Hepatic Arterial Doppler Sonography in Patients with Cirrhosis and Controls: Observer and Equipment Variability with use of the Ultrasonic Contrast Agent SHU 508A

Zusammenfassung

Ziel: Das Ziel der Studie der hepatisch arteriellen Doppler-Sonographie war es, die Interobserver- und Interequipmentvariabilität zu ermitteln, jeden möglichen artifiziellen Einfluss des Ultraschallsignalverstärkers auf die Doppler-Messungen zu untersuchen und die Ergebnisse bei Gesunden und Leberzirrhose zu vergleichen. Methoden: Bei 9 Lebergesunden und 9 Patienten mit Leberzirrhose wurde die Doppler-Sonographie der linken Leberarterie durch drei unabhängige Untersucher an drei verschiedenen Geräten durchgeführt. Dabei erfolgte eine doppelt verblindete, kontinuierliche Infusion des Ultraschallsignalverstärkers SHU 508A und Plazebo. Es wurden systolische, mittlere und diastolische Geschwindigkeit, Resistenz- und Pulsatilitätsindex gemessen. Ergebnisse: Die geräteabhängige Varianz (5,8 - 12,7 %) der fünf Doppler-Parameter war größer als die untersucherabhängige Varianz (0,3 - 3,6 %). Es bestanden keine signifikanten Unterschiede bei den Geschwindigkeiten zwischen Ultraschallsignalverstärker und Plazebo. Die systolische (65,9 ± 3,6 vs. 47,7 ± 4,2 cm/s mean ± SE, p = 0,02) und mittlere Geschwindigkeit (35,4 ± 1,6 vs. 24,5 ± 1,8 cm/s, p = 0,007) waren bei Leberzirrhose signifikant höher als bei Lebergesunden, während sich Resistenz- und Pulsatilitätsindex nicht unterschieden. Schlussfolgerung: Die Doppler-Sonographie der linken Leberarterie ist bei unterschiedlichen Untersuchern reproduzierbar, solange das gleiche Gerät verwendet wird. Unter klinischen Bedingungen werden bei der Anwendung des Ultraschallsignalverstärkers die Geschwindigkeiten korrekt gemessen und sind bei Patienten mit Zirrhose erhöht.

Abstract

Purpose: The aims of this study on hepatic arterial Doppler sonography were to ascertain interobserver and interequipment variability, to investigate any potential artificial influence of the ultrasonic contrast agent on the Doppler measurements and to compare the results in healthy and cirrhotic subjects. Methods: Doppler sonography of the left hepatic artery was performed in nine healthy and nine cirrhotic subjects by three independent observers using three different devices. Continuous infusion of the ultrasonic contrast agent SHU 508A and placebo were administered in a double blind fashion. Systolic, mean and end diastolic peak velocities as well as resistive and pulsatility indices were measured. Results: Equipment associated variances (5.8 - 12.7 %) of the five Doppler parameters were greater than interobserver variances (0.3 - 3.6 %). No significant differences were observed between the velocities using ultrasonic contrast agent and placebo. Systolic (65.9 ± 3.6 vs. 47.7 ± 4.2 cm/s mean ± SE, p = 0.02) and mean peak velocity (35.4 ± 1.6 vs. 24.5 ± 1.8 cm/s, p = 0.007) were significantly higher in cirrhotic than in healthy subjects whereas the resistive and pulsatility indices were not different. Conclusions: Doppler sonography of the left hepatic artery performed by various observers is reproducible as long as the same device is used. Under clinical conditions, velocities are correctly measured with the use of ultrasonic contrast agent and are elevated in patients with cirrhosis.

Leberzirrhose - Doppler-Sonographie - Leberarterie - Ultraschallsignalverstärker

Liver cirrhosis - Doppler sonography - hepatic artery - ultrasonic contrast agent

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