Duplexsonographie der Lebergefäße - eine Übersicht

Zusammenfassung

Die (Farb-)Duplexsonographie hat sich bei Patienten mit arteriellen, portalvenösen und venösen Veränderungen der Lebergefäße etabliert. Im Vordergrund des Indikationsspektrums stehen Erkrankungen mit portaler Hypertension (z. B. zirrhotischer Umbau der Leber, Pfortaderthrombose, Lebervenenverschlusssyndrom) sowie entzündliche und neoplastische Veränderungen. In der Literatur herrscht bisher kein Konsens bezüglich der Untersuchungstechnik (z. B. Messort, Gefäßabschnitt, Einschallwinkel). Die Duplexsonographie der Lebergefäße ist durch die nur eingeschränkt reproduzierbare Erfassung von absoluten Geschwindigkeiten (maximale systolische Geschwindigkeit, enddiastolische Geschwindigkeit, mittlere Geschwindigkeit) und durch ungünstige Untersuchungsbedingungen und Einschallwinkel > 60^o limitiert. Bei der Berechnung des Blutflussvolumens können zusätzliche Abweichungen durch einen variablen Gefäßquerschnitt entstehen. Die Analyse von Frequenzspektren nichtlaminarer Blutflüsse kann zu Fehlinterpretationen führen. Die in der Literatur angegebenen Normwerte zeigen deswegen eine große Streuung und sind selten miteinander vergleichbar. In dieser Übersicht werden die in der Literatur angegebenen Untersuchungsmethoden zusammengefasst, analysiert und Vorschläge für eine multizentrische Evaluierung duplexsonographischer Normwerte der Lebergefäße formuliert.

Abstract

Hepatic blood flow has been investigated using color Doppler ultrasonography in patients with liver disease, especially in patients with portal hypertension (e. g. liver cirrhosis, portal vein thrombosis, Budd-Chiari-syndrome).

Duplex examination protocols, however, differ considerably because no standard technique has been established so far. Whereas there is an agreement about the angle of the ultrasound application (< 60 °), neither the exact location nor the relevant examination parameters have been standardized. Based on a search of the relevant literature, published examination techniques and results were analyzed. These findings are to serve as a basis for a prospective multicenter study for the determination of standard values.

Schlüsselwörter

Arteria Hepatica - Pfortader - Lebervenen - Portale Hypertension - Doppler-Perfusionsindex

Key words

Hepatic Artery - Portal Vein - Hepatic Vein - Portal Hypertension - Doppler-Perfusion-Index

