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Research Paper | Radiology and Medical Imaging Sciences | India | Volume 13 Issue 12, December 2024 | Popularity: 5.4 / 10

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Colour Doppler Ultrasound of the Hepatic Veins and its Association with Child Pugh's Score and Oesophageal Varices

Dr. Mohammed Rakheeb CG, Dr. Naufal P.

Abstract: Background: Liver cirrhosis is characterized by extensive fibrosis and the formation of regenerative nodules, resulting from repeated episodes of hepatocyte necrosis and degeneration. This condition leads to irreversible hepatic scarring, significantly impairing liver function and giving rise to various severe complications, including portal hypertension, ascites, Hepatic encephalopathy, hepatorenal syndrome, and esophageal varices, and spontaneous bacterial peritonitis. Among these, portal hypertension represents one of the most critical complications of liver cirrhosis, often manifesting as esophageal varices, gastric varices, and portal hypertensive gastropathy. The clinical assessment of chronic liver disease is commonly performed using the Modified Child-Pugh Scoring System. Portal hypertension can be evaluated through both invasive and non-invasive methods. Doppler ultrasound, a non-invasive imaging modality, has demonstrated potential in assessing liver hemodynamics. Parameters such as hepatic vein waveform, splenoportal index, and damping index provide valuable insights into the severity of liver disease and the associated risk regarding esophageal varices. Objectives: To evaluate the association between hepatic venous doppler parameters with severity of cirrhosis assessed with Child Pugh?s score and oesophageal varices. Methodology: A cross-sectional study was conducted on 51 patients to evaluate the association between hepatic venous Doppler parameters and the severity of cirrhosis, assessed using the Child-Pugh score, as well as the presence of esophageal varices. The study included patients aged 18 to 70 years who were diagnosed with cirrhosis. Exclusion criteria comprised coexisting cardiac or respiratory diseases, hepatocellular carcinoma, non- cirrhotic portal fibrosis, and a history of endoscopic variceal ligation or sclerotherapy. A comprehensive evaluation was performed, incorporating patient history, physical examination findings, laboratory investigations, and Doppler ultrasound results. Patients were stratified into three groups?Child-Pugh class A, B, and C?based on the Child-Pugh scoring system, which includes characteristics in the laboratory (serum bilirubin, serum albumin, and international normalized ratio [INR] of prothrombin time) and clinical findings. Data were recorded using a standardized template and analyzed using Microsoft Excel. Statistical analysis was performed using unpaired t-tests and one-way ANOVA, with a p-value of <0.05 considered statistically significant. Results: The study enrolled 51 patients with a male-to-female ratio of 1.4:1 (58.8% males, 41.2% females), categorized into three age groups: 20?40 years (27.5%), 41?60 years (49.0%), and 61?70 years (23.5%). The majority of patients (54.9%) were classified as Child- Pugh Class C, followed by Class B (27.5%) and Class A (17.6%). Ascites was present in 49.0% of patients, significantly associated with the Child-Pugh classification (P = 0.0036), being most common in Class C. Encephalopathy, observed in 7.8% of patients, was exclusively found in Class C, though there was no statistically significant correlation. (P = 0.1682). Hepatic waveforms included biphasic (43.1%), monophasic (41.2%), and triphasic (15.7%), with a significant correlation to Child-Pugh classification (P = 0.0015). The damping index >0.6 was noticeably more common in Class C patients (P < 0.001). Abnormal splenomegaly was present in 56.9% of patients and significantly associated with Child-Pugh class (P = 0.0097). The splenoportal index varied across groups, but no statistical significance was found. Esophageal varices were observed in 60.8% of patients, significantly associated with both Child-Pugh classification (P = 0.0299) and hepatic waveform patterns (P = 0.0041). Conclusion: This study emphasizes the utility of hepatic venous Doppler ultrasonography in assessing liver cirrhosis severity and related complications, such as esophageal varices. Male patients predominated, with the highest prevalence in the 41?60 age group. Doppler parameters correlated strongly with the Child-Pugh classification, with a transition from triphasic to monophasic waveforms indicating worsening of both portal hypertension and cirrhosis. The Doppler index (DI) was significantly elevated in advanced cirrhosis (Child-Pugh Class C), marking it as a reliable non-invasive indicator. While the splenoportal index (SPI) showed limited clinical relevance, esophageal varices were closely linked to Child-Pugh scores and Doppler findings. These results affirm the role of Doppler ultrasonography as a complementary tool to traditional cirrhosis staging methods.

Keywords: Oesophageal Varices, Portal Hypertension, Cirrhosis, Child-Pugh Score, Non-invasive methods, Doppler ultrasound, hepatic vein waveform, splenoportal index, damping index

Edition: Volume 13 Issue 12, December 2024

Pages: 1451 - 1479

DOI: https://www.doi.org/10.21275/SR241222174954

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