Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Spain; Centre de Diagnostic per l'Imatge, Hospital Clinic, Barcelona, Spain.
J Hepatol. 2013 Oct;59(4):717-22. doi: 10.1016/j.jhep.2013.04.037. Epub 2013 May 10.
BACKGROUND & AIMS: Hepatic blood flow (HBF) is best estimated by the Fick's method during indocyanine green constant infusion (ICG-HBF) on hepatic vein catheterization. We investigated the consistency and agreement of HBF measured by Doppler ultrasound (US-HBF) as compared with ICG-HBF in portal hypertensive patients with cirrhosis.
In 50 patients observed for HVPG measurement (56% compensated; Child score 7 ± 2; HVPG 16.6 ± 6.0 mmHg; varices in 75%) US-HBF (Sequoia-512-Acuson; 4.5-7 MHz convex probe; US-HBF = hepatic artery blood flow+portal vein blood flow) and ICG-HBF (Fick's method after an equilibration period of at least 45 min of ICG bolus of 5 mg + constant rate infusion of 0.2 mg/min). Intraclass correlation coefficient (ICC) for consistency and absolute agreement between US-HBF and ICG-HBF were calculated.
Mean ICG-HBF and US-HBF were similar, being respectively 1004 ± 543 ml/min and 994 ± 494 ml/min (p = 0.661 vs. ICG-HBF). However, results in individual patients disclosed marked differences between the two methods (386 ± 415 ml/min) and showed only moderate consistency (ICC 0.456; p < 0.0001), absolute agreement (ICC 0.461; p < 0.0001) and linear correlation (R = 0.464; p < 0.0001). The discrepancy between the two methods was maximal in patients with poor liver function, high HBF by any technique and more arterialized liver circulation. Hepatic artery blood flow ≥40% of US-HBF indicated, with 90% specificity, a discrepancy ≥20% between US-HBF and ICG-HBF.
HBF estimations by Doppler-ultrasound and ICG are significantly correlated, but their discrepancy in individual cases is high. Estimation of HBF by Doppler-US should be considered unreliable in patients with poor hepatic function and large liver arterialization.
在经肝静脉插管的吲哚菁绿持续输注（ICG-HBF）期间，通过 Fick 法可最佳估计肝血流量（HBF）。我们研究了在伴有肝硬化的门脉高压患者中，多普勒超声（US-HBF）测量的 HBF 与 ICG-HBF 的一致性和吻合度。
在 50 例接受 HVPG 测量的患者中（56%代偿；Child 评分 7±2；HVPG 16.6±6.0mmHg；75%有静脉曲张），使用 Sequoia-512-Acuson（4.5-7MHz 凸阵探头）进行 US-HBF（肝动脉血流量+门静脉血流量）和 ICG-HBF（至少 45minICG 弹丸 5mg+0.2mg/min 恒速输注后的 Fick 法）测量。计算 US-HBF 和 ICG-HBF 之间一致性和绝对一致性的组内相关系数（ICC）。
ICG-HBF 和 US-HBF 的平均值相似，分别为 1004±543ml/min 和 994±494ml/min（p=0.661 与 ICG-HBF 相比）。然而，在个别患者中，两种方法之间存在明显差异（386±415ml/min），且一致性仅为中度（ICC0.456；p＜0.0001），绝对一致性（ICC0.461；p＜0.0001）和线性相关性（R=0.464；p＜0.0001）。在肝功能较差、任何技术下 HBF 较高和肝脏循环更动脉化的患者中，两种方法之间的差异最大。US-HBF 中肝动脉血流≥40%表明，US-HBF 和 ICG-HBF 之间的差异≥20%，特异性为 90%。
多普勒超声和 ICG 对 HBF 的估计具有显著相关性，但在个别病例中差异较大。在肝功能较差和肝脏动脉化较大的患者中，多普勒-US 对 HBF 的估计应视为不可靠。
