Detection of benign and malignant portal vein thrombosis in cirrhosis and hepatocellular carcinoma by echo-doppler study

Patients with cirrhosis are at a much greater risk of developing benign or malignant portal vein thrombosis [PVT]. Most benign PVT occurs because of the development of portal venous hypertension and venous stasis, while malignant PVT occurs by direct invasion of the portal vein by hepatocellular carcinoma [HCC]. To assess and evaluate the use of color Doppler technique in detecting PVT and diagnosing its nature in cirrhotic and in HCC patients, and to find out the distinguishing features of patients with benign from patients with malignant PVT. Fifty male patients with HCC and 10 male cirrhotic patients were enrolled in the study, together with 10 age and sex matched volunteers as controls. Complete clinical examination, liver function tests, serum alpha fetoprotein [AFP] levels, and abdominal ultrasonography was carried out for each participant. Color echo-Doppler study to detect PVT was performed for all patients using a Toshiba Ecco-C machine; pulsatile intrathrombus blood flow was used as an indicator of the malignant nature of the thrombus. The echo-Doppler scanning revealed the presence of PVT in 10/50 HCC patients [20%], while the presence of intrathrombus hepatofugal pulsatile blood flow was detected in 7/10 [70%], indicating malignant PVT. Continuous hepatopetal blood flow was detected in 3/10 HCC [30%] and in one out of 10 cirrhotic patients [10%], indicating benign PVT. Patients with malignant PVT had ascites [60%], placed in Child's class C [40%], and serum AFP level 400 ng/ml [70%].

As the clinical picture and prognosis of patients with cirrhosis and patients with HCC could be affected by the occurrence of PVT, therefore, whenever suspected, echo-Doppler should be performed as it could be considered a useful mean of screening for PVT, in addition, the detection of pulsatile intrathrombus blood flow could be an indicator of its malignant nature

Echodoppler measurments of portal venous system in portal hypertension due to schistosomal hepatic fibrosis

This work was carried out on thirty adult male patients with portal hypertension due to schistosomal hepatic fibrosis, and ten age matched normal individuals as controls. All patients and control were examined clinically, by ultrasonography and by echodoppler for measurement of congestion index, maximum blood flow velocity, mean blood flow velocity, blood flow volume and cross sectional area of portal vein and transplenic portal venous pressure. The congestion index is a new parameter of hepatic hemodynamics. It is increased in SHF up to two and a half times the normal values [0.266 +/- 0.128/0.096 +/- 0.03]. It means show an increase in the cross sectional area of portal vein [2.44 +/- 1.1/1.23 +/- 0.42] and significant decrease in the mean blood flow velocity [9.4 +/- 11.88/12.85 +/- 1.99]. The resultant significant increase in blood flow volume of portal circulation [1396 +/- 675/1173 +/- 478] favours increased collateral blood flow and directly correlates with the incidence of bleeding gastro-oesophageal varices. The congestion index has a positive direct correlation with the CSA, and correlates negatively with blood flow velocity. It reflects an augmented hepatic vascular resistance to portal venous perfusion

Ultrasonographic liver volume and echodoppler measured portal haemodynamic indices in schistosomal hepatic fibrosis

This work was carried out on 35 adult male patients with schistosomal hepatic fibrosis and portal hypertension as well as 10 normal healthy controls. All patients and controls were examined clinically then by ultrasonography and echodoppler for measurement of the liver volume, maximum portal vein blood flow velocity, mean blood flow volume and cross sectional area. The congestion index was determined. The liver volume was increased in 25 patients and decreased in 10. There was a significant decrease in mean blood flow velocity along with an increase of cross sectional area and congestion index particularly in cases with decreased liver volume. Moreover, the blood flow volume was decreased but less evidently in patients with shrunken liver. A negative correlation was recorded between the decreased liver volume and each of the portal vein cross sectional area, blood flow volume, congestion index and portal venous pressure

multivariate prognostic analysis in hepatocellular carcinoma

A multivariate prognostic analysis was carried out on 40 schistosomal patients with evidence of cirrhosis and HCC. The included patients were subjected to proper history taking, through clinical examination, histopathological and ultrasonographic studies as well as some laboratory investigations such as: serum sodium, serum bilirubin, blood urea nitrogen and gamma glutamyl transpeptidase. Our results showed that the longest ultrasonographically measured tumour diameter was the only univariable factor that roughly correlated with prognosis. The calculated relative risk of death [RRD] was found to correlated significantly with the median survival of HCC patients. they were divided into two groups according to their RRD with a relatively good prognosis in group I and a poor prognosis in group II, where the median survival was 170 days in group I and 60 days in group II. This multivariate analysis of RRD would permit more accurate grouping of HCC patients according to their expected median survival and would thus help in evaluating efficacy of different therapeutic modalities

Ultra-sonically guided fine needle aspiration biospy in the diagnosis of focal hepatic malignancy

Seventy-two patients suspected of having hepatic malignancy were examined by real time ultrasonography using sonoline. Aspiration biopsy with an ultrasonically guided fine needle passed through the special linear array puncture transducer was done. Results were 91.2% diagnostic of hepatic malignancy by sole US examination and 97% diagnostic when fine needle aspiration cytology was done. Fifty-nine patients were cytologically diagnosed as HCC and eleven as metastatic deposits. Diagnosis was confirmed by follow-up of all patients. On the basis of the cytomorphologic features of the aspiration, primary HCCs were further subclassified into well, moderately and poorly differentiated. Cytomorphologically, these 3 types were clearly different and their features were distinctive from those of metastatic hepatic cancer. However, no relationship was found between the various echopatterns of the neoplastic lesion and its cell type or primary site of origin. Ultrasonically guided fine needle aspiration biopsy of focal hepatic lesions is a reasonably simple and stage procedure recommended for the diagnosis of hepatic malignancy, as it may obviate more invasive procedures