Brown B P, Abu-Yousef M, Farner R, LaBrecque D, Gingrich R
Department of Radiology, University of Iowa College of Medicine, Iowa City 52242.
AJR Am J Roentgenol. 1990 Apr;154(4):721-4. doi: 10.2214/ajr.154.4.2107664.
Hepatic venocclusive disease is a serious complication associated with chemotherapy and radiation used in bone marrow transplantation patients. In the past, liver biopsy has been the only reliable means of diagnosing venocclusive disease. Biopsy in such patients may be dangerous or impossible because of severe coagulopathies. The purpose of our study was to evaluate duplex Doppler sonography in diagnosing hepatic venocclusive disease. We measured the blood velocity and flow in the portal vein, hepatic vein, and inferior vena cava of six patients who were histologically proved to have developed hepatic venocclusive disease after bone marrow transplantation. There were three men and three women with a mean age of 32 years (range, 21-44 years). Examination with Doppler sonography suggested the diagnosis a mean of 41 days (range, 11-62 days) after transplantation. In three patients, the diagnosis was suggested by reversed or "to and fro" flow in the portal vein. In the other three patients, the diagnosis was suggested by a decreased flow in the portal vein. One of these patients with decreased flow had subclinical hepatic venocclusive disease. In this patient, it was not the absolute level of flow but the decrease from a baseline established before ablative therapy that suggested the diagnosis. The amplitude of pulsatility in the hepatic veins appeared to decrease with the onset of venocclusive disease. In the hepatic veins and inferior vena cava, flow toward the heart was maintained. Our findings suggest that duplex Doppler sonography may be useful in detection of hepatic venocclusive disease. We speculate that, with wider experience, Doppler sonographic detection of decreased or reversed flow in the portal vein, in the proper clinical setting, may provide a noninvasive means of reliably diagnosing hepatic venocclusive disease in patients too ill to undergo liver biopsy.
肝静脉闭塞性疾病是骨髓移植患者化疗和放疗相关的严重并发症。过去，肝活检一直是诊断静脉闭塞性疾病的唯一可靠方法。由于严重的凝血障碍，此类患者进行活检可能有危险或无法进行。我们研究的目的是评估双功多普勒超声在诊断肝静脉闭塞性疾病中的作用。我们测量了6例经组织学证实骨髓移植后发生肝静脉闭塞性疾病患者的门静脉、肝静脉和下腔静脉的血流速度和流量。患者中有3名男性和3名女性，平均年龄32岁（范围21 - 44岁）。多普勒超声检查提示诊断的平均时间为移植后41天（范围11 - 62天）。3例患者通过门静脉血流反向或“往返”血流提示诊断。另外3例患者通过门静脉血流减少提示诊断。其中1例血流减少的患者患有亚临床肝静脉闭塞性疾病。在该患者中，提示诊断的并非血流的绝对水平，而是与消融治疗前建立的基线相比血流的减少。肝静脉搏动幅度似乎随着静脉闭塞性疾病的发生而降低。在肝静脉和下腔静脉中，朝向心脏的血流得以维持。我们的研究结果表明，双功多普勒超声可能有助于检测肝静脉闭塞性疾病。我们推测，随着经验的积累，在适当的临床环境中，通过多普勒超声检测门静脉血流减少或反向，可能为病情过重无法进行肝活检的患者提供一种可靠诊断肝静脉闭塞性疾病的非侵入性方法。
