Arterioportal fistulas in patients with liver cirrhosis: Usefulness of color Doppler US for screening

PURPOSE: To evaluate the usefulness of routine ultrasonographic (US) evalua tion of the hepatic arterial resistive and pulsatility indexes and of the d irection of portal venous blood flow for the diagnosis of intrahepatic arte rioportal fistulas (APFs) in patients with liver cirrhosis. MATERIALS AND METHODS: in all patients with cirrhosis examined at one cente r over 4 years, the resistive (RI) and the pulsatility (PI) indexes in the right and left branches of the hepatic artery were evaluated with Doppler U S. An APF was suspected when an RI decrease of at least 20% and a PI decrea se of at least 30% were present in one hepatic lobe relative to values in t he other lobe and portal blood flow in the robe with the decreased values w as reversed. The RI and PI in patients with an APF were compared with those in 75 patients with cirrhosis and without APFs at angiography. RESULTS: Seven patients with an APF were identified. APFs suspected at Dopp ler US were always confirmed with angiography. The percent differences ir. SD in the RI and the pi between the two intrahepatic branches of the hepati c artery in patients with versus in patients without an APF were as follows : RI, 35% +/- 6 (range, 27%-42%) versus 5% +/- 4 (range, 0%-15%) (P < .001) ; Pl, 50% +/- 5 (range, 41%-58%) versus 11% +/- 7 (range, 0%-26%) (P < .001 ). CONCLUSION: The intrahepatic arterial resistive and pulsatility indexes and the direction of portal blood flow should be evaluated in routine screenin g for APFs in patients with liver cirrhosis.