Literatur

• 1 Bolondi L, Gandolfi L, Arienti V. et al . Ultrasonography in the diagnosis of portal hypertension: Diminished response of portal vessels to respiration.  Radiology. 1982;  142 167-172
• 2 Seitz K. (Duplex sonographic findings in the portal system).  Verh Dtsch Ges Inn Med. 1988;  94 560-568
• 3 Sabba C, Buonamico P, Antonica G. et al . (Echo-color Doppler in the study of portal hypertension).  Radiol Med (Torino). 1993;  85 56-59
• 4 Piscaglia F, Gaiani S, Donati G, Masi L, Bolondi L. Doppler evaluation of the effects of pharmacological treatment of portal hypertension.  Ultrasound Med Biol. 1999;  25 923-932
• 5 Haag K, Rossle M, Ochs A. et al . Correlation of duplex sonography findings and portal pressure in 375 patients with portal hypertension.  AJR Am J Roentgenol. 1999;  172 631-635
• 6 Schwerk W B. Portal vein thrombosis: Real-time sonographic demonstration and follow-up.  Gastrointest Radiol. 1986;  11 312-318
• 7 Tanaka K, Numata K, Okazaki H. et al . Diagnosis of portal vein thrombosis in patients with hepatocellular carcinoma: Efficacy of color Doppler sonography compared with angiography.  AJR Am J Roentgenol. 1993;  160 1279-1283
• 8 Piscaglia F, Gaiani S, Zironi G, Siringo S, Bolondi L. Hepatic artery resistance in portal vein thrombosis (letter; comment).  Radiology. 1996;  200 285-286
• 9 Bolondi L, Gaiani S, Brignola C. et al . Changes in splanchnic hemodynamics in inflammatory bowel disease. Noninvasive assessment by Doppler ultrasound flowmetry.  Scand J Gastroenterol. 1992;  27 501-507
• 10 Crowe A, Taffinder N, Layer G T, Irvine A, Nicholls R J. Portal vein thrombosis in a complicated case of Crohn’s disease.  Postgrad Med J. 1992;  68 291-293
• 11 Leen E, Goldberg J A, Angerson W J, McArdle C S. Potential role of doppler perfusion index in selection of patients with colorectal cancer for adjuvant chemotherapy (see comments).  Lancet. 2000;  355 34-37
• 12 Leen E, Goldberg J A, Robertson J, Sutherland G R, McArdle C S. The use of duplex sonography in the detection of colorectal hepatic metastases.  Br J Cancer. 1991;  63 323-325
• 13 Kruger S, Strobel D, Wehler M. et al . (Hepatic Doppler perfusion index - a sensitive screening method for detecting liver metastases?).  Ultraschall Med. 2000;  21 206-209
• 14 Dietrich C F, Lee J H, Gottschalk R. et al . Hepatic and portal vein flow pattern in correlation with intrahepatic fat deposition and liver histology in patients with chronic hepatitis C.  AJR Am J Roentgenol. 1998;  171 437-443
• 15 Bolondi L, Gaiani S, Li B S, Zironi G. et al . Diagnosis of Budd-Chiari syndrome by pulsed Doppler ultrasound.  Gastroenterology. 1991;  100 1324-1331
• 16 Coulden R A, Britton P D, Farman P, Noble-Jamieson G, Wight D G. Preliminary report: Hepatic vein Doppler in the early diagnosis of acute liver transplant rejection.  Lancet. 1990;  336 273-275
• 17 Colli A, Cocciolo M, Mumoli N. et al . Hepatic artery resistance in alcoholic liver disease.  Hepatology. 1998;  28 1182-1186
• 18 Iwao T, Toyonaga A, Shigemori H. et al . Hepatic artery hemodynamic responsiveness to altered portal blood flow in normal and cirrhotic livers.  Radiology. 1996;  200 793-798
• 19 Sacerdoti D, Merkel C, Bolognesi M. et al . Hepatic arterial resistance in cirrhosis with and without portal vein thrombosis: Relationships with portal hemodynamics.  Gastroenterology. 1995;  108 1152-1158
• 20 Kok T, van der Jagt E J, Haagsma E B. et al . The value of Doppler ultrasound in cirrhosis and portal hypertension.  Scand J Gastroenterol Suppl. 1999;  230 82-88
• 21 Schneider A W, Kalk J F, Klein C P. Hepatic arterial pulsatility index in cirrhosis: Correlation with portal pressure.  J Hepatol. 1999;  30 876-881
• 22 Numata K, Tanaka K, Kiba T. et al . Hepatic arterial resistance after mixed-meal ingestion in healthy subjects and patients with chronic liver disease.  J Clin Ultrasound. 1999;  27 239-248
