Effects of respiratory maneuvers hepatic vein Doppler waveform and flow velocities in healthy population

Transcription

1 Effects of respiratory maneuvers hepatic vein Doppler waveform and flow velocities in healthy population Poster No.: C-3214 Congress: ECR 2010 Type: Scientific Exhibit Topic: Vascular Authors: N. Altinkaya, Z. Koc, S. Ulusan, S. Demir, K. Gurel; Adana/TR Keywords: Hepatic vein, Doppler ultrasonography, Flow pattern DOI: /ecr2010/C-3214 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 7

2 Purpose This study was performed to determine the variations in Doppler waveforms and flow velocity during respiratory manoeuvres in healthy individuals with no liver disease. Modifications of hepatic vein flow pattern are usually studied in disease processes and the normal flow pattern is usually recorded in a healthy control group. To our knowledge, the effects of respiration on hepatic venous flow have not been studied systematically in healthy adults. A prospective study was performed to document the frequencies of triphasic, biphasic and monophasic flow patterns and peak systolic velocities in the middle hepatic vein (MHV) taking into account its variability with respiratory manoeuvres in healthy subjects. Methods and Materials We performed a prospective examination of the HV of 100 consecutive adults with no known liver or heart disease (75 women, 25 men; mean age, 31 years; range, years). Patients with heart diseases were excluded by medical history and physical examination, and those with acute or chronic liver diseases and malignancy were also eliminated by appropriate clinical, laboratory and B-mode US. Patients who were positive for antibodies to hepatitis C virus or hepatitis B surface antigen were also disqualified. All subject in the study had normal results on liver function tests. To prevent the effects of obesity in the evaluation, patients with a body mass index (BMI=weight/height 2 ) over 25 were excluded. All subjects were examined with B-mode and duplex Doppler US using a 2-4-MHz convex array transducer (Sonoline Antares; Siemens Medical Solutions) in the supine position after an overnight fast. The liver parenchyma was scanned carefully, and those with vascular malformations, space-occupying lesions, haepatomegaly and fatty infiltration of the liver were excluded. Evaluation of the MHV was performed through the right lateral intercostal approach by the same radiologist (NA) at three different phases of respiration: during normal respiration without breath-holding, after non-forced expiration with breath-holding and during deep inspiration with breath-holding. Spectral analysis was recorded for at least two to three cycles of the waveform and the Doppler angle Page 2 of 7

3 was set at less than 50. Measurements were performed on a frozen spectral strip. The values of the maximum peak systolic velocity (V max, in cm/s) were obtained in all subjects. The waveform patterns of the HV were classified into three groups: regular triphasic waveform, biphasic waveform without reverse flow and monophasic or flat waveform (Figure 1-3). Images for this section: Fig. 1: Right intercostal scans of duplex Doppler sonography in the MHV demonstrating regular triphasic waveform Page 3 of 7

4 Fig. 2: biphasic waveform without reverse flow Page 4 of 7

5 Fig. 3: monophasic or flat waveform Page 5 of 7

6 Results During normal respiration, hepatic venous waveforms were triphasic in 93% of subjects, monophasic in 6% and biphasic in 1%. During breath-holding after quiet expiration, the percentages were 91%, 6% and 3%, respectively. During deep inspiration, they were 80%, 18% and 2%, respectively. Although significant differences were noted between rates during deep inspiration and normal respiration, they were quite similar during normal respiration and breath-holding after quiet expiration (P<0.05). The values of V max were significantly higher during normal respiration compared to quiet expiration and during quiet expiration compared to deep inspiration (P<0.05). Conclusion The results of the present study confirmed that an abnormal HV Doppler waveform, biphasic as well as monophasic, can be seen in healthy adults. This can be explained by changes in intrathoracic pressure or changes in the angle of the HV orifice in the inferior vena cava with respiratory manoeuvres. The velocities and Doppler waveform patterns of the HV also varied during respiratory manoeuvres. To achieve standard measurements of the HV flow pattern on Doppler US examinations, the respiratory state must be taken into account, and samples taken during deep inspiration should be avoided. References [1] Bolondi L, Li Bassi S, Gaiani S, et al. Liver cirrhosis: changes of Doppler waveform of hepatic veins. Radiology 1991;178: [2] Karabulut N, Kazil S, Yagci B, Sabir N. Doppler waveform of the hepatic veins in an obese population. Eur Radiol 2004;14: [3] Ahmeto#lu A, Ko#ucu P, Arikan E, Dinç H, Re#it Gümele H. Hepatic vein flow pattern in children: assesment [sic] with Doppler sonography. Eur J Radiol 2005;53:72-7. [4] Pedersen JF, Dakhil AZ, Jensen DB, Søndergaard B, Bytzer P. Abnormal hepatic vein Doppler waveform in patients without liver disease. Br J Radiol 2005;78: Page 6 of 7

7 [5] Oguzkurt L, Yildirim T, Torun D, Tercan F, Kizilkilic O, Niron EA. Hepatic vein Doppler waveform in patients with diffuse fatty infiltration of the liver. Eur J Radiol 2005;54: [6] Murat A, Akarsu S, Cihangiro#lu M, Yildirim H, Serhatlio#lu S, Kalender O. Assessment of Doppler waveform patterns and flow velocities of hepatic veins in children with acute viral hepatitis. Diagn Interv Radiol 2006;12:85-9. [7] Teichgraber UK, Gebel M, Benter T, Manns MP. Effect of respiration, exercise and food intake on hepatic vein circulation. J Ultrasound Med 1997;16: [8] Shapiro RS, Winsberg F, Maldjian C, Stancato-Pasik A. Variability of hepatic vein Doppler tracings in normal subjects. J Ultrasound Med 1993;12: [9] Jequier S, Jequier JC, Hanquinet S, Gong J, Le Coultre C, Belli DC. Doppler waveform of hepatic veins in healthy children. Am J Roentgenol 2000;175: [10] Balci A, Karazincir S, Sumbas H, Oter Y, Egilmez E, Inandi T. Effects of diffuse fatty infiltration of the liver on portal vein flow hemodynamics. J Clin Ultrasound 2008;36: [11] Arda K, Ofelli M, Calikoglu U, Olcer T, Cumhur T. HV Doppler waveform changes in early stage (Child-Pugh A) chronic parenchymal liver disease. J Clin Ultrasound 1997;25:15-9. [12] Von Herbay A, Frieling T, Haussinger D. Association between duplex Doppler sonographic flow pattern in right hepatic vein and various liver diseases. J Clin Ultrasound 2001;29: Personal Information Page 7 of 7