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1 ٩٥ Downloaded from tumj.tums.ac.ir at 0:51 IRST on Tuesday January nd 019. : :. 0/5 ROC. ) :. 0/81±0/07 ) hepatic arterial resistance index (RI) (10/95±1/69 1/67±/7 (1/4±0/ 1/87±0/48 ) hepatic arterial pulsatility index (PI) (0/74±0/09.(p=)..(p=) (6/74±8/74 16/50±5/59 )..(p=) %95/45 4/1 1/54 PI. (CI95%: %91/-%97/70) 0/765 RI (CI95%: 79/48%-90/9%) %85/71 :. (CI95%: 6/81%-78/11%) %71/05 : * * : rokniyaz@sina.tums.ac.ir... (Cirrhosis)

2 96 Downloaded from tumj.tums.ac.ir at 0:51 IRST on Tuesday January nd SPSS (test ) ROC ( (Wilson score ) %95. Pulsatility ROC. ) ROC (1-5 ROC.. ( ) 0/5. 0/7. ROC. ROC. 0/5 ROC. 0/05 p. Pulsatility. (p=) (p=) (1 ). (p=) / 117. (case control) ) / ( EUB-55 Hitachi ). ( Pulsatility Supine Pulsatility.. t (Independent samples t-test) Fisher's exact ) χ

3 97 Downloaded from tumj.tums.ac.ir at 0:51 IRST on Tuesday January nd 019 ( ) ± () () :1 - p -- 0/47 0/99 0/46 0/ /4±15/16 7(%54/00) 1(%0/95) (%56/10) 16/50±5/59 1/67±/7 76/0±6/46 17/0±10/10 0/81±0/07 1/87±0/ /4±14/7 6(%5/94) 0(%0/0) 0(%0/0) 6/74±8/74 10/95±1/69 87/±86/0 0/4±11/00 0/74±0/09 1/4±0/ ( ) * * Pulsatility * * * * Pulsatility %95 ( ) ROC : - %95/45 (%97/70-%91/) %85/71 (%90/9-%79/48) %71/05 (%78/11-%6/81) %98/68 %98/49 %97/60 %99/18 %97/70 %97/01 (%99/18-%89/75) %89/ (%94/68-%79/40) %84/1 (%91/8-%71/99) Pulsatility %9/0 (%97/60-%81/9) %80/85 (%89/58-%67/46) %60/ (%71/47-%47/98) %95/59 (%98/49-%87/81) %86/57 (%9/77-%76/40) %6/4 (%7/70-%51/6) %95/4 (%98/68-%84/1) %84/44 (%9/5-%71/) %8/61 (%90/91-%69/8) 0/984 0/87 0/75 *(4 cm/s) Pulsatility *(1/54) *(0/77) (Fisher's Exact test p<0/05) * 4/1 : - % 95 %84/1 %87/81 %81/9 %89/75 %91/ %95/4 %95/59 %9/0 %97/01 %95/45 4/1 %95/45 Fisher's exact test.(1 ).(p<0/05) %95. Pulsatility.. (p=).(1 ) pulsatility ROC

4 98 Downloaded from tumj.tums.ac.ir at 0:51 IRST on Tuesday January nd 019 Iwao Grading (Child ) 1 9 Lu. 14 O'Donohue 1 Chawla. ). (p=).(10/95±1/69 1/67±/7. Child's I Child. Child (p=) ROC hepatic arterial pulsatility index ROC 1 -. (0/87= (p=) ) %95 (. 15 %95 Wilson.( ) score method (p=) Kok (p=) Pulsatility. ). (p=).(6/74±8/74 16/50±5/ Haktanir

5 99 Downloaded from tumj.tums.ac.ir at 0:51 IRST on Tuesday January nd flow profile. 1/54 pulsatility (CI%95:%71/-%9/5)%84/44 %85/71 (CI%95:%76/40-%9/77)%5786 Iwao. (IC%95:%90/9-%97/48) 1/1 %81 %84 pulsatility. 0/765 %6/4 (CI%95:%69/8-90/91)%8/61 (CI%95 :%6/81-78/11) (CI%95:%51/6-7/70). %71/05 8. compensated cut-off 11 pulsatility (0 cm/s 19 Hepatic circulatory index ). 14 O'Donohue Piscaglia... pulsatility 18 Barakat. (p=) pulsatility... pulsatility Iwao. 4/1 (CI%95:%87/81-98/49) (CI%95:%84/1-98/68)%95/4. (CI%95:%91/-97/70)%95/45 %95/59 4 Tuney. 0cm/s Iwao 1. %8 cut-off %8. %

