Department of Radiology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri-si, Korea.
J Ultrasound Med. 2011 Apr;30(4):455-62. doi: 10.7863/jum.2011.30.4.455.
The purposes of this study were to assess retrospectively whether the waveform change during respiration on hepatic vein Doppler sonography is a parameter of severe portal hypertension as estimated by the hepatic venous pressure gradient (HVPG) and to compare with a hepatic vein damping index (DI) at expiration.
Spectral Doppler sonography of the hepatic vein was performed on 22 consecutive patients who underwent HVPG measurement for portal hypertension with liver cirrhosis. From the maximum and minimum velocities of systolic hepatofugal venous flow on Doppler sonography, 3 parameters were derived: damping index at expiration (DI(exp)), damping index ratio (DI(ratio)), and damping index difference (ΔDI) between inspiration and expiration. Considering an HVPG level of 12 mm Hg or higher as the threshold level for high-grade portal hypertension, we assessed the diagnostic capability of these Doppler sonographic parameters to discriminate using receiver operating characteristic curve analysis.
Area under the curve values for the DI(ratio) and ΔDI (0.875 and 0.889, P = .807 and .682, respectively) were slightly higher than the area for the DI(exp) (0.861; respectively). When the DI(exp) was greater than 0.56, the sensitivity and specificity for high-grade portal hypertension were 66.7% and 100.0%, respectively. In the case of the DI(ratio), the sensitivity and specificity were 77.8%, and 100.0% at greater than 0.69. The corresponding sensitivity and specificity at a value of 0.25 or less for the ΔDI were 83.3% and 100.0%.
The ratio and difference of the DI of the hepatic vein waveform are helpful parameters in assessing the severity of portal hypertension as well as using the existing DI on its own.
本研究旨在回顾性评估肝静脉多普勒超声检查中呼吸时的波形变化是否为肝静脉压力梯度（HVPG）估计的严重门静脉高压的参数，并与呼气末肝静脉阻尼指数（DI）进行比较。
对 22 例因肝硬化行 HVPG 测量的门静脉高压患者进行肝静脉频谱多普勒超声检查。从多普勒超声上收缩期向肝血流的最大和最小速度中得出 3 个参数：呼气末阻尼指数（DI(exp)）、阻尼指数比（DI(ratio)）和吸气与呼气之间的阻尼指数差（ΔDI）。考虑 HVPG 水平为 12mmHg 或更高作为重度门静脉高压的阈值水平，我们使用受试者工作特征曲线分析评估这些多普勒超声参数的诊断能力来进行区分。
DI(ratio)和 ΔDI 的曲线下面积值（0.875 和 0.889，P=.807 和.682，分别）略高于 DI(exp)（0.861）。当 DI(exp)大于 0.56 时，用于重度门静脉高压的敏感性和特异性分别为 66.7%和 100.0%。在 DI(ratio)的情况下，敏感性和特异性分别为 77.8%和 100.0%，大于 0.69。ΔDI 值为 0.25 或更低时，相应的敏感性和特异性为 83.3%和 100.0%。
肝静脉波形的 DI 比值和差值是评估门静脉高压严重程度的有用参数，并且单独使用现有的 DI 也很有用。
