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Savvakis S, Lagopoulos VI, Mantalovas S, Paschou E, Kopsidas P, Sevva C, Karakousis AV, Gigi E, Kesisoglou I. Streamline Flow of the Portal Vein Affects the Distribution of Colorectal Cancer Metastases: Clinical Reality or Just a Belief? A Systematic Review and Meta-Analysis. Cancers (Basel) 2024; 16:3902. [PMID: 39682091 DOI: 10.3390/cancers16233902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 11/19/2024] [Accepted: 11/20/2024] [Indexed: 12/18/2024] Open
Abstract
Background: The "streamline flow" of the portal vein (PV) is a controversial yet well-known theory presented almost 125 years ago. It states that blood from the superior mesenteric vein (SMV) goes preferentially to the right liver lobe, while splenic and inferior mesenteric veins divert blood predominantly to the left lobe, affecting this way the metastatic distribution of colorectal cancer (CRC). The aim of this systematic review is to assess its validity by examining and combining all the relevant literature with a critical eye. Materials and methods: This study constitutes a systematic review of the literature and adheres to all PRISMA system criteria. Three search engines (PubMed, Google Scholar, and the Cochrane Library) were used, and 11 out of 435 studies between 1984 and 2024 were finally included in this meta-analysis. All statistical analysis was conducted using RevMan Web, Version: 7.12.0, and Jamovi v 2.3.260 software. Results: The meta-analysis revealed that regardless of the primary location of the tumor, the metastases preferentially migrate to the right lobe due to various possible reasons. The prevalence of metastases from right colon cancer to the right liver lobe was 75%, while the prevalence of left colon cancer metastases to the right lobe was 68%. This difference was not found statistically significant. Conclusions: The theory has been proven inaccurate, at least from the perspective of the origin-associated distribution of CRC metastases in the liver lobes, and therefore bears no clear predictive value. Further research under different perspectives is essential for determining more definite conclusions.
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Affiliation(s)
- Stavros Savvakis
- 3rd Surgical Department, AHEPA University Hospital of Thessaloniki, School of Medicine, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
| | - Vasileios I Lagopoulos
- 3rd Surgical Department, AHEPA University Hospital of Thessaloniki, School of Medicine, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
| | - Stylianos Mantalovas
- 3rd Surgical Department, AHEPA University Hospital of Thessaloniki, School of Medicine, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
| | - Eleni Paschou
- 3rd Surgical Department, AHEPA University Hospital of Thessaloniki, School of Medicine, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
| | - Periklis Kopsidas
- 3rd Surgical Department, AHEPA University Hospital of Thessaloniki, School of Medicine, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
| | - Christina Sevva
- 3rd Surgical Department, AHEPA University Hospital of Thessaloniki, School of Medicine, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
| | - Alexandros Vasileios Karakousis
- 3rd Surgical Department, AHEPA University Hospital of Thessaloniki, School of Medicine, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
| | - Eleni Gigi
- 2nd Internal Medicine Department, Aristotle University of Thessaloniki, Hippokrateio General Hospital, 54642 Thessaloniki, Greece
| | - Isaak Kesisoglou
- 3rd Surgical Department, AHEPA University Hospital of Thessaloniki, School of Medicine, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
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Pandey K, Dash D, Koiri RK. Liver lobes and cirrhosis: Diagnostic insights from lobar ratios. GASTROENTEROLOGY & ENDOSCOPY 2024. [DOI: 10.1016/j.gande.2024.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Chau P, Yoon JS, Moses D, Pather N. A systematic review and meta-analysis of portal vein morphometry in pediatric and adult populations: Drawing the line between normal and abnormal findings. Eur J Radiol 2023; 168:111016. [PMID: 37742371 DOI: 10.1016/j.ejrad.2023.111016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 07/13/2023] [Accepted: 07/26/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE The morphometry of the hepatic portal vein is of clinical importance, particularly in pre-operative assessments, surgical management, and diagnoses of liver conditions. This systematic review and meta-analysis aimed to characterize the morphometry of the normal portal vein in both pediatric and adult patients. METHODS The study, conducted using the PRISMA guidelines and registered with PROSPERO, utilized