Park Hee Sun, Desser Terry S, Jeffrey R Brooke, Kamaya Aya
Konkuk University School of Medicine, Seoul, Korea.
Stanford University Medical Center, Stanford, California, USA.
J Ultrasound Med. 2017 Apr;36(4):725-730. doi: 10.7863/ultra.16.03107. Epub 2016 Dec 27.
To determine whether hepatic arterial and portal venous Doppler ultrasound measurements of the liver in cirrhotic patients correlate with patients' Model for End-Stage Liver Disease (MELD) scores, splenomegaly, or ascites.
Sonographic images and reports were reviewed of 264 patients with hepatic cirrhosis who underwent abdominal ultrasound with Doppler in this internal review board-approved retrospective study. MELD scores were recorded at the time of ultrasound. On gray-scale ultrasound, spleen length was measured and the presence of ascites was noted. Hepatic arterial velocity (HAv) with angle correction, hepatic arterial resistive index, and portal vein velocity with angle correction were measured on Doppler ultrasound. Correlation of hepatic arterial and portal venous Doppler values with MELD score, presence of splenomegaly, and presence of ascites was tested using linear or binary logistic regression analysis. Diagnostic performance of Doppler parameters for high-risk MELD was assessed.
The HAv statistically significantly correlated with the MELD score (P = .0001), spleen size (P =.027), and presence of ascites (P =.0001), whereas the hepatic arterial resistive index and portal vein velocity did not correlate with these factors. For MELD scores greater than 19, an HAv greater than 120 cm/s showed accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 74, 42, 90, 67, and 76%, respectively. With an HAv greater than 160 cm/s, the odds ratio for MELD scores greater than 19 was 42.1.
We found a statistically significant correlation with elevated HAv and increasing MELD scores, splenomegaly, and presence of ascites in patients with cirrhotic liver disease; this may be a useful imaging biomarker in the evaluation of patients with cirrhosis.
确定肝硬化患者肝脏的肝动脉和门静脉多普勒超声测量值是否与患者的终末期肝病模型（MELD）评分、脾肿大或腹水相关。
在这项经内部审查委员会批准的回顾性研究中，对264例接受腹部多普勒超声检查的肝硬化患者的超声图像和报告进行了回顾。在超声检查时记录MELD评分。在灰阶超声上，测量脾脏长度并记录腹水的存在情况。在多普勒超声上测量经角度校正的肝动脉速度（HAv）、肝动脉阻力指数以及经角度校正的门静脉速度。使用线性或二元逻辑回归分析测试肝动脉和门静脉多普勒值与MELD评分、脾肿大的存在情况以及腹水的存在情况之间的相关性。评估多普勒参数对高风险MELD的诊断性能。
HAv与MELD评分（P = 0.0001）、脾脏大小（P = 0.027）和腹水的存在情况（P = 0.0001）在统计学上具有显著相关性，而肝动脉阻力指数和门静脉速度与这些因素无关。对于MELD评分大于19的情况，HAv大于120 cm/s时，准确性、敏感性、特异性、阳性预测值和阴性预测值分别为74%、42%、90%、67%和76%。当HAv大于160 cm/s时，MELD评分大于19的优势比为42.1。
我们发现肝硬化患者中，HAv升高与MELD评分增加、脾肿大和腹水的存在情况在统计学上具有显著相关性；这可能是评估肝硬化患者的一种有用的影像学生物标志物。
