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Arterioportal Fistulas in Patients with Liver Cirrhosis: Usefulness of Color Doppler US for Screening¹

¹ From the Department of Clinical and Experimental Medicine (M.B., D.S., G.B., C.M., A.G.) and the Institute of Radiology (M.C.C.), Clinica Medica 5, Policlinico Universitario, Via Giustiniani 2, 35128 Padova, Italy. Received November 3, 1999; revision requested December 7; revision received February 3, 2000; accepted February 7. Address correspondence to M.B. (e-mail: bolognes@ux1.unipd.it).

PURPOSE: To evaluate the usefulness of routine ultrasonographic (US) evaluation of the hepatic arterial resistive and pulsatility indexes and of the direction of portal venous blood flow for the diagnosis of intrahepatic arterioportal fistulas (APFs) in patients with liver cirrhosis.

MATERIALS AND METHODS: In all patients with cirrhosis examined at one center over 4 years, the resistive (RI) and the pulsatility (PI) indexes in the right and left branches of the hepatic artery were evaluated with Doppler US. An APF was suspected when an RI decrease of at least 20% and a PI decrease of at least 30% were present in one hepatic lobe relative to values in the other lobe and portal blood flow in the lobe with the decreased values was reversed. The RI and PI in patients with an APF were compared with those in 75 patients with cirrhosis and without APFs at angiography.

RESULTS: Seven patients with an APF were identified. APFs suspected at Doppler US were always confirmed with angiography. The percent differences ± SD in the RI and the PI between the two intrahepatic branches of the hepatic artery in patients with versus in patients without an APF were as follows: RI, 35% ± 6 (range, 27%–42%) versus 5% ± 4 (range, 0%–15%) (P < .001); PI, 50% ± 5 (range, 41%–58%) versus 11% ± 7 (range, 0%–26%) (P < .001).

CONCLUSION: The intrahepatic arterial resistive and pulsatility indexes and the direction of portal blood flow should be evaluated in routine screening for APFs in patients with liver cirrhosis.

Index terms: Fistula, arteriovenous, 761.49, 952.494, 957.494 • Gastrointestinal tract, hemorrhage, 71.75, 952.717, 957.717 • Hepatic arteries, US, 952.12983 • Liver, cirrhosis, 761.794 • Liver, US, 761.12983 • Portal vein, US, 957.12983 • Ultrasound (US), Doppler studies, 761.12983, 952.12983, 957.12983

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