Portal ht

1. ‫بسم ا الرحمن‬ ‫الرحيم‬

2. Role of color Doppler in evaluation of portal hypertension By Dr. HATEM EL-AZIZI ASS. PROF. OF RADIODIAGNOSIS CAIRO UNIVERSTIY

3. What is portal hypertension

4. Portal hypertension  Defined as  elevation of pressure above 10 mmHg  Difference in pressure between PV & IVC more than 5 mmHg  Complication of portal hypertension occurs above 12mmHg

5. Portal hypertension Definition  Acute or chronic hepatocellular disease can block the flow of blood throughout the liver, causing it to back up into the hepatic portal circulation.  This causes the blood pressure in the hepatic circulation to increase (portal hypertension).  In an effort to relieve the pressure, collateral veins are formed that connect to the systemic veins.  This is known as varicose veins and occurs most frequently in the area of the esophagus, stomach, and rectum. Rupture of these veins may cause massive bleeding that may result in death.

6. Portal hypertension  causes  pre hepatic  Hepatic  Post hepatic

7. ? what to examin

8. Portal hypertension  Portal vein  Hepatic vines  IVC  Splenic vein  Hepatic artery  Splenic artery  Superior mesenteric artery

9. !! Search & analysis

10. Portal hypertension  Flow pattern  velocity  Doppler indices  waveform

11. Flow pattern

12. Portal hypertension  Flow pattern  Normal  Hepatopedal  Abnormal  hepatopedal  Hepatofugal  Bidirectional  Static

13. Basics of Doppler

14. Basics of Doppler The sound frequency from an approaching source is higher than from one receding

23. Basics of Doppler Re dB loo d Ce lls No rm al R ed Blo o dC ells Ce Ab llul no ar rm stru ctu al R re ed of r Bl o ed od blo Re od C ells d cel blo l od c ell as vi

24. Basics of Doppler Red Blood Cells Normal Red Blood Cells Ab Cellular structure of red blood cell

25. Basics of Doppler Re dB loo dC ells No rm al R ed Blo o dC ells Ce llula r stru ctu re o f re db loo Re dc d bl ell

28. Basics of Doppler Re dB loo d Ce lls No rm Re al R dB ed Blo loo o dC dC ells ells Norm Ce al R llul ed ar stru Blo ctu od re Ce of r lls ed blo Re od db cel lo o l dc ell Ce as llul vie ar we stru d fr ctu om re the of r s id ed e b lo Re od db cel l l

38. Portal hypertension  Flow pattern  Normal  Hepatopedal  Abnormal  hepatopedal  Hepatofugal  Bidirectional  Static

39. Portal hypertension

45. Doppler indices

46. Portal hypertension  Portal vein velocity  Normal  20.2 -33.3 cm/sec  Cirrhosis  11.0 cm/sec  Portal hypertension  15.9 cm/sec

47. Portal hypertension  Congestion index  ratio between cross section area and flow velocity  Increase in PH  Normal  0.06  Oesophageal varices  0.145  Cirrhosis  0.11

48. Portal hypertension  Splenic arterial RI  0.60 measured at splenic hilum  Increased in PH

49. Portal hypertension  Liver vascular index  Ratio between portal venous velocity & hepatic artery PI  Cut-off of liver vascular index 12 cm/sec  Liver vascular index  Normal  8.7+2.1  Significantly higher in patient with PH 17.2+4.3

50. Waveform analysis

51. Portal vein  Continuous low velocity phasic signal; phasic means that the velocity increases and decreases with respirations giving the signal a smooth wavelike appearance  Normal flow is termed hepatopedal (toward the liver( Reversed flow is hepatofugal.

52. Portal vein

53. Portal vein

54. Portal vein

55. Portal vein

56. Portal vein

57. Portal vein

58. Portal vein

59. Portal vein

60. Portal vein

61. Portal vein

62. Portal vein

63. Portal vein

64. Portal vein

65. Portal vein

66. Portal vein

67. Portal vein

68. Portal vein

69. Hepatic Artery  Low resistance waveform; forward flow in diastole above baseline  NOTE: The hepatic artery and portal vein flow should be in the same direction as the hepatic artery runs parallel with the portal vein.

70. Hepatic Artery

71. Hepatic Artery

72. Hepatic Venous System  Multi-phasic pulsatile flow pattern secondary to proximity of the right atrium with flow above and below the baseline  Right sided heart failure may cause the hepatic veins to become pulsatile and dilated.  Increased intrahepatic pressure or venous obstruction demonstrates a more continuous or monophonic signal

73. Hepatic Venous System

79. Inferior Vena Cava  Continuous waveform with respiratory variations; become more pulsatile as it empties into the right atrium.  Best imaged with a slight cranial- caudal sweep in the longitudinal plane with the patient in deep inspiration  Thrombosis can cause the IVC waveform to appear monophasic with high velocities.

80. Thank You

Portal ht

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Portal ht