Korean J Radiol.  2015 Apr;16(2):314-324. 10.3348/kjr.2015.16.2.314.

The Accuracy of Ultrasonography for the Evaluation of Portal Hypertension in Patients with Cirrhosis: A Systematic Review

• Kim G
• Cho YZ
• Baik SK
• Kim MY
• Hong WK
• Kwon SO

• KMID: 2070175
• DOI: http://doi.org/10.3348/kjr.2015.16.2.314

Abstract

OBJECTIVE
Studies have presented conflicting results regarding the accuracy of ultrasonography (US) for diagnosing portal hypertension (PH). We sought to identify evidence in the literature regarding the accuracy of US for assessing PH in patients with liver cirrhosis.
MATERIALS AND METHODS
We conducted a systematic review by searching databases, including MEDLINE, EMBASE, and the Cochrane Library, for relevant studies.
RESULTS
A total of 14 studies met our inclusion criteria. The US indices were obtained in the portal vein (n = 9), hepatic artery (n = 6), hepatic vein (HV) (n = 4) and other vessels. Using hepatic venous pressure gradient (HVPG) as the reference, the sensitivity (Se) and specificity (Sp) of the portal venous indices were 69-88% and 67-75%, respectively. The correlation coefficients between HVPG and the portal venous indices were approximately 0.296-0.8. No studies assess the Se and Sp of the hepatic arterial indices. The correlation between HVPG and the hepatic arterial indices ranged from 0.01 to 0.83. The Se and Sp of the hepatic venous indices were 75.9-77.8% and 81.8-100%, respectively. In particular, the Se and Sp of HV arrival time for clinically significant PH were 92.7% and 86.7%, respectively. A statistically significant correlation between HVPG and the hepatic venous indices was observed (0.545-0.649).
CONCLUSION
Some US indices, such as HV, exhibited an increased accuracy for diagnosing PH. These indices may be useful in clinical practice for the detection of significant PH.

Keyword

Ultrasonography; Hepatic venous pressure gradient; Portal hypertension; Cirrhosis

MeSH Terms

Hepatic Veins/ultrasonography
Humans
Hypertension, Portal/*diagnosis/*ultrasonography
Liver Cirrhosis/*ultrasonography
Middle Aged
Portal Pressure
Portal Vein/ultrasonography
Prospective Studies
Sensitivity and Specificity
Vascular Resistance

Figure

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  Fig. 1 Flow diagram depicting evaluation process for inclusion of studies reviewed in this study.

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  Fig. 2 Summary of risk of bias for 14 selected studies.

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  Fig. 3 Measurement of damping index (DI) of hepatic vein wave form. Damping index is calculated by dividing minimum velocity by maximum velocity of hepatic vein waveform. A. Patient with cirrhosis exhibits DI of 0.27 with 5 mm Hg hepatic venous pressure gradient (HVPG). B. Another patient with cirrhosis exhibits DI of 0.7 with 15 mm Hg of HVPG.

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