the MEDLINE, EMBASE, SCOPUS and Web of Science databases up to May 2020, and updated to May 2023. All studies reporting extractable data on diameter, length, and cross-sectional area (CSA) of the main, left, and right portal veins (PV, LPV, RPV, respectively) were included. The AQUA Tool was used to assess the quality of the included studies. Data analysis included subgroup analyses based on geographical location, sex, age, and imaging modality. RESULTS A total of 122 studies with 11,637 subjects were eligible for inclusion. Overall, the pooled mean diameter of the PV (PVD) was 10.09 mm (95% CI: 9.56-10.62). Significant differences in diameter were found between pediatric (6.60 mm; 95% CI: 5.38-7.82) and adult (10.72 mm; 95% CI: 10.25-11.19) subjects. Additionally, there was a significantly larger PVD measurement from computed tomography (CT) than other imaging modalities: CT, 13.28 mm (95% CI: 11.71-14.84); magnetic resonance imaging (MRI), 10.50 mm (95% CI: 9.35-11.66) and ultrasound (US), 9.81 mm (95% CI: 9.47-10.16). The mean diameters of the LPV and RPV were 8.27 mm (95% CI: 6.78-9.77) and 8.33 mm (95% CI: 6.70-9.95), respectively. Mean PV length in adults is 48.63 mm (95% CI: 35.63-61.64). Mean CSA of the PV was 1.09 cm2. CONCLUSIONS The study obtained aim to improve the understanding of portal vein anatomy, especially with relevance to surgical interventions of the liver in both pediatric and adult patients. Measurements from ultrasound imaging closely approximates the generated pooled PVD mean for pediatric and adult patients. CT imaging, however, significantly exceeded the established 13 mm threshold for adults. For pediatric patients, a threshold of 8 mm is proposed as a diagnostic upper limit for a normal PVD. Although not significant, the PVD decreased from the portal confluence towards its bifurcation.
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Affiliation(s)
- Patrick Chau
- Department of Anatomy, School of Biomedical Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Ji Soo Yoon
- Department of Anatomy, School of Biomedical Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Daniel Moses
- Department of Radiology, Prince of Wales Hospital, Sydney, Australia
| | - Nalini Pather
- Department of Anatomy, School of Biomedical Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia; Academy of Medical Education, Medical School, Faculty of Medicine, University of Queensland, Australia; Medical Education, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.
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Chen Y, Li J, Zhou Q, Lyu G, Li S. Detection of liver and spleen stiffness in rats with portal hypertension by two-dimensional shear wave elastography. BMC Med Imaging 2022; 22:68. [PMID: 35418033 PMCID: PMC9006581 DOI: 10.1186/s12880-022-00786-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The measurement of liver stiffness (LS) and spleen stiffness (SS) based on ultrasound elastography can be used for non-invasive assessment of portal hypertension (PH). However, there are few studies on the corresponding mechanism of increased spleen stiffness. Our aim was to use two-dimensional shear wave elastrography (2D-SWE) to evaluate the relationship between LS and SS and the severity of PH in rats. And explore the mechanism of the increase of LS and SS in PH. METHODS Sixty male Sprague-Dawley rats were randomly divided into portal hypertension (PH group, n = 45) and normal control (NC group, n = 15). At 12 weeks, LS and SS was detected by 2D-SWE in vivo. Related hemodynamic parameters and portal vein pressure (PVP) was measured. Spleen and liver 2D-SWE detection was performed again after sacrifice. Pathological changes were observed. RESULTS The SS and LS were increased in PH group (P < 0.05). The SS decreased after sacrifice, and what's more the magnitude of SS decline significantly higher in PH group than in NC group (P < 0.05). The correlation between SS and PVP is stronger than LS (r = 0.624, P < 0.001). SS has positive correlation with indexes of hyperdynamic circulation, but LS was weakly. The correlation between SS and the pathological grade (r = 0.633, P < 0.001) was lower than that in LS (r = 0.905, P < 0.001). Multiple linear regression analysis revealed that SS, portal vein inner diameter (PVD) and splenic vein blood flow velocity (SVV) were significantly associated with PH. CONCLUSIONS Spleen and liver measurement by 2D-SWE may be helpful in evaluating PVP. The correlation between SS and PVP is stronger than LS in rats measured by 2D-SWE. Hemodynamic circulation are important in the elevation of SS with portal hypertension. Pathological changes also have a degree of influence, but have more significance for the elevation of LS. SS may be a more effective noninvasive predictor of PH than LS.
