Ultrasound and duplex-Doppler in the diagnosis and follow-up of portal hypertension.

Ultrasound examination should be carried out as the first investigation in all patients with suspected hepatobiliary disease. It has a high accuracy in detecting signs of portal hypertension such as ascites, splenomegaly and collateral veins. The most common cause of portal hypertension in the Western world is cirrhosis. Although there is an overlap of ultrasound findings in normal liver, fatty liver, chronic liver disease with and without fibrosis, and cirrhosis, a correct diagnosis of cirrhosis by judgment of ultrasound findings is reported to be achieved in up to 80%. Diagnostic parameters used are size and outline of the liver, its reflectivity and attenuation of the echo-pattern. If used in combination with the Doppler duplex system, the information gained vastly increases. Areas where this technique is able to provide useful and reliable data have been defined in a consensus conference held in Bologna. Doppler flowmetry of hepatic vessels allows detection of presence, direction and characteristics of blood flow. The reliability of the quantitative measurements of blood flow in abdominal vessels is still questioned. When using the same equipment by skilled operators, however, duplex-Doppler data of the portal vein are of value in the assessment of the risk of variceal bleeding, in the evaluation of the progression of liver disease and in the evaluation of medical therapy for portal hypertension. Furthermore, the technique is of practical value in pre-and postoperative examinations for shunt surgery as well as in the pre-procedural work-up of transjugular intrahepatic portosystemic stent shunt (TIPS), during the TIPS procedure and in the post-TIPS followup.