• 23 Iwao T, Toyonaga A, Oho K. et al . Postprandial splanchnic hemodynamic response in patients with cirrhosis of the liver: Evaluation with „triple-vessel” duplex US.  Radiology. 1996;  201 711-715
• 24 Dietrich C F, Ignee A, Seitz K H, Caspary W F. Duplexsonographie der Mesenterialarterien, eine Übersicht.  Ultraschall Med 2001. In press.
• 25 Schaberle W, Seitz K. (Duplex ultrasound measurement of blood flow in the superior mesenteric artery).  Ultraschall Med. 1991;  12 277-282
• 26 Walsh K M, Leen E, MacSween R N, Morris A J. Hepatic blood flow changes in chronic hepatitis C measured by duplex Doppler color sonography: Relationship to histological features.  Dig Dis Sci. 1998;  43 2584-2590
• 27 Piscaglia F, Gaiani S, Zironi G. et al . Intra- and extrahepatic arterial resistances in chronic hepatitis and liver cirrhosis.  Ultrasound Med Biol. 1997;  23 675-682
• 28 Bolondi L, Zironi G, Gaiani S. et al . Caliber of splenic and hepatic arteries and spleen size in cirrhosis of different etiology.  Liver. 1991;  11 198-205
• 29 Basilico R, Filippone A, Guidotti A. et al . (Reproducibility of Doppler ultrasonography in the study of hepatic blood flow).  Radiol Med (Torino). 1994;  87 268-274
• 30 De Salvo L, Razzetta F, Arezzo A. et al . Surveillance after colorectal cancer surgery.  Eur J Surg Oncol. 1997;  23 522-525
• 31 Uzawa M, Karasawa E, Sugiura N. et al . Doppler color flow imaging in the detection and quantitative measurement of the gastroduodenal artery blood flow.  J Clin Ultrasound. 1993;  21 9-17
• 32 Nakamura T, Moriyasu F, Ban N. et al . Quantitative measurement of abdominal arterial blood flow using image-directed Doppler ultrasonography: Superior mesenteric, splenic, and common hepatic arterial blood flow in normal adults.  J Clin Ultrasound. 1989;  17 261-268
• 33 Numata K, Tanaka K, Kiba T. et al . Hemodynamic changes in hepatic artery after glucose ingestion in healthy subjects and patients with cirrhosis.  J Clin Ultrasound. 1998;  26 137-142
• 34 Lautt W W. The 1995 Ciba-Geigy Award Lecture. Intrinsic regulation of hepatic blood flow.  Can J Physiol Pharmacol. 1996;  74 223-233
• 35 Leen E, Angerson W J, Wotherspoon H. et al . Comparison of the Doppler perfusion index and intraoperative ultrasonography in diagnosing colorectal liver metastases. Evaluation with postoperative follow-up results.  Ann Surg. 1994;  220 663-667
• 36 Giulio G D, Lupo L, Tirelli A. et al . (Blood flow assessment with Doppler color ultrasonography in primary and secondary tumors of the liver).  Radiol Med (Torino). 1997;  93 225-229
• 37 Strunk H, von Falkenhausen M, Hofer U. et al . (Variants of the hepatic artery: Detection with color-coded sonography pre and post levovist injection).  Ultraschall Med. 1999;  20 26-30
• 38 Strunk H. Viszerale Angiographie. Schild H Angiographie - angiographische Interventionen Stuttgart; Georg Thieme Verlag 1994: 140-221
• 39 De Santis M, Ariosi P, Calo G F, Romagnoli R. (Hepatic arterial vascular anatomy and its variants).  Radiol Med (Torino). 2000;  100 145-151
• 40 Chen C Y, Lee R C, Tseng H S. et al . Normal and variant anatomy of hepatic arteries: Angiographic experience.  Chung Hua I Hsueh Tsa Chih (Taipei). 1998;  61 17-23
• 41 Gattoni F, Baldini U, Pompili G, Pozzato C, Uslenghi C. (Abnormalities of the hepatic artery in relation to portal hypertension surgery. Study with angiography and echography).  Radiol Med (Torino). 1993;  85 421-424
• 42 Atlas der Anatomie des Menschen/Sobotta. München; Urban & Schwarzenberg 1998
• 43 Camunas J, Enriquez J M, Devesa J M, Morales V, Millan I. Value of follow-up in the management of recurrent colorectal cancer.  Eur J Surg Oncol. 1991;  17 530-535
• 44 Taourel P, Blanc P, Dauzat M. et al . Doppler study of mesenteric, hepatic, and portal circulation in alcoholic cirrhosis: Relationship between quantitative Doppler measurements and the severity of portal hypertension and hepatic failure.  Hepatology. 1998;  28 932-936