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Affiliation(s)
- YongJian Chen
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Licheng District, , Quanzhou, 362000, Fujian, China
| | - JingYun Li
- Maternal and Child Health Service Application Technology Collaborative Innovation Center, Quanzhou Medical College, Quanzhou, Fujian, China
| | - Qin Zhou
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Licheng District, , Quanzhou, 362000, Fujian, China
| | - GuoRong Lyu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Licheng District, , Quanzhou, 362000, Fujian, China. .,Maternal and Child Health Service Application Technology Collaborative Innovation Center, Quanzhou Medical College, Quanzhou, Fujian, China.
| | - ShiLin Li
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Licheng District, , Quanzhou, 362000, Fujian, China
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Hassnine AA, Soliman W, Elsayed AM, Higazi MM, Saied M, Abdelraheem EM. Effect of direct-acting antiviral drugs on portal circulation hemodynamics in cirrhotic patients infected with HCV. EGYPTIAN LIVER JOURNAL 2022. [DOI: 10.1186/s43066-022-00181-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Liver cirrhosis (LC) is the most common cause of portal hypertension. In chronic hepatitis C patients who are treated with direct-acting antiviral therapy (DAAS), the progression of cirrhosis can be reversed with treatment. Portal hypertension is also expected to improve with a virological response.
Aim
To evaluate the effect of direct-acting antiviral therapy on portal circulation hemodynamics in cirrhotic patients infected with HCV.
Methods
This study included 78 consecutive patients with chronic HCV-related liver disease. They were treated by a sofosbuvir-based regimen in combination with daclatasavir. All patients were subjected to routine investigations (complete blood count, liver and renal function tests), hepatitis B surface antigen, α feto protein, PCR of HCV RNA, imaging (abdominal ultrasound and colored Doppler and duplex examination for the assessment portal hypertension) before starting treatment and after 1 year.
Results
There was a significant improvement in Doppler parameters such as portal vein (PV) diameter, PV velocity, PV cross-sectional area, portal congestive index, splenic vein diameter, and spleen span; the decrease in portal pressure occur in about 55% of the patients; several factors are associated with non-response as a history of bilharziasis, patients from a rural area, presence of splenomegaly and varices, low HB level, low platelet count, and high level of fibrosis.
Conclusion
Sustained virological response to direct-acting antiviral therapy is associated with a reduction in portal pressure in patients with liver cirrhosis and clinically significant portal hypertension.
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Onwuka C, Famurewa O, Adekanle O, Ayoola O, Adegbehingbe O. Hepatic function predictive value of hepatic venous waveform versus portal vein velocity in liver cirrhosis. J Med Ultrasound 2022; 30:109-115. [PMID: 35832354 PMCID: PMC9272706 DOI: 10.4103/jmu.jmu_91_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/13/2021] [Accepted: 07/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background: This study assessed the hepatic vein waveform (HVW) and mean maximum portal vein velocity (MM-PVV) on Doppler ultrasound in patients with liver cirrhosis (LC) and compared it with that of age and sex-matched controls. It correlated the degree of HVW abnormality and MM-PVV changes with liver function based on Child-Turcotte-Pugh (CTP) to determine which was more predictive of CTP. Methods: Sixty patients with LC and 60 healthy controls were consecutively recruited into this study. Each patient was classed based on the CTP system after relevant tests. Doppler evaluation of the hepatic vein (HV) and MM-PVV were performed. HVW obtained was classified either into triphasic, biphasic, or monophasic. Results: Sixty cirrhotic and 60 age-matched control subjects aged 19–69 and 18–69 years, respectively, completed this study. All control subjects had a normal HVW pattern while 46 (76.7%) cirrhotic subjects had abnormal HVW (P < 0.001). The MM-PVV was significantly lower in cirrhotic subjects than in controls; 22.8 cm/s versus 33.6 cm/s (P < 0.001). The degree of HVW abnormality among cirrhotics showed a significant positive correlation with CTP (r = 0.283, P = 0.029). MM-PVV on the other hand showed no correlation with CTP class (r = −0.124; P = 0.346). Linear regression showed that HVW was a significant predictor of hepatic dysfunction based on CTP. Conclusion: Changes in the waveform pattern of the HVs are a good predictor of the derangement of hepatic function in patients with LC than changes in PVV. HVW pattern could therefore serve as an adjunct to CTP class in hepatic function assessment.