6 Rokniye yazdi H. et al. 100 Downloaded from tumj.tums.ac.ir at 0:51 IRST on Tuesday January nd 019 1/54 PI. 0/765 RI %85/71. %71/05 References 1. Chung RT, Podolsky DK. Cirrhosis and Its Complications. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, editors. Harrison's Textbook of Internal Medicine. 16 th ed. New York: McGrow-Hill; 005: p Kok T, van der Jagt EJ, Haagsma EB, Bijleveld CM, Jansen PL, Boeve WJ. The value of Doppler ultrasound in cirrhosis and portal hypertension. Scand J Gastroenterol Suppl 1999; 0: Iwao T, Toyonaga A, Oho K, Tayama C, Masumoto H, Sakai T, et al. Value of Doppler ultrasound parameters of portal vein and hepatic artery in the diagnosis of cirrhosis and portal hypertension. Am J Gastroenterol 1997; 9: Tüney D, Aribal ME, Ertem D, Kotiloğlu E, Pehlivanoğlu E. Diagnosis of liver cirrhosis in children based on colour Doppler ultrasonography with histopathological correlation. Pediatr Radiol 1998; 8: Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 198; 14: Bolondi L, Li Bassi S, Gaiani S, Zironi G, Benzi G, Santi V, et al. Liver cirrhosis: changes of Doppler waveform of hepatic veins. Radiology 1991; 178: Gorka W, Gorka TS, Lewall DB. Doppler ultrasound evaluation of advanced portal vein pulsatility in patients with normal echocardiograms. Eur J Ultrasound 1998; 8: Cioni G, D'Alimonte P, Cristani A, Ventura P, Abbati G, Tincani E, et al. Duplex-Doppler assessment of cirrhosis in patients with chronic compensated liver disease. J Gastroenterol Hepatol 199; 7: Haktanir A, Cihan BS, Celenk C, Cihan S. Value of Doppler sonography in assessing the progression of chronic viral hepatitis and in the diagnosis and grading of cirrhosis. J Ultrasound Med 005; 4: pulsatility 10. Chawla Y, Santa N, Dhiman RK, Dilawari JB. Portal hemodynamics by duplex Doppler sonography in different grades of cirrhosis. Dig Dis Sci 1998; 4: Gorka W, Kagalwalla A, McParland BJ, Kagalwalla Y, al Zaben A. Diagnostic value of Doppler ultrasound in the assessment of liver cirrhosis in children: histopathological correlation. J Clin Ultrasound 1996; 4: Lu LG, Zeng MD, Wan MB, Li CZ, Mao YM, Li JQ, et al. Grading and staging of hepatic fibrosis, and its relationship with noninvasive diagnostic parameters. World J Gastroenterol 00; 9: Chawla Y, Santa N, Dhiman RK, Dilawari JB. Portal hemodynamics by duplex Doppler sonography in different grades of cirrhosis. Dig Dis Sci 1998; 4: O'Donohue J, Ng C, Catnach S, Farrant P, Williams R. Diagnostic value of Doppler assessment of the hepatic and portal vessels and ultrasound of the spleen in liver disease. Eur J Gastroenterol Hepatol 004; 16: Sugimoto H, Kaneko T, Hirota M, Inoue S, Takeda S, Nakao A. Physical hemodynamic interaction between portal venous and hepatic arterial blood flow in humans. Liver Int 005; 5: Piscaglia F, Gaiani S, Calderoni D, Donati G, Celli N, Gramantieri L, et al. Influence of liver fibrosis on hepatic artery Doppler resistance index in chronic hepatitis of viral origin. Scand J Gastroenterol 001; 6: Piscaglia F, Gaiani S, Zironi G, Gramantieri L, Casali A, Siringo S, Serra C, Bolondi L. Intra- and extrahepatic arterial resistances in chronic hepatitis and liver cirrhosis. Ultrasound Med Biol 1997; : Barakat M. Portal vein pulsatility and spectral width changes in patients with portal hypertension: relation to the severity of liver disease. Br J Radiol 00; 75: Sugimoto H, Kaneko T, Inoue S, Takeda S, Nakao A. Simultaneous Doppler measurement of portal venous peak velocity, hepatic arterial peak velocity, and splenic arterial pulsatility index for assessment of hepatic circulation. Hepatogastroenterology 00; 49:

7 101 Tehran University Medical Journal; Vol. 66, No., May 008: Diagnostic accuracy of hepatic artery and portal vein Doppler ultrasonography in cirrhotic patients Downloaded from tumj.tums.ac.ir at 0:51 IRST on Tuesday January nd 019 Rokni yazdi H. * Shirmohammadi M. Department of Radiology Tehran University of Medical Sciences Abstract Background: Cirrhosis and portal hypertension influence the hepatic circulation. The purpose of this study was to evaluate the diagnostic accuracy of liver Doppler ultrasonography parameters in cirrhosis. Methods: This case-control study involved 118 subjects. All case subjects had biopsyproven hepatic cirrhosis. The controls were healthy people, case-matched for age and gender. All cases and controls underwent Doppler ultrasonographic evaluation. We compared the area under the ROC curve of each parameter for cases vs. controls using Fisher s exact test, with p <0.5 indicating significance. Results: The means of the following parameters for case vs. control subjects were: frequency of portal venous flow inversion, portal vein diameter 1.67±.7 vs ±1.69, and hepatic arterial resistance index 0.81±0.07 vs. 0.74±0.09. The mean hepatic artery pulsatility index (1.87±0.48 vs. 1.4±0.), was significantly higher among the case subjects (P=0.001). The maximum flow rate of the portal vein was also significantly lower in the case subjects (16.50±5.59 vs. 6.74±8.74 cm/s, P=0.001). We did not observe significant differences in the means of the hepatic artery maximum flow rate and end-diastolic flow rate. For diagnosing cirrhosis, the application of 4.1 cm/s as the cutoff point for the portal vein maximum flow rate, we obtain an accuracy of 95.45% (91.%-97.70%, CI=95%), whereas a cutoff point of 1.54 or more for the hepatic artery pulsatility index yields an accuracy of 85.71% (79.48%-90.9%, CI=95%). Utilizing a hepatic arterial resistance index of or greater is associated with an accuracy of 71.05% (6.81%-78.11%, CI=95%) in diagnosing cirrhosis. Conclusions: Doppler ultrasonography and assessment of hepatic artery and portal vein parameters are accurate methods in the diagnosis of cirrhosis. Keywords: Hepatic artery, portal vein, doppler ultrasonography, cirrhosis. *Corresponding author: Imam Khomeini Hospital, Keshavarz Blvd., Tehran. Tel: rokniyaz@sina.tums.ac.ir

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