Value of Doppler ultrasonography in the depiction of changes in hepatic hemodynamics due to primary liver tumours

Abstract

Backgroud: Ultrasound (US) is the imaging method most frequently used for the detection and diagnosis of hepatocellular carcinoma (HCC). The ability to resolve hepatic arterial and portal venous components of blood flow on a global and regional constitutes the primary goal of liver perfusion imaging. 

Aim: The purpose of our study was to estimate alterations in the hepatic blood flow in large hepatocellular carcinomas occurring in liver cirrhosis, in comparison with liver cirrhosis.

Methodology. By using the color Doppler velocity profile tehnique, portal vein and hepatic artery hemodynamic status was assessed in 42 patients with hepatocellular carcinoma. 20 patients with liver cirrhosis were taken as control.

Results. Portal vein average velocity was 8.33 cm/sec ± 2.31 in patients with HCC vs 15.80 cm/sec ± 2.31 in cirrhotic patients without HCC (p=0.72). Portal vein flux was significantly lower in patients with HCC (209 mL/ mm ± 83.08 vs. 649 mL/ min ±83.08 in cirrhotic patients;p=0.02). The hepatic arterial blood flow was increased in patients with hepatocellular carcinoma as compared to the cirrhotic patients (P<0.001). The ratio of hepatic arterial flow to portal vein flow was 1.239 +/- 0.246 in patients with hepatocellular carcinoma, which is twice the basic control value (0.66 +/- 0.259 l/min).

Conclusions. These results suggest that in hepatocellular carcinomas there is a decreased portal vein blood flow, accompanied by an increased hepatic arterial blood flow. In the case of hypo-echoic or hyperechoic, mass in the cirrhotic liver, increased blood flow in the hepatic artery, and decreased portal venous flow, a malignant liver tumor is virtually certain.