• 45 Gruenberger T, Jourdan J L, Zhao J, King J, Morris D L. Echogenicity of liver metastases is an independent prognostic factor after potentially curative treatment.  Arch Surg. 2000;  135 1285-1290
• 46 Hartley J E, Kumar H, Drew P J. et al . Laparoscopic ultrasound for the detection of hepatic metastases during laparoscopic colorectal cancer surgery.  Dis Colon Rectum. 2000;  43 320-324
• 47 Ludwig D. Wertigkeit der dynamischen abdominellen Dopplersonographie in der Beurteilung von Schweregrad Therapieerfolg und Prognose bei Leberzirrhose und chronisch entzündlichen Darmerkrankungen - Habilitationsschrift. 1999
• 48 Arienti V, Califano C, Brusco G. et al . Doppler ultrasonographic evaluation of splanchnic blood flow in coeliac disease.  Gut. 1996;  39 369-373
• 49 Sabba C, Ferraioli G, Genecin P. et al . Evaluation of postprandial hyperemia in superior mesenteric artery and portal vein in healthy and cirrhotic humans: An operator-blind echo-Doppler study.  Hepatology. 1991;  13 714-718
• 50 Guadagni S, Pizzutilli A, Mancini E. et al . Significance of duplex/colour Doppler sonography in hepatic arterial chemotherapy for patients with liver metastases from colorectal carcinoma.  Eur J Surg Oncol. 2000;  26 381-386
• 51 Maconi G, Parente F, Bollani S. et al . Factors affecting splanchnic haemodynamics in Crohn’s disease: A prospective controlled study using Doppler ultrasound (see comments).  Gut. 1998;  43 645-650
• 52 Herbetko J, Grigg A P, Buckley A R, Phillips G L. Venoocclusive liver disease after bone marrow transplantation: Findings at duplex sonography.  AJR Am J Roentgenol. 1992;  158 1001-1005
• 53 Leen E. The detection of occult liver metastases of colorectal carcinoma.  J Hepatobiliary Pancreat Surg. 1999;  6 7-15
• 54 Leen E, Anderson J R, Robertson J. et al . Doppler index perfusion in the detection of hepatic metastases secondary to gastric carcinoma.  Am J Surg. 1997;  173 99-102
• 55 Leen E, Angerson W J, Wotherspoon H. et al . Detection of colorectal liver metastases: Comparison of laparotomy, CT, US, and Doppler perfusion index and evaluation of postoperative follow- up results (see comments).  Radiology. 1995;  195 113-116
• 56 Leveson S H, Wiggins P A, Nasiru T A. et al . Improving the detection of hepatic metastases by the use of dynamic flow scintigraphy.  Br J Cancer. 1983;  47 719-721
• 57 Leveson S H, Wiggins P A, Giles G R, Parkin A, Robinson P J. Deranged liver blood flow patterns in the detection of liver metastases.  Br J Surg. 1985;  72 128-130
• 58 Ridge J A, Bading J R, Gelbard A S, Benua R S, Daly J M. Perfusion of colorectal hepatic metastases. Relative distribution of flow from the hepatic artery and portal vein.  Cancer. 1987;  59 1547-1553
• 59 Oppo K, Leen E, Angerson W J, McArdle C S. The effect of resecting the primary tumour on the Doppler Perfusion Index in patients with colorectal cancer.  Clin Radiol. 2000;  55 791-793
• 60 Filippone A, Basilico R, Guidotti A. et al . (Color Doppler ultrasonography in the identification and characterization of secondary focal lesions of the liver).  Radiol Med (Torino). 1994;  87 283-288
• 61 Leen E, Cooke T G, Angerson W J, McArdle C S. Estimation of total hepatic blood flow by duplex ultrasound.  Gut. 1992;  33 1293-1294
• 62 Leen E, Goldberg J A, Robertson J. et al . Detection of hepatic metastases using duplex/color Doppler sonography.  Ann Surg. 1991;  214 599-604
• 63 Leen E, Goldberg J A, Anderson J R. et al . Hepatic perfusion changes in patients with liver metastases: Comparison with those patients with cirrhosis.  Gut. 1993;  34 554-557
• 64 Oppo K, Leen E, Angerson W J, Cooke T G, McArdle C S. Doppler perfusion index: An interobserver and intraobserver reproducibility study.  Radiology. 1998;  208 453-457
• 65 Ohta M, Hashizume M, Tomikawa M. et al . Analysis of hepatic vein waveform by Doppler ultrasonography in 100 patients with portal hypertension.  Am J Gastroenterol. 1994;  89 170-175
