Saline-enhanced ultrasonography: prediction of X-ray appearance of hepatic venography in patients with cirrhosis

Abstract

Objective. To examine the efficacy of saline-enhanced ultrasound (US) in predicting the X-ray appearance of hepatic venography. Materials and methods. This prospective study consisted of 50 cirrhosis patients (31 males and 19 females; mean age, 64.2 ± 11.1 years). US patterns in the liver, after injection of agitated saline via balloon-occluded catheter, were evaluated with respect to the findings of CO₂-enhanced hepatic venogram. Results. US demonstrated two patterns: type I showing positive parenchymal enhancement (40 patients) and type II showing negative parenchymal enhancement with detection of hepatic vein (10 patients). There were also two patterns shown by hepatic venography: type A showing retrograde detection of intrahepatic portal vein (41 patients) and type B showing hepatic venous enhancement via intrahepatic venous–venous communications with no detection of intrahepatic portal vein (9 patients). All patients with type I showed retrograde detection of intrahepatic portal vein via hepatic sinusoid on X-ray venograms (type A). Of the 10 patients with type II, nine showed type B and one showed type A. Sensitivity and specificity of type I US pattern to predict the detection of intrahepatic portal vein on the venogram were 100% and 90%, respectively. There was no significant difference in hepatic venous pressure gradient or wedged hepatic venous pressure between patients with type I and type II. Conclusions. Saline-enhanced US is effective in predicting the findings of hepatic venogram. As type II strongly suggests the shunt-modified venogram, image taking in these cases would be superfluous with the added advantage of avoiding unnecessary radiation exposure.

Key Words::

• Cirrhosis
• hepatic venography
• portal hypertension
• ultrasound

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.