THE VALUE OF PORTAL-VEIN PULSATILITY ON DUPLEX SONOGRAMS AS A SIGN OFPORTAL-HYPERTENSION IN CHILDREN WITH LIVER-DISEASE

OBJECTIVE. The purpose of this study was to determine the significance of portal vein pulsatility on duplex Doppler waveforms in children wi th end-stage hepatic failure undergoing liver transplantation. SUBJECT S AND METHODS. Thirty-eight children with end-stage hepatic decompensa tion were examined with color-assisted spectral Doppler waveform analy sis of the hepatic artery and the portal vein. Correlation was made wi th age, duration of illness, clinical and pathologic diagnosis, and pr esence of portal hypertension. Findings were compared with those for s ix patients with acute viral hepatitis and 12 healthy control subjects . RESULTS. Portal vein pulsatility was noted in all 36 patients in who m portal vein flow was detected by Doppler imaging. The majority of th ese (34) had clinical or sonographic evidence of portal hypertension. In two patients, no portal vein flow was identified in the liver hilum ; both had a large portosystemic shunt through collaterals or surgical graft. Significantly increased pulsatility of the hepatic artery wave form (resistive index [RI] = 0.89 +/- 0.15, p < .0001) was seen in pat ients with end-stage liver disease. In contrast, no portal vein pulsat ility and normal hepatic artery pulsatility (RI = 0.60 +/- 0.11) was n oted in all patients with acute hepatitis and control subjects. CONCLU SION. Portal vein waveform pulsatility is 94% sensitive and 90% specif ic for portal hypertension in end-stage liver disease.