Radiol Oncol. 2012 Sep;46(3):198-206. doi: 10.2478/v10019-012-0028-9. Epub 2012 Apr 19.

Fluctuating portal velocity tracing with rhythmicity: ultrasonic differential diagnosis and clinical significance.

Radiology and oncology

Qingxin Meng, Lei Lv, Bin Yang, Ninghua Fu, Guangming Lu

PMID: 23077458 PMCID: PMC3472948 DOI: 10.2478/v10019-012-0028-9

Abstract

BACKGROUND: To evaluate the usefulness of the routine sonographic evaluation of the pattern of fluctuate portal velocity tracings and the hepatic veins for the diagnosis of arterioportal fistula (APF) and cardiogenic trans-sinusoidal shunting (CTS). MATERIALS AND METHODS.: Color Doppler flow imaging and pulsed-wave Doppler (PW) examinations of the portal vein were performed in 282 subjects. The waveforms of the velocity tracings in the portal main trunk and its branches were determined to infer APF or CTS. Suspected cases of APFs or CTSs were always confirmed by echocardiography, contrast-enhanced ultrasound, computed tomography, or digital subtraction angiography findings. The portal maximum velocity (V(max)), minimum velocity(V(min)), V(max)/V(min), arterial peak systolic velocity and resistance index, and venous reverse and forward velocities were used to estimate their haemodynamics.

RESULTS: The waveform of the velocity tracing for the draining portal vein of APF was typically arterial-like or diphase, as indicated by a systolic hepatofugal dwarf peak and a diastolic hepatopetal low flat shape. The flow in the affected portal vein was always hepatofugal in an intrahepatic patient, whereas a hepatopetal flow was observed in an extrahepatic APF patient. The waveform of the velocity tracing for the portal vein of CTS patients, especially its intrahepatic branches, showed a typical hump-like shape with or without a transitory hepatofugal tracing. The PW results displayed an increase in the retrograde phase of the hepatic venous flow with increased velocities in the two phases.

CONCLUSIONS: Portal velocity tracings should be evaluated during routine detecting for APF or CTS, especially in patients with gastrointestinal upsets.

Keywords: arterioportal fistula; cardiogenic trans-sinusoidal shunting; portal hypertension; tricuspid regurgitation; velocity tracing

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