Non-invasive diagnosis of hepatic cirrhosis by transit-time analysis of an ultrasound contrast agent
Hepatic cirrhosis is accompanied by several haemodynamic changes including arterialisation of the liver, intrahepatic shunts, pulmonary arteriovenous shunts, and a hyperdynamic circulatory state. We postulated that the hepatic first pass of a bolus of an ultrasound contrast agent injected into a per...
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| Veröffentlicht in: | The Lancet (British edition) 1999-05, Vol.353 (9164), p.1579-1583 |
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| creator | Albrecht, Thomas Blomley, Martin JK Cosgrove, David O Taylor-Robinson, Simon D Jayaram, Vijay Eckersley, Robert Urbank, Albrecht Butler-Barnes, Jenny Patel, Nayna |
| description | Hepatic cirrhosis is accompanied by several haemodynamic changes including arterialisation of the liver, intrahepatic shunts, pulmonary arteriovenous shunts, and a hyperdynamic circulatory state. We postulated that the hepatic first pass of a bolus of an ultrasound contrast agent injected into a peripheral vein is accelerated in patients with cirrhosis. We investigated this first pass in patients with diffuse liver disease and in normal controls to assess whether it provides useful differential diagnostic information.
We enrolled 15 patients with biopsy-proven cirrhosis, 12 patients with biopsy-proven non-cirrhotic diffuse liver disease, and 11 normal controls. We carried out continuous spectral doppler ultrasonography of a hepatic vein from 20 s before to 3 min after a peripheral intravenous bolus injection of 2·5 g Levovist. The intensity of the doppler signal was measured and used to plot time-intensity curves.
Patients with cirrhosis showed a much earlier onset of enhancement (arrival time; mean 18·3 s) and peak enhancement (mean 55·5 s) than controls (49·8 s and 97·5 s) or patients with non-cirrhotic diffuse liver disease (35·8 s and 79·7 s). All patients with cirrhosis had an arrival time of the bolus of less than 24 s, whereas the arrival time was 24 s or more in 22 of the 23 other participants. Peak enhancement was higher in patients with cirrhosis (mean 48·7 units) than in the other two groups (12·5 and 12·3 units, respectively). We found highly significant differences between the patients with cirrhosis and each of the other two groups for all variables (P |
| doi_str_mv | 10.1016/S0140-6736(98)06373-9 |
| format | Article |
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We enrolled 15 patients with biopsy-proven cirrhosis, 12 patients with biopsy-proven non-cirrhotic diffuse liver disease, and 11 normal controls. We carried out continuous spectral doppler ultrasonography of a hepatic vein from 20 s before to 3 min after a peripheral intravenous bolus injection of 2·5 g Levovist. The intensity of the doppler signal was measured and used to plot time-intensity curves.
Patients with cirrhosis showed a much earlier onset of enhancement (arrival time; mean 18·3 s) and peak enhancement (mean 55·5 s) than controls (49·8 s and 97·5 s) or patients with non-cirrhotic diffuse liver disease (35·8 s and 79·7 s). All patients with cirrhosis had an arrival time of the bolus of less than 24 s, whereas the arrival time was 24 s or more in 22 of the 23 other participants. Peak enhancement was higher in patients with cirrhosis (mean 48·7 units) than in the other two groups (12·5 and 12·3 units, respectively). We found highly significant differences between the patients with cirrhosis and each of the other two groups for all variables (P<0·005), whereas we found no significant differences between non-cirrhotic patients and controls.
