<abstract xml:lang="en" xmlns="http://www.w3.org/1999/xhtml"><bold>Background.</bold> 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).<bold>Materials and methods.</bold> 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 (<italic>V</italic>max), minimum velocity(<italic>V</italic>min), <italic>V</italic>max/<italic>V</italic>min, arterial peak systolic velocity and resistance index, and venous reverse and forward velocities were used to estimate their haemodynamics.<bold>Results.</bold> 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.<bold>Conclusions.</bold> Portal velocity tracings should be evaluated during routine detecting for APF or CTS, especially in patients with gastrointestinal upsets.</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 (Vmax), minimum velocity(Vmin), Vmax/Vmin, 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.

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

Department of Ultrasound, Nanjing University, Nanjing, Jiangsu Province, China

Department of Cardiology, Nanjing University, Nanjing, Jiangsu Province, China

Department of Medical Imaging, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China

Radiology and Oncology

Background. To evaluate the usefulness of the routine sonographic evaluation of the pattern of fluctuate portal velocity tracings and the hepatic veins for the...

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

Published Online: Apr 19, 2012

Page range: 198 - 206

DOI: https://doi.org/10.2478/v10019-012-0028-9

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

This content is open access.

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

Published Online: Apr 19, 2012

Page range: 198 - 206

DOI: https://doi.org/10.2478/v10019-012-0028-9

Keywordsvelocity tracing, portal hypertension, tricuspid regurgitation, arterioportal fistula, cardiogenic trans-sinusoidal shunting

This content is open access.

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