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Using volume index and lateral hepatic angle to differentiate biliary atresia from TPN-associated cholestasis. J Pediatr Gastroenterol Nutr 2014; 59:403-8. [PMID: 24821537 DOI: 10.1097/mpg.0000000000000433] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Differential diagnosis between biliary atresia (BA) and total parenteral nutrition-associated cholestasis (TPN-AC) and early treatment for cholestatic infants are challenges for evaluating neonatal or infantile cholestasis. The aim of our retrospective study was to apply noninvasive indices of magnetic resonance images to differentiate BA from TPN-AC. METHODS A total of 44 patients diagnosed as having BA (n = 30) or TPN-AC (n = 14) were included in the present retrospective study and underwent abdominal magnetic resonance imaging to evaluate the possibility of BA. The left lateral hepatic angle was determined from the coronal image of the left portal vein and portal vein of segment II. Adjusted volume indices of the right hepatic lobe (AVIR) and left lateral segment (AVILL) were calculated as the product of 3 diameters (centimeters) divided by each patient's body weight. RESULTS The left lateral hepatic angles of patients with BA (74° ± 21°) were significantly larger than for patients with TPN-AC (33° ± 9°) and controls (36° ± 5°, P < 0.05). AVILL of the BA (0.037 ± 0.012 cm/g) and TPN-AC groups (0.042 ± 0.030 cm/g) were not significantly different (P = 0.61) but were significantly larger than for controls (0.020 ± 0.011 cm/g) (P < 0.05). The right hepatic lobe to left lateral hepatic segment ratio (RLR) of patients with BA was significantly (P < 0.05) smaller (1.61 ± 0.58) than for patients with TPN-AC (3.08 ± 2.43) and controls (2.98 ± 0.92). Patients with BA could have relative sparing and selective enlargement of the left lateral liver with a resultant lobar difference and blunt left lateral hepatic angle. CONCLUSIONS Noninvasive indices of lobar difference and left lateral hepatic angle help differentiate patients with BA from those with TPN-AC.
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Fan M, Su C, Lu L, Qin JC, Li P, Yuan JY. Ultrasonic diagnosis and vasoactive substances examination in patients with cirrhosis. ASIAN PAC J TROP MED 2014; 7:329-32. [PMID: 24507687 DOI: 10.1016/s1995-7645(14)60050-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/15/2014] [Accepted: 02/15/2014] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To investigate hemodynamic change of patients with cirrhosis by using Color Doppler ultrasound technique and to explore the significance of change in the content of vasoactive substances-plasma endothelin-1 (ET-1) and calcitonin gene-related peptide (CGRP). METHODS A total of 178 cases with cirrhosis were regarded as study groups, and were divided into three degrees: A, B and C according to child-pugh and meanwhile 60 cases were regarded as normal control group. Portal vein and splenic vein of patients were explored by adopting Color Doppler ultrasound technique, related indexes were recorded and the blood flow as well as their ration in the two groups was calculated. Radio immunoassay was adopted to detect the content of plasma ET-1 and CGRP in both study group and contrast group. RESULTS Compared with the healthy cases in the contrast group, there was abnormal hemodynamics in the system of portal vein of patients with cirrhosis and the content of plasma ET-1 and CGRP was increased obviously. In the Child-Pugh liver function grades, the content of ET-1 and CGRP was increased as the degree of cirrhosis became more and more serious. There was no significant difference in the comparison between those without ascites and those in contrast group (P>0.05), the content of plasma ET-1 and CGRP in patients without ascites was increased remarkably. Besides, there was positive correlation between the content of plasma ET-1 and CGRP and Dpv, Dsv and Qsv. CONCLUSION Detection of abnormal hemodynamics of portal vein and splenic vein by Color Doppler ultrasound technique can be one of the means for diagnosis of hypertension. Plasma ET-1 and CGRP of patients with cirrhosis reflect the serious degree of the damage in live function and play an important role in the formation and development of portal hypertension.
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Affiliation(s)
- Mei Fan
- Department of Sonography, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chun Su
- Department of Gynaecology and Obstetrics, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Lu
- Department of Radiology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun-Chang Qin
- Department of Sonography, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pei Li
- Department of Pathophysiology, College of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China.
| | - Jia-Ying Yuan
- Department of Sonography, the Affiliated Hospital of Henan Military Region, Zhengzhou, China
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Sumiyoshi T, Shima Y, Tokorodani R, Okabayashi T, Kozuki A, Hata Y, Noda Y, Murata Y, Nakamura T, Uka K. CT/99mTc-GSA SPECT fusion images demonstrate functional differences between the liver lobes. World J Gastroenterol 2013; 19:3217-3225. [PMID: 23745023 PMCID: PMC3671073 DOI: 10.3748/wjg.v19.i21.3217] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 03/07/2013] [Accepted: 04/10/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the functional differences between the 2 liver lobes in non-cirrhotic patients by using computed tomography/99mTc-galactosyl human serum albumin (CT/99mTc-GSA) single-photon emission computed tomography (SPECT) fusion images.