Our preliminary study suggests that analysis of liver transit time of a bolus of ultrasound contrast agent provides useful information about haemodynamic changes in patients with cirrhosis. Measurement of the arrival time of the bolus allows discrimination of patients with cirrhosis from controls and from patients with non-cirrhotic diffuse liver disease, and has potential as a non-invasive test for cirrhosis.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(98)06373-9</identifier><identifier>PMID: 10334257</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>London: Elsevier Ltd</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Contrast Media - pharmacokinetics ; Diagnosis, Differential ; Diagnostic Techniques, Digestive System ; Digestive system. Abdomen ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; Hepatitis C, Chronic - diagnosis ; Hepatitis C, Chronic - diagnostic imaging ; Humans ; Injections, Intravenous ; Investigative techniques, diagnostic techniques (general aspects) ; Liver ; Liver cirrhosis ; Liver Cirrhosis - diagnosis ; Liver Cirrhosis - diagnostic imaging ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Male ; Medical research ; Medical sciences ; Middle Aged ; Other diseases. Semiology ; Pilot Projects ; Polysaccharides - pharmacokinetics ; Time Factors ; Ultrasonic imaging ; Ultrasonic investigative techniques ; Ultrasonography</subject><ispartof>The Lancet (British edition), 1999-05, Vol.353 (9164), p.1579-1583</ispartof><rights>1999 Elsevier Ltd</rights><rights>1999 INIST-CNRS</rights><rights>Copyright Lancet Ltd. May 8, 1999</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c483t-1008ee2d33b7b74e3c851ff5892688b254054fcd97f273349d99a89f209bac193</citedby><cites>FETCH-LOGICAL-c483t-1008ee2d33b7b74e3c851ff5892688b254054fcd97f273349d99a89f209bac193</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0140673698063739$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1773440$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10334257$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Albrecht, Thomas</creatorcontrib><creatorcontrib>Blomley, Martin JK</creatorcontrib><creatorcontrib>Cosgrove, David O</creatorcontrib><creatorcontrib>Taylor-Robinson, Simon D</creatorcontrib><creatorcontrib>Jayaram, Vijay</creatorcontrib><creatorcontrib>Eckersley, Robert</creatorcontrib><creatorcontrib>Urbank, Albrecht</creatorcontrib><creatorcontrib>Butler-Barnes, Jenny</creatorcontrib><creatorcontrib>Patel, Nayna</creatorcontrib><title>Non-invasive diagnosis of hepatic cirrhosis by transit-time analysis of an ultrasound contrast agent</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Hepatic cirrhosis is accompanied by several haemodynamic changes including arterialisation of the liver, intrahepatic shunts, pulmonary arteriovenous shunts, and a hyperdynamic circulatory state. We postulated that the hepatic first pass of a bolus of an ultrasound contrast agent injected into a peripheral vein is accelerated in patients with cirrhosis. We investigated this first pass in patients with diffuse liver disease and in normal controls to assess whether it provides useful differential diagnostic information.
We enrolled 15 patients with biopsy-proven cirrhosis, 12 patients with biopsy-proven non-cirrhotic diffuse liver disease, and 11 normal controls. We carried out continuous spectral doppler ultrasonography of a hepatic vein from 20 s before to 3 min after a peripheral intravenous bolus injection of 2·5 g Levovist. The intensity of the doppler signal was measured and used to plot time-intensity curves.
Patients with cirrhosis showed a much earlier onset of enhancement (arrival time; mean 18·3 s) and peak enhancement (mean 55·5 s) than controls (49·8 s and 97·5 s) or patients with non-cirrhotic diffuse liver disease (35·8 s and 79·7 s). All patients with cirrhosis had an arrival time of the bolus of less than 24 s, whereas the arrival time was 24 s or more in 22 of the 23 other participants. Peak enhancement was higher in patients with cirrhosis (mean 48·7 units) than in the other two groups (12·5 and 12·3 units, respectively). We found highly significant differences between the patients with cirrhosis and each of the other two groups for all variables (P<0·005), whereas we found no significant differences between non-cirrhotic patients and controls.
