Influence of the Spleen on Portal Haemodynamics: a Non-invasive Study with Doppler Ultrasound in Chronic Liver Disease and Haematological Disorders

• Published in: Scandinavian journal of gastroenterology 2002-10, Vol.37 (10), p.1220-1227
• Main Authors: Piscaglia, F., Donati, G., Cecilioni, L., Celli, N., Stagni, B., Pini, P., Gaiani, S., Gherlinzoni, F., Bolondi, L.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Chronic Disease; Digestive system. Abdomen; Doppler Ultrasound; Female; Hematologic Diseases - complications; Hematologic Diseases - diagnostic imaging; Hematologic Diseases - physiopathology; Hemodynamics - physiology; Humans; Investigative techniques, diagnostic techniques (general aspects); Liver Diseases - complications; Liver Diseases - diagnostic imaging; Liver Diseases - physiopathology; Male; Medical sciences; Middle Aged; Portal Hypertension; Sensitivity and Specificity; Splanchnic Circulation - physiology; Spleen - diagnostic imaging; Spleen - physiopathology; Splenomegaly; Splenomegaly - complications; Splenomegaly - diagnostic imaging; Splenomegaly - physiopathology; Ultrasonic investigative techniques; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Pulsed
• ISSN: 0036-5521; 1502-7708
• DOI: 10.1080/003655202760373452

Background: Splanchnic haemodynamic parameters for the differential diagnosis of splenomegalies of different origins are still suboptimal and the role of spleen enlargement in cirrhosis remains controversial. In an attempt to elucidate these questions, we assessed splanchnic haemodynamics in chronic liver diseases and various other disorders with splenomegaly. Methods: Study groups comprised: (i) patients with chronic liver disease (89 with cirrhosis, 35 with chronic hepatitis), (ii) patients with splenomegaly without relevant portal hypertension (14 with haematological splenomegaly and 25 liver transplant recipients without complications), (iii) 15 patients with arterial hypertension, (iv) 22 healthy controls. In all subjects, spleen size, portal flow parameters and splenic artery resistance index were measured using duplex-Doppler ultrasound. Results: Splenic artery resistance index was significantly and selectively increased in patients with cirrhosis (0.63, whereas all other group means ranged between 0.53 and 0.56; P < 0.01). Portal flow velocity was significantly decreased in cirrhosis ( P < 0.01). The combination of these two parameters provided an accuracy of 87.5% in distinguishing portal hypertensive from haematological splenomegaly. In patients with cirrhosis, the degree of spleen enlargement was positively correlated with increasing portal flow volume, portal vein diameter and variceal size, whereas splenic resistance index and portal velocity did not differ in connection with spleen size. Conclusions: Splenoportal Doppler sonography provides specific findings in cirrhosis and may therefore be a useful tool in differentiating between splenomegaly of portal hypertensive or haematological origin. In patients with cirrhosis, the presence of splenomegaly is associated with the presence of larger oesophageal varices.