Doppler ultrasound-derived indices are not a reliable means of grading the severity of chronic liver disease, according to researchers from Hammersmith Hospital in London.
"None of the usually employed indices of portal hypertension (B-mode or Doppler) predicted ... cirrhosis in our group of patients with hepatitis-C chronic liver disease," said Dr. David Cosgrove during a presentation at the 2003 RSNA conference in Chicago.
While many authors have claimed that Doppler ultrasound indices are valuable for grading and assessing diffuse liver disease, the reproducibility and reliability of the techniques are controversial. A variety of techniques have been proposed, using B-mode (vessel caliber, caudate lobe hypertrophy) and Doppler (hepatic artery [HA] and portal vein [PV] velocities/ratios), Doppler perfusion index (DPI), and congestion index (CI).
To assess the indices, the Hammersmith researchers performed a prospective study on 65 patients with biopsy-proven hepatitis C virus (HCV)-related liver disease. Blinded to the histology results, a single experienced sonologist and radiologist performed ultrasound studies using a Sequoia scanner (Siemens Medical Solutions, Malvern, PA).
The average time from biopsy to ultrasound scan was 9.3 months. Vessel B-mode and Doppler measurements were taken, and the spleen and caudate lobe was assessed.
Measurements included:
- Caliber (maximum portal vein diameter and circumference).
- Peak velocity (main hepatic artery velocity, angle corrected; main portal vein velocity, angle corrected).
Ratios included:
- HA resistive index (peak systolic-end diastolic/peak systolic).
- Portal vein congestion index (portal vein area/portal vein velocity).
- Hepatic artery velocity (HAVmax) / portal vein velocity (PVVmax).
Of the 65 patients, 20 had mild hepatitis, 25 had moderate to severe hepatitis, and 20 had cirrhosis. The researchers encountered technical difficulties in the course of the study, and were able to obtain optimal hepatic arterial traces in only 30 patients, hepatic artery circumference in eight patients, and portal vein circumference in 18 patients, Cosgrove said. In addition, the Doppler perfusion index couldn’t be assessed.
The study team found no significant differences in the Doppler indices with increasing liver disease severity. An abnormal hepatic vein trace (i.e. biphasic or monophasic) was found in five of 17 patients (29%) with mild hepatitis, compared to 11 of 20 (55%) of patients with moderate/severe hepatitis, and 12 of 20 (60%) patients with cirrhosis.
Only spleen length correlated with stage and grade, but there was no clear separation between the categories, Cosgrove said. The group concluded that none of the often-utilized B-mode or Doppler indices for portal hypertension predicted cirrhosis in the study population.
"Perhaps this was because this disease behaves differently from alcoholic cirrhosis, for example," Cosgrove told AuntMinnie.com. He noted, however, that microbubble contrast tracer methods show promise in this application.
"The measurement of the time for a bolus of microbubbles to reach the hepatic veins (a measure of shunting in the liver) is easy to make with the new bubble-specific software and seems to be very reliable," he said.
By Erik L. RidleyAuntMinnie.com staff writer
February 26, 2004
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Copyright © 2004 AuntMinnie.com
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