METHODS: Between December 2008 and March 2012, 264 non-cirrhotic patients underwent preoperative liver function assessment using CT/99mTc-GSA SPECT fusion images. Of these, 30 patients, in whom the influence of a tumor on the liver parenchyma was estimated to be negligible, were selected. Specifically, the selected patients were required to meet either of the following criteria: (1) the presence of an extrahepatic tumor; or (2) presence of a single small intrahepatic tumor. These 30 patients were retrospectively analyzed to calculate the percentage volume (%Volume) and the percentage function (%Function) of each lobe. The ratio between the %Function and %Volume (function-to-volume ratio) of each lobe was also calculated, and the ratios were compared between the 2 lobes. Furthermore, the correlations between the function-to-volume ratio and each of 2 liver parameters [lobe volume and diameter ratio of the left portal vein to the right portal vein (LPV-to-RPV diameter ratio)] were investigated.
RESULTS: The median values of %Volume and %Function were 62.6% and 67.1% in the right lobe, with %Function being significantly higher than %Volume (P < 0.01). The median values of %Volume and %Function were 31.0% and 28.7% in the left lobe, with %Function being significantly lower than %Volume (P < 0.01). The function-to-volume ratios of the right lobe (1.04-1.14) were significantly higher than those of the left lobe (0.74-0.99) (P < 0.01). The function-to-volume ratio showed no significant correlation between the lobe volume in either lobe. In contrast, the function-to-volume ratio showed significant correlations with the LPV-to-RPV diameter ratio in both lobes (right lobe: negative correlation, rs = -0.37, P = 0.048; left lobe: positive correlation, rs = 0.71, P < 0.001). The function-to-volume ratio in the left lobe tended to be higher, and that in the right lobe tended to be lower, in accordance with the increase in the LPV-to-RPV diameter ratio.
CONCLUSION: CT/99mTc-GSA SPECT fusion images demonstrated that the function of the left lobe was significantly decreased compared with that of the right lobe in non-cirrhotic livers.
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Ran HT, Ye XP, Zheng YY, Zhang DZ, Wang ZG, Chen J, Madoff D, Gao J. Spleen stiffness and splenoportal venous flow: assessment before and after transjugular intrahepatic portosystemic shunt placement. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:221-228. [PMID: 23341376 DOI: 10.7863/jum.2013.32.2.221] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To prospectively assess changes in spleen stiffness and splenoportal venous flow before and after transjugular intrahepatic portosystemic shunt (TIPS) placement. METHODS We prospectively evaluated spleen stiffness measured by the mean shear wave velocity with acoustic radiation force impulse imaging and the splenoportal venous velocity with color Doppler sonography in 12 patients (mean age ± SD, 42.6 ± 11.0 years; range, 29-65 years) who underwent TIPS placement for portal hypertension and gastroesophageal bleeding. The mean shear wave velocity and angle-corrected splenoportal venous velocity at the main portal and splenic veins were measured 1 day before and 3 to 9 days after TIPS placement (mean interval, 6.0 ± 1.95 days; range, 4-10 days) and were compared with portal vein pressure measured during the procedure. RESULTS There was a significant difference in portal vein pressure before and after TIPS (25.34 ± 6.21 versus 15.66 ± 6.07 mm Hg; P = .0005). After TIPS, the mean shear wave velocity decreased significantly in all 12 cases (3.50 ± 0.46 versus 3.15 ± 0.39 m/s before and after TIPS; P = .00015). The flow velocity at the main portal vein increased significantly after TIPS (22.21 ± 4.13 versus 47.25 ± 12.37 cm/s; P = .0000051). The splenic vein velocity and spleen index measured 25.57 ± 6.98 cm/s and 55.99 ± 21.27 cm(2), respectively, before TIPS and 35.72 ± 11.10 cm/s and 50.11 ± 21.12 cm(2) after TIPS (P = .0004 and .003). CONCLUSIONS A significant decrease in the mean shear wave velocity and increase in the splenoportal venous velocity occurred with reduced portal vein pressure after TIPS placement. Hence, both parameters can be used as noninvasive quantitative markers for monitoring TIPS function after placement.