• 66 Teichgraber U K, Gebel M, Benter T, Manns M P. Effect of respiration, exercise, and food intake on hepatic vein circulation.  J Ultrasound Med. 1997;  16 549-554
• 67 Bolondi L, Li B S, Gaiani S. et al . Liver cirrhosis: Changes of Doppler waveform of hepatic veins. (Published erratum appears in Radiology 1991; 100: 586).  Radiology. 1991;  178 513-516
• 68 Ohta M, Hashizume M, Kawanaka H. et al . Prognostic significance of hepatic vein waveform by Doppler ultrasonography in cirrhotic patients with portal hypertension.  Am J Gastroenterol. 1995;  90 1853-1857
• 69 Teichgraber U K, Gebel M, Hecker H, Benter T, Manns M P. (Importance of duplex velocity histograms in the diagnosis of liver cirrhosis).  Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 1996;  164 401-405
• 70 Hosoki T, Kuroda C, Tokunaga K. et al . Hepatic venous outflow obstruction: Evaluation with pulsed duplex sonography.  Radiology. 1989;  170 733-737
• 71 Roobottom C A, Hunter J D, Weston M J, Dubbins P A. Hepatic venous Doppler waveforms: Changes in pregnancy.  J Clin Ultrasound. 1995;  23 477-482
• 72 Pekindil G, Varol F G, Yuce M A, Yardim T. Evaluation of hepatic venous pulsatility and portal venous velocity with Doppler ultrasonography during the puerperium.  Eur J Radiol. 1999;  29 266-269
• 73 Dauzat M, Lafortune M, Patriquin H, Pomier-Layrargues G. Meal induced changes in hepatic and splanchnic circulation: A noninvasive Doppler study in normal humans.  Eur J Appl Physiol. 1994;  68 373-380
• 74 Joynt L K, Platt J F, Rubin J M, Ellis J H, Bude R O. Hepatic artery resistance before and after standard meal in subjects with diseased and healthy livers (see comments).  Radiology. 1995;  196 489-492
• 75 Tanaka K, Mitsui K, Morimoto M. et al . Increased hepatic arterial blood flow in acute viral hepatitis: Assessment by color Doppler sonography.  Hepatology. 1993;  18 21-27
• 76 Zoli M, Merkel C, Sabba C. et al . Interobserver and inter-equipment variability of echo-Doppler sonographic evaluation of the superior mesenteric artery.  J Ultrasound Med. 1996;  15 99-106
• 77 Okazaki K, Miyazaki M, Onishi S, Ito K. Effects of food intake and various extrinsic hormones on portal blood flow in patients with liver cirrhosis demonstrated by pulsed Doppler with the Octoson.  Scand J Gastroenterol. 1986;  21 1029-1038
• 78 Moriyasu F, Ban N, Nishida O. et al . Portal hemodynamics in patients with hepatocellular carcinoma.  Radiology. 1986;  161 707-711
• 79 Sato S, Ohnishi K, Sugita S, Okuda K. Splenic artery and superior mesenteric artery blood flow: Nonsurgical Doppler US measurement in healthy subjects and patients with chronic liver disease.  Radiology. 1987;  164 347-352
• 80 Furuse J, Maru Y, Mera K. et al . Visualization of blood flow in hepatic vessels and hepatocellular carcinoma using B-flow sonography.  J Clin Ultrasound. 2001;  29 1-6
• 81 Ohnishi K, Saito M, Nakayama T. et al . Portal venous hemodynamics in chronic liver disease: Effects of posture change and exercise.  Radiology. 1985;  155 757-761
• 82 Pugliese D, Ohnishi K, Tsunoda T, Sabba C, Albano O. Portal hemodynamics after meal in normal subjects and in patients with chronic liver disease studied by echo-Doppler flowmeter.  Am J Gastroenterol. 1987;  82 1052-1056
• 83 Leen E, Goldberg J A, Robertson J. et al . Image-directed Doppler ultrasonography: A novel technique for the diagnosis of colorectal liver metastases.  J Clin Ultrasound. 1993;  21 221-230
• 84 Leen E, Goldberg J A, Robertson J. et al . Early detection of occult colorectal hepatic metastases using duplex colour Doppler sonography.  Br J Surg. 1993;  80 1249-1251
• 85 Schafer C, Zundler J, Bode J C. Thrombolytic therapy in patients with portal vein thrombosis: Case report and review of the literature.  Eur J Gastroenterol Hepatol. 2000;  12 1141-1145