impedance indices significantly decreased compared The spleen plays a pivotal role in the pathogenesis with other cirrhotic patients (RI and PI P Ƶ .0001). In and maintenance of portal hypertension. Few data exist patients who underwent liver transplantation, splenic about splenic hemodynamics evaluated by duplex soimpedance indices were the same as those in controls. nography in this condition. Twenty-six normal subjects, In 23 of the 52 patients surgically treated (surgical shunt 207 patients with portal hypertension of various causes, or liver transplantation), impedance indices were evaluand in different splenoportal hemodynamic conditions, ated both before and after surgical treatment. All these and 31 patients with liver transplantation were evalupatients showed a decrease in splenic impedance indices ated. In each patient the splenic resistive index (RI (RI and PI, P Ƶ .0001) after surgical treatment. RI and Ć
peak systolic 0 end diastolic velocity/peak systolic ve-PI values were higher in patients with large esophageal locity) and pulsatility index (PI Ć
peak systolic 0 end varices as compared with patients without or with small diastolic velocity/mean velocity) were measured. In 17 varices (P Ƶ .02 and P Ƶ .01). RI and PI values were cirrhotic patients, splenic indices were compared with not related to age, mean arterial pressure, sex, Childportal hemodynamics as invasively evaluated by hepatic Turcotte-Pugh score, presence of ascites, or cause. A sigvein catheterization. In the various groups, RI and PI nificant correlation was found between splenic impedwere respectively: normal subjects, 0.51 { 0.05 and 0.72 ance indices and portal resistance as evaluated by { 0.11; cirrhotic patients with hepatopetal portal blood hepatic vein catheterization (r Ć
.80, P Ƶ .001 for RI flow (n Ć
167), 0.64 { 0.08 and 1.03 { 0.24; cirrhotic pavalues; r Ć
.87, P Ƶ .001 for PI values). In conclusion, this tients with hepatofugal portal flow (n Ć
3), 0.74 { 0.08 study shows that splenic impedance indices are inand 1.27 { 0.08; cirrhotic patients with portal vein creased in cirrhotic patients, and seems to demonstrate thrombosis (n Ć
9), 0.74 { 0.08 and 1.36 { 0.34; patients that in patients with cirrhosis these indices reflect porwith noncirrhotic obstruction of the portal system (n tal vein blood flow resistance. (HEPATOLOGY 1996;23: Ć
7), 0.69 { 0