De Gottardi Andrea, Keller Pierre-Frédéric, Hadengue Antoine, Giostra Emile, Spahr Laurent
Division of Gastroenterology and Hepatology, University Hospitals and Faculty of Medicine, Geneva, Switzerland.
BMC Res Notes. 2012 Jan 27;5:77. doi: 10.1186/1756-0500-5-77.
The evaluation of the hepatic parenchyma in patients with chronic liver disease is important to assess the extension, localization and relationship with adjacent anatomical structures of possible lesions. This is usually performed with conventional abdominal ultrasound, CT-scan or magnetic resonance imaging. In this context, the feasibility and the safety of intravascular ultrasound in the liver have not been assessed yet.
We tested the safety and performance of an intracardiac echography (ICE) catheter applied by a transjugular approach into the hepatic veins in patients with chronic liver disease undergoing hepatic hemodynamic measurements.
Five patients were enrolled in this pilot study. The insertion of the ICE catheter was possible into the right and middle, but not into the left hepatic vein. The position of the ICE was followed using fluoroscopy and external conventional ultrasound. Accurate imaging of focal hepatic parenchymal lesions, Doppler ultrasound of surrounding blood vessels and assessment of liver surface and ascites were achieved without complications.
This study demonstrated that a diagnostic approach using an ICE device inserted in the hepatic veins is feasible, safe and well tolerated. However, it remains for the moment only an experimental investigative tool. Whether ICE adds further information regarding parenchymal lesions and associated vascular alterations as compared to other techniques, needs additional investigation.
评估慢性肝病患者的肝实质对于评估可能病变的范围、定位及其与相邻解剖结构的关系非常重要。这通常通过传统腹部超声、CT扫描或磁共振成像来进行。在此背景下，血管内超声在肝脏中的可行性和安全性尚未得到评估。
我们测试了经颈静脉途径将心内超声（ICE）导管应用于接受肝脏血流动力学测量的慢性肝病患者肝静脉中的安全性和性能。
五名患者参与了这项初步研究。ICE导管能够插入右肝静脉和中肝静脉，但无法插入左肝静脉。使用荧光透视和外部传统超声跟踪ICE的位置。实现了对肝脏局灶性实质病变的精确成像、周围血管的多普勒超声检查以及肝脏表面和腹水的评估，且无并发症发生。
本研究表明，将ICE设备插入肝静脉的诊断方法是可行、安全且耐受性良好的。然而，目前它仍然只是一种实验性研究工具。与其他技术相比，ICE是否能提供有关实质病变及相关血管改变的更多信息，还需要进一步研究。
