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Ultrasonography in the diagnosis of complications in patients with portal hypertension

  • Special Feature: Review Article
  • Imaging-based diagnosis and management of cirrhosis/portal hypertension
  • Published:
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Abstract

This review focuses on ultrasonography (US) to diagnose patients with complications in portal hypertension. Clinicians first use US to evaluate patients with suspected portal hypertension, because US is quick, simple, and radiation free. US is necessary for grading and performing paracentesis for ascites. Doppler US-based detection of reverse splanchnic vein flow or the presence of a spontaneous portosystemic shunt is highly specific in patients with cirrhosis. Since it is important to estimate spleen size in patients with portal hypertension, spleen size is usually measured by US. Spleen volume can be more accurately measured with 3D-US. Estimation of viable residual splenic volume after partial splenic embolization should be limited to cases with total splenic volume less than 1000 ml. Portal vein thrombosis is often detected during the US examination performed when symptoms first appear or during the follow-up. Two-dimensional transthoracic echocardiography is an excellent noninvasive screening test in patients with pulmonary portal hypertension who can undergo it. By measuring the maximum and minimum diastolic blood flow velocities in the renal arteries using renal color Doppler US, the pulsatility index (PI) and resistive index (RI) can be calculated. The PI and RI in cirrhotic patients were significantly higher than those in healthy subjects and patients with chronic hepatitis, and showed a significant positive correlation with the Child–Pugh Score. In conclusion, US is an essential tool for the diagnosis and treatment of patients with portal hypertension.

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Abbreviations

US:

Ultrasonography

CE-US:

Contrast-enhanced US

PS:

Portosystemic shunts

PVT:

Portal vein thrombosis

PVTT:

Portal venous tumor thrombosis

HVPG:

Hepatic venous pressure gradient

CSPH:

Clinically significant portal hypertension

PoPH:

Pulmonary portal hypertension

HRS:

Hepatorenal syndrome

SBP:

Spontaneous bacterial peritonitis

UVSs:

Umbilical vein shunts

MSs:

Mesenteric shunts

CT:

Computed tomography

SI:

Splenic index

VOCAL:

Virtual organ computer-aided analysis

ICCs:

Interclass correlation coefficients

PSE:

Partial splenic embolization

RHC:

Right-sided heart catheterization

TTE:

Transthoracic echocardiography

RVSP:

Right-ventricular systolic pressure

PASP:

Pulmonary artery systolic pressure

PI:

Pulsatility index

RI:

Resistive index

BUN:

Blood urea nitrogen

Cr:

Creatinine

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Acknowledgements

We thank Hitoshi Maruyama, MD, PhD, Department of Gastroenterology, Juntendo University, for advice on writing the manuscript, and Robert E. Brandt, Founder, CEO, and CME, of MedEd Japan, for editing and formatting the manuscript.

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The authors disclose no sources of funding.

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  1. Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

    Hisashi Hidaka & Haruki Uojima

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  1. Hisashi Hidaka
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Correspondence to Hisashi Hidaka.

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Hidaka, H., Uojima, H. Ultrasonography in the diagnosis of complications in patients with portal hypertension. J Med Ultrasonics 49, 347–358 (2022). https://doi.org/10.1007/s10396-021-01158-3

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