Diffüz karaciğer yağlanmasının karaciğere ait hemodinamik parametreler üzerine etkisinin doppler ultrasonografi ile araştırılması
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Date
2010
Authors
Orcan, Serap
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Publisher
Uludağ Üniversitesi
Abstract
Farklı derecelerdeki diffüz karaciğer yağlanmasının hepatik hemodinamik parametreler üzerine etkisinin Doppler Ultrasonografi (US) ile araştırılması amaçlandı.Karaciğer yağlanması olan kırk hasta ve yirmi sağlıklı gönüllü çalışmaya katıldı. Yağlanma derecesi Manyetik Rezonans (MR)'da kimyasal şift yöntemi ile kantitatif yağ miktarı hesaplanarak belirlendi. Doppler US ile hepatik arterde rezistans indeksi (RI), pulsatilite indeksi (PI), pik sistolik ve end-diastolik hız, portal vende RI, PI, konjesyon indeksi, en yüksek hız değeri (Vmax), hepatik venlerde RI, PI, ve Vmax ölçüldü. Hepatik venlerin dalga formları trifazik, bifazik veya monofazik olarak sınıflandırıldı.MR'la yapılan kantitatif ölçüme göre 15 hastada hafif (grup 1), 14 hastada orta (grup 2), 11 hastada belirgin derecede (grup 3) yağlanma vardı. Portal ven Vmax değeri, grup 1, 2, 3 ve kontrol grubunda (grup 4) sırasıyla, ortalama 20±6.2 cm/sn (ortalama±SD), 22±9 cm/sn, 17.4±5 cm/sn ve 27.2±7.7 cm/sn olarak bulundu (p=0.009). Konjesyon indeksi grup 1, 2, 3 ve 4'te sırasıyla 0.056±0.03, 0.078±0.05, 0.127±0.05 ve 0.060±0.03 olarak bulundu (p=0.002). Hepatik arter RI değeri, grup 1, 2, 3 ve 4'te sırasıyla, 0.75±0.13, 0.68±0.10, 0.81±0.16 ve 0.82±0.47 olarak bulundu (p=0.046). Hepatik arter PI değeri, grup 1, 2, 3 ve 4'te sırasıyla, 1.9±0.73, 1.4±0.39, 2±0.61 ve 1.7±0.69 olarak bulundu (p=0.036). Hepatosteatozisin şiddetiyle hepatik venlerin normal trifazik dalga formu yüzdesi arasında ters orantı vardı.Sonuç olarak diffüz karaciğer yağlanmasında arterial kan akımı artarken, portal venöz akım azalmaktadır. Karaciğer vasküler kompliansındaki azalma, hepatik ven dalga formlarında değişikliğe neden olmaktadır. Karaciğer yağlanması olan olguların US incelemesine, Doppler US'nin de eklenmesi yağlanmanın şiddeti ve karaciğer perfüzyonuna etkisi hakkında daha objektif bilgiler sağlayabilir.
The objective of our study is to investigate the effect of various degrees of diffuse fatty infiltration of the liver on hepatic hemodynamic parameters with Doppler Ultrasonography (US).Forty patients with hepatosteatosis and twenty healthy volunteers were included to the study. The quantitative assessment of the severity of hepatic steatosis was performed by chemical shift Magnetic Resonance Imaging (MRI). Hepatic artery Resistance Index (RI), Pulsatility Index (PI), hepatic artery peak systolic and end-diastolic velocity, hepatic veins RI, PI, portal vein RI, PI, congestion index, peak maximum velocity (Vmax) were evaluated by Doppler US. The waveform patterns of the hepatic veins were classified as triphasic, biphasic or monophasic.According to the quantitative assessment with MRI, 15 patients had mild (group 1), 14 patients had moderate (group 2), 11 patients had severe (group 3) degree of fatty infiltration. Vmax values of portal vein were found to be 20±6.2 cm/sec (mean±SD), 22±9 cm/sec, 17.4±5 cm/sec and 27.2±7.7 cm/sec in groups 1, 2, 3 and control group (group 4), respectively (p=0.009) Congestion index were found to be 0.056±0.03, 0.078±0.05, 0.127±0.05 and 0.060±0.03 in group 1, 2, 3 and 4, respectively (p=0.002). Hepatic artery RI value were found to be 0.75±0.13, 0.68±0.10, 0.81±0.16 and 0.82±0.47 in group 1, 2, 3 and 4, respectively (p=0.046). Hepatic artery PI value were found to be 1.9±0.73, 1.4±0.39, 2±0.61 and 1.7±0.69 in group 1, 2, 3 and 4, respectively (p=0.036).There was a negative correlation between the degree of the fatty infiltration and hepatic vein?s triphasic waveform ratio.In conclusion, hepatic artery blood flow increases and portal vein flow decreases in the hepatosteatosis. Impaired hepatic compliance leads to alteration in the hepatic venous waveform. To evaluate patients with hepatosteatosis using Doppler US in addition to US, may provide objective informations about severity of fatty infiltrations and effects on liver perfusion.
The objective of our study is to investigate the effect of various degrees of diffuse fatty infiltration of the liver on hepatic hemodynamic parameters with Doppler Ultrasonography (US).Forty patients with hepatosteatosis and twenty healthy volunteers were included to the study. The quantitative assessment of the severity of hepatic steatosis was performed by chemical shift Magnetic Resonance Imaging (MRI). Hepatic artery Resistance Index (RI), Pulsatility Index (PI), hepatic artery peak systolic and end-diastolic velocity, hepatic veins RI, PI, portal vein RI, PI, congestion index, peak maximum velocity (Vmax) were evaluated by Doppler US. The waveform patterns of the hepatic veins were classified as triphasic, biphasic or monophasic.According to the quantitative assessment with MRI, 15 patients had mild (group 1), 14 patients had moderate (group 2), 11 patients had severe (group 3) degree of fatty infiltration. Vmax values of portal vein were found to be 20±6.2 cm/sec (mean±SD), 22±9 cm/sec, 17.4±5 cm/sec and 27.2±7.7 cm/sec in groups 1, 2, 3 and control group (group 4), respectively (p=0.009) Congestion index were found to be 0.056±0.03, 0.078±0.05, 0.127±0.05 and 0.060±0.03 in group 1, 2, 3 and 4, respectively (p=0.002). Hepatic artery RI value were found to be 0.75±0.13, 0.68±0.10, 0.81±0.16 and 0.82±0.47 in group 1, 2, 3 and 4, respectively (p=0.046). Hepatic artery PI value were found to be 1.9±0.73, 1.4±0.39, 2±0.61 and 1.7±0.69 in group 1, 2, 3 and 4, respectively (p=0.036).There was a negative correlation between the degree of the fatty infiltration and hepatic vein?s triphasic waveform ratio.In conclusion, hepatic artery blood flow increases and portal vein flow decreases in the hepatosteatosis. Impaired hepatic compliance leads to alteration in the hepatic venous waveform. To evaluate patients with hepatosteatosis using Doppler US in addition to US, may provide objective informations about severity of fatty infiltrations and effects on liver perfusion.
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Keywords
Hepatosteatoz, Doppler US, Hepatik arter, Hepatik ven, Portal ven, Hepatosteatosis, Hepatic artery, Hepatic vein, Portal vein
Citation
Orcan, S. (2010). Diffüz karaciğer yağlanmasının karaciğere ait hemodinamik parametreler üzerine etkisinin doppler ultrasonografi ile araştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.