Usefulness of Parametric Imaging in hemodynamic evaluation of portal hypertension

Abstract

Objective: To determine whether differences in the perfusion pattern in the liver parenchyma visualized by sonazoid-enhanced ultrasonography (S-US) is useful in predicting the incidence of portal hypertension-associated complications.
Materials and Methods: A total of 253 patients with type C chronic liver disease underwent S-US evaluation using Toshiba Aplio XG ultrasound system to obtain enhancement patterns in the S5 region of the liver and the right kidney through right intercostal scanning which took 30s after intravenous infusion of sonazoid. Captured video was processed to create the Parametric Images, which enabled the evaluation of perfusion patterns in the liver parenchyma by color visualization. Obtained perfusion patterns were assessed in relation to the incidence of complications of portal hypertension.
Results: Perfusion patterns were classified into 3 patterns depending on whether the liver parenchyma was perfused mainly by the portal vein (pattern P), equivalently by the portal vein and hepatic artery (pattern AP) or mainly by the hepatic artery (pattern A). Compared to pattern P, patterns AP and A were observed significantly more frequently in patients with esophageal varix and in those with splenomegaly (p < 0.01). Pattern P was not observed in any of the patients with ascites, while patterns AP and A were observed significantly more frequently in these patients (p < 0.01).
Conclusion: The Parametric Imaging was useful in predicting the incidence of complications associated with portal hypertension.