ULTRASOUND AND DUPLEX-DOPPLER IN THE DIAGNOSIS AND FOLLOW-UP OF PORTAL-HYPERTENSION

Ultrasound examination should be carried out as the first investigatio n in all patients with suspected hepatobiliary disease. It has a high accuracy in detecting signs of portal hypertension such as ascites, sp lenomegaly and collateral veins. The most common cause of portal hyper tension in the Western world is cirrhosis. Although there is an overla p of ultrasound findings in normal liver, fatty liver, chronic liver d isease with and without fibrosis, and cirrhosis, a correct diagnosis o f cirrhosis by judgment of ultrasound findings is reported to be achie ved in up to 80%. Diagnostic parameters used are size and outline of t he liver, its reflectivity and attenuation of the echo-pattern. If use d in combination with the Doppler duplex system, the information gaine d vastly increases, Areas where this technique is able to provide usef ul and reliable data have been defined in a consensus conference held in Bologna. Doppler flowmetry of hepatic vessels allows detection of p resence, direction and characteristics of blood flow. The reliability of the quantitative measurements of blood flow in abdominal vessels is still questioned. When using the same equipment by skilled operators, however, duplex-Doppler data of the portal vein are of value in the a ssessment of the risk of variceal bleeding, in the evaluation of the p rogression of liver disease and in the evaluation of medical therapy f or portal hypertension. furthermore, the technique is of practical val ue in pre-end postoperative examinations for shunt surgery as well as in the pre-procedural work-up of transjugular intrahepatic portosystem ic stent shunt (TIPS), during the TIPS procedure and in the post-TIPS follow-up.