC values of the patients with moderate PASP were higher than those of the control group (p < 0.01).
Congestion due to moderate PHT might be diagnosed with DW-MRI. As PASP increase; mean ADC and ADC-II values increase.
充血性肝肿大可能是肺动脉高压的首个体征。定量扩散加权磁共振成像（DW-MRI）获得的表观扩散系数（ADC）值受肝纤维化和灌注的影响。我们旨在评估DW-MRI联合生化标志物、超声检查（US）和超声心动图（TTE）在确定肺动脉高压（PHT）继发肝充血程度方面的诊断价值。
35例PHT患者和26例对照者纳入本研究。如果通过TTE测量肺动脉收缩压（PASP）高于35 mmHg，则诊断为PHT。研究组分为轻度和中度PHT。使用0、500和1000 sec/mm²的b值进行DW-MRI。比较两组的平均ADC、ADC-II（右叶前后段ADC值的平均值）、US、TTE和血液生化参数。
肝脏大小与下腔静脉、右心房、右肝静脉（RHV）、肝中静脉（MHV）、左肝静脉（LHV）的直径之间存在正相关（p < 0.01）。PASP与RHV、MHV、LHV之间存在正相关。与对照组相比，患者的射血分数较低（p < 0.01），乳酸脱氢酶（LDH）和碱性磷酸酶（ALP）水平较高（p < 0.01和p < 0.05）。中度PASP患者的ADC值高于轻度PASP患者（p < 0.05）。与对照组相比，中度PHT患者的平均ADC更高（p = 0.009）。PASP与肝右叶后段的ADC值之间存在正相关（p < 0.05）。中度PASP患者的ADC-II和平均ADC值高于对照组（p < 0.01）。
中度PHT引起的充血可通过DW-MRI诊断。随着PASP升高，平均ADC和ADC-II值增加。
