Hepatic Vascular Imaging,

Diagnostic Criteria - Hepatic Vascular Imaging

Interpretation Grayscale Compression Doppler Signal Color Doppler Portal Veins: A. Normal No intraluminal echoes; bright, echogenic borders Low velocity signal with respiratory variation Smooth fill in of color B. Thrombosis Enlarged or normal portal venous system with low level echoes within the lumen; may appear isoechoic with the liver. Decreased low velocity to absent Doppler waveform; look for hepatofugal flow Decreased to absent color flow C. Portal Hypertension Enlargement of the portal venous system. Recannilization of the umbilical vein Look for hepatofugal flow in portal venous system Hepatofugal flow with good color fill of lumen D. Cavernous Transformation Multiple vascular channels near the portal hepatis and/or splenic hilum. Thrombosis of the extrahepatic portal vein (may be difficult to image) Look for recannalized umbilical vein Continuous low velocity flow Color fills dilated collateral vessels; portal vein is difficult to fill with color Hepatic Artery: A. Normal Follow course of portal vein to image hepatic artery anterior. Enlarge/res image size to visuage artery Proximal HA best seen at level of celiax axis Distal HA seen in intercostals coronal view at level of MPV and CBD Low resistance waveform with systolic and diastolic component Increase gain slightly to fill in vessel lumen with color B. Thrombosis Increased low level echoes within the lumen Obstruction would cause increased velocity waveforms Turbulence or absence of flow if complete obstruction is present Inferior Vena Cava: A. Normal Low level intraluminal echoes within the lumen returning into right atrium; changes with respiration Continuous triphasic waveform with respiratory variations Color fills lumen B. Thrombosis Increased echogenicity of low level echoes filling lumen Evaluate renal veins for extension of thrombus Decreased Doppler waveform secondary to degree of thrombosis Decreased color within lumen; color will outline the area of thrombus/obstruction C. Right sided heart failure Dilation of lumen that does not change with respiration Multiphastic, pulsatile flow Color fills lumen of hepatic veins and inferior vena cava D. Thrombosis/ Budd Chiari Low level echoes within the lumen of the hepatic veins; may completely restrict blood flow into the inferior vena cava Caudate lobe enlargement may be suspicious of thrombosis of hepatic veins Decreased flow signal Decreased color fill in of hepatic veins; IVC may appear collapsed with decreased blood return.