The blood flow dynamics of peripheral veins in the splenic hilum and marginal regions were observed using Doppler ultrasonography. In patients in whom peripheral vein blood flow waveforms exhibited arterial pulsation, suggestive of diffuse arteriovenous shunts, the dynamics of these veins, the degree of splenomegaly, and the presence of ascites were evaluated. A total of 324 patients comprising 164 men, and 160 women with a median age of 66 years (range: 18 to 93 years) were included in the study. In patients without splenomegaly, peripheral venous blood flow in the splenic marginal region exhibited steady flow with velocities around 8 cm/s, and arterial pulsatile flow was not observed. “Diffuse A-V shunt” blood flow in the splenic marginal region was observed in various chronic liver diseases, including idiopathic portal hypertension (IPH). This phenomenon occurred more frequently in patients with severe splenomegaly, and ascites was present in nearly all patients where this phenomenon was observed. The blood flow velocity in the peripheral veins of the spleen increased in correlation with the degree of splenomegaly. Thus, it was considered that diffuse A-V shunts appear against the background of increased splenic blood flow and are associated with exacerbation of portal hypertension.

Shear wave elastography is one of the non-invasive method for diagnosing the degree of hepatic fibrosis. The aim of this study is to clarify the usefulness of liver or spleen shear wave elastography (L-SWE, S-SWE) and liver or spleen shear wave dispersion (L-SWD, S-SWD) for diagnosing esophageal varices (EVs), high-risk EVs (HR-EVs), ascites (AS) and hepatic encephalopathy (HE). The 86 liver cirrhosis patients performed L-SWE, S-SWE, L-SWD and S-SWD were enrolled. The values of L/S-SWE and L/S-SWD were the median values measured six times. L/S-SWE in patients with EVs were significantly higher than that in patients without EVs. S-SWE in patients with HR-EVs were significantly higher than that in patients without HR-EVs. L/S-SWE and L-SWD in patients with AS were significantly higher than those in patients without AS. L-SWE/SWD in patients with HE were significantly higher than that in patients without HE. In diagnosing EVs, HR-EVs and AS, AUROCs of S-SWE were the highest values (0.772, 0.700, 0.767, respectively). In diagnosing HE, AUROC of L-SWE was the highest value (0.649). L/S-SWE might be able to be the useful non-invasive method for the prediction of EVs, HR-EVs, AS and HE.