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Affiliation(s)
- Hai-Tao Ran
- Institute of Ultrasound Imaging, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Endovascular placement of iodine-125 seed strand and stent combined with chemoembolization for treatment of hepatocellular carcinoma with tumor thrombus in main portal vein. J Vasc Interv Radiol 2011; 22:479-89. [PMID: 21463757 DOI: 10.1016/j.jvir.2010.11.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 11/15/2010] [Accepted: 11/23/2010] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To study the safety and feasibility of endovascular placement of an iodine-125 ((125)I) seed strand and stent combined with chemoembolization to treat hepatocellular carcinoma (HCC) with tumor thrombus in the main portal vein (MPV). MATERIALS AND METHODS From February 2008 to October 2009, 32 patients with HCC complicated by tumor thrombus in MPV were enrolled into this study (28 men and 4 women, mean age 53.2 years ± 8.8). After (125)I seed strand and self-expandable stent had been placed in the obstructed MPV, chemoembolization was performed. All patients were followed up every 30 days. Patency of stent and response of HCC were evaluated by abdominal contrast-enhanced computed tomography (CT) scan. RESULTS The technical success rate was 100% for placement of the (125)I seed strand and stent in the obstructed MPV. No serious procedure-related complications occurred. During a mean follow-up of 217.5 days ± 151.6, the objective response rate of HCC to chemoembolization was 37.5%. The 90-day, 180-day, and 360-day cumulative survival rates were 96.4%, 67.4%, and 39.3%, and the cumulative stent patency rates were 96.7%, 83.4%, and 83.4%. CONCLUSIONS Endovascular placement of (125)I seed strand and stent combined with chemoembolization was safe and feasible to treat HCC with tumor thrombus in the MPV.
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Feng YH, Qian LX, Hu XD. Advances in ultrasonic diagnosis of hepatic fibrosis and early cirrhosis. Shijie Huaren Xiaohua Zazhi 2010; 18:454-461. [DOI: 10.11569/wcjd.v18.i5.454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
With the development of medical ultrasonic technology, sonography has become an important means for diagnosis and evaluation of hepatic fibrosis and early cirrhosis. Two-dimensional sonography is the basic means of ultrasonic diagnosis and can be used to display the appearance and echo of the liver. Color Doppler sonography and Doppler frequency spectrum permit assessment of the portal venous system and detection of portal blood flow. They can be used not only for estimation of hepatic parenchymal changes but also for evaluation of portal hypertension and its complications. Contrast-enhanced ultrasound permits use of a blood-pool tracer and can assess the blood flow perfusion of hepatic parenchyma. Elasticity imaging indirectly reflects tissue pathological changes by measuring tissue elastic modulus. Fibroscan has shown great promise for staging and diagnosing hepatic fibrosis and monitoring the development of hepatic cirrhosis and portal hypertension, thus offering a new method for noninvasive diagnosis of hepatic diseases. The clinical application of these techniques has greatly improved the diagnosis of hepatic diseases. In this article, we will review the recent advances in ultrasonic diagnosis of hepatic fibrosis and early cirrhosis.
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Keskin M, Dolar E, Dirican M, Kiyici M, Yilmaz Y, Gurel S, Nak SG, Erdinc S, Gulten M. Baseline and salt-stimulated paraoxonase and arylesterase activities in patients with chronic liver disease: relation to disease severity. Intern Med J 2009; 39:243-8. [PMID: 19402863 DOI: 10.1111/j.1445-5994.2009.01793.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Yang Y, George S, Martin DR, Tannenbaum AR, Giddens DP. 3D modeling of patient-specific geometries of portal veins using MR images. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2008; 2006:5290-3. [PMID: 17946691 DOI: 10.1109/iembs.2006.260291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this note, we present an approach for developing patient-specific 3D models of portal veins to provide geometric boundary conditions for computational fluid dynamics (CFD) simulations of the blood flow inside portal veins. The study is based on MRI liver images of individual patients to which we apply image registration and segmentation techniques and inlet and outlet velocity profiles acquired using PC-MRI in the same imaging session. The portal vein and its connected veins are then extracted and visualized in 3D as surfaces. Image registration is performed to align shifted images between each breath-hold when the MRI images are acquired. The image segmentation method first labels each voxel in the 3D volume of interest by using a Bayesian probability approach, and then isolates the portal veins via active surfaces initialized inside the vessel. The method was tested with two healthy volunteers. In both cases, the main portal vein and its connected veins were successfully modeled and visualized.
