Ultrasonography in the diagnosis of portal hypertension: diminished response of portal vessels to respiration.

TLDR

Portal hypertension is suggested by the absence of normal respiratory caliber variation in portal, splenic, and superior mesenteric veins. The study evaluates the diagnostic value of ultrasound for portal hypertension in patients with hepatic cirrhosis. Ultrasound was performed on 79 portal‑hypertension patients and 45 controls, measuring portal vein caliber and respiratory variation of splenic and superior mesenteric veins. Ultrasound detecting respiratory caliber variation achieved 79.7 % sensitivity and 100 % specificity, whereas portal dilatation alone yielded only 41.8 % sensitivity.

Abstract

This study assesses the usefulness of ultrasound in the diagnosis of portal hypertension due to hepatic cirrhosis. Seventy-nine patients with portal hypertension and 45 control subjects underwent ultrasonography. Two factors were measured: (a) the caliber of the portal vein and (b) the caliber variation of the splenic and superior mesenteric veins during respiration. A lack of normal caliber variation (an increase during inspiration and a decrease during expiration) in these vessels is put forward as an ultrasonographic sign of portal hypertension, and the pathophysiological and clinical significance of this finding are discussed. The sensitivity of ultrasound in detecting portal hypertension, based on the measurement of caliber variation, was 79.7%, and the specificity was 100%. In contrast, the sensitivity of the method, assessed on the basis of portal dilatation, was only 41.8%.