Our preliminary study suggests that analysis of liver transit time of a bolus of ultrasound contrast agent provides useful information about haemodynamic changes in patients with cirrhosis. Measurement of the arrival time of the bolus allows discrimination of patients with cirrhosis from controls and from patients with non-cirrhotic diffuse liver disease, and has potential as a non-invasive test for cirrhosis.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Contrast Media - pharmacokinetics</subject><subject>Diagnosis, Differential</subject><subject>Diagnostic Techniques, Digestive System</subject><subject>Digestive system. Abdomen</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. 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Academic</collection><jtitle>The Lancet (British edition)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Albrecht, Thomas</au><au>Blomley, Martin JK</au><au>Cosgrove, David O</au><au>Taylor-Robinson, Simon D</au><au>Jayaram, Vijay</au><au>Eckersley, Robert</au><au>Urbank, Albrecht</au><au>Butler-Barnes, Jenny</au><au>Patel, Nayna</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Non-invasive diagnosis of hepatic cirrhosis by transit-time analysis of an ultrasound contrast agent</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>1999-05-08</date><risdate>1999</risdate><volume>353</volume><issue>9164</issue><spage>1579</spage><epage>1583</epage><pages>1579-1583</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>Hepatic cirrhosis is accompanied by several haemodynamic changes including arterialisation of the liver, intrahepatic shunts, pulmonary arteriovenous shunts, and a hyperdynamic circulatory state. We postulated that the hepatic first pass of a bolus of an ultrasound contrast agent injected into a peripheral vein is accelerated in patients with cirrhosis. We investigated this first pass in patients with diffuse liver disease and in normal controls to assess whether it provides useful differential diagnostic information.
We enrolled 15 patients with biopsy-proven cirrhosis, 12 patients with biopsy-proven non-cirrhotic diffuse liver disease, and 11 normal controls. We carried out continuous spectral doppler ultrasonography of a hepatic vein from 20 s before to 3 min after a peripheral intravenous bolus injection of 2·5 g Levovist. The intensity of the doppler signal was measured and used to plot time-intensity curves.
Patients with cirrhosis showed a much earlier onset of enhancement (arrival time; mean 18·3 s) and peak enhancement (mean 55·5 s) than controls (49·8 s and 97·5 s) or patients with non-cirrhotic diffuse liver disease (35·8 s and 79·7 s). All patients with cirrhosis had an arrival time of the bolus of less than 24 s, whereas the arrival time was 24 s or more in 22 of the 23 other participants. Peak enhancement was higher in patients with cirrhosis (mean 48·7 units) than in the other two groups (12·5 and 12·3 units, respectively). We found highly significant differences between the patients with cirrhosis and each of the other two groups for all variables (P<0·005), whereas we found no significant differences between non-cirrhotic patients and controls.
Our preliminary study suggests that analysis of liver transit time of a bolus of ultrasound contrast agent provides useful information about haemodynamic changes in patients with cirrhosis. Measurement of the arrival time of the bolus allows discrimination of patients with cirrhosis from controls and from patients with non-cirrhotic diffuse liver disease, and has potential as a non-invasive test for cirrhosis.</abstract><cop>London</cop><pub>Elsevier Ltd</pub><pmid>10334257</pmid><doi>10.1016/S0140-6736(98)06373-9</doi><tpages>5</tpages></addata></record> |
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| subjects | Adult Aged Biological and medical sciences Contrast Media - pharmacokinetics Diagnosis, Differential Diagnostic Techniques, Digestive System Digestive system. Abdomen Female Gastroenterology. Liver. Pancreas. Abdomen Hepatitis C, Chronic - diagnosis Hepatitis C, Chronic - diagnostic imaging Humans Injections, Intravenous Investigative techniques, diagnostic techniques (general aspects) Liver Liver cirrhosis Liver Cirrhosis - diagnosis Liver Cirrhosis - diagnostic imaging Liver. Biliary tract. Portal circulation. Exocrine pancreas Male Medical research Medical sciences Middle Aged Other diseases. Semiology Pilot Projects Polysaccharides - pharmacokinetics Time Factors Ultrasonic imaging Ultrasonic investigative techniques Ultrasonography |
| title | Non-invasive diagnosis of hepatic cirrhosis by transit-time analysis of an ultrasound contrast agent |
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