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Affiliation(s)
- Yan Yang
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA.
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Schneider ARJ, Teuber G, Kriener S, Caspary WF. Noninvasive assessment of liver steatosis, fibrosis and inflammation in chronic hepatitis C virus infection. Liver Int 2005; 25:1150-5. [PMID: 16343065 DOI: 10.1111/j.1478-3231.2005.01164.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Duplex-Doppler ultrasound is a noninvasive method for the assessment of hepatic hemodynamics beyond conventional gray-scale imaging. The clinical value of the method for the grading and staging of chronic hepatitis C virus (HCV) infection and the prediction of hepatic steatosis still has to be determined. This study aimed to compare Duplex-Doppler and ultrasound with the histologic staging and the estimation of hepatic steatosis in chronic HCV infection. PATIENTS AND METHODS One hundred and nineteen consecutive patients with chronic HCV infection underwent both liver biopsy and ultrasound with Duplex-Doppler. Maximum portal venous blood flow velocity, portal venous flow undulation, hepatic venous flow pattern and spleen size were assessed and compared with histologic findings. Histologic grading and staging was performed according to the modified HAI and hepatic steatosis was estimated. RESULTS Doppler ultrasound was unable to discriminate between different degrees of fibrosis. Sensitivity/specificity of portal venous flow and undulations for the diagnosis of hepatic cirrhosis was 74.5%/53% and 76.5%/100%. The PPV and NPV of reduced undulations was 100% and 96.2%. Mono- or biphasic hepatic venous flow indicated advanced hepatic steatosis (sensitivity 88.2%, specificity 74.5%, PPV 36.6%, NPV 97.5%). Spleen size was significantly enlarged both in patients with cirrhosis and steatosis. CONCLUSIONS Although Duplex-Doppler of the portal and hepatic veins is not a substitute for histologic grading and staging, portal vein undulations can predict liver cirrhosis with considerable accuracy. Moreover, triphasic patterns of hepatic venous flow virtually exclude significant fatty liver disease. Additional studies should perform intraindividual follow-up investigations to further define the role of Duplex-Doppler ultrasound in chronic HCV infection.
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Affiliation(s)
- A R J Schneider
- Medical Department I, University Hospital, Frankfurt/Main, Germany.
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Nakanishi S, Shiraki K, Yamamoto K, Koyama M, Kimura N, Nakano T. Hemodynamics in the portal vein evaluated by pulse wave Doppler ultrasonography in patients with chronic hepatitis C treated with interferon. World J Gastroenterol 2005; 11:396-9. [PMID: 15637752 PMCID: PMC4205346 DOI: 10.3748/wjg.v11.i3.396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To employ pulse wave Doppler ultrasonography to evaluate the changes in portal blood flow velocity in patients with chronic hepatitis C (CHC) receiving interferon (IFN) treatment.
METHODS: The subjects in this study were 14 patients (13 men and 1 woman) with CHC who received IFN treatment. Portal blood flow velocity was measured in the vessels at the porta hepatis at four time points: before IFN administration (pre-IFN), 2 wk after the start of administration (wk 2), 24 wk after the start of administration (wk 24, i.e., the end of IFN administration), and 24 wk after the end of administration (wk 48).
RESULTS: The patients with CHC in whom IFN treatment resulted in complete elimination or effective elimination of viruses showed a significant increase in portal blood flow velocity at the end of IFN treatment compared with that before IFN treatment. In contrast, when IFN was ineffective, no significant increase in portal blood flow velocity was observed at wk 24 or 48 compared with the pre-IFN value. In addition, the patients with CHC in whom IFN was ineffective showed significantly lower portal blood flow velocity values than control subjects at all measurement time points.
CONCLUSION: Pulse wave Doppler ultrasonography is a noninvasive and easily performed method for evaluating the effects of IFN treatment in patients with CHC. This technique is useful for measuring portal blood flow velocity before and 24 wk after IFN administration in order to evaluate the changes over time, thus assessing the effectiveness of IFN treatment.
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Affiliation(s)
- Shigeo Nakanishi
- First Department of Internal Medicine, Mie University School of Medicine, Tsu, Mie 514-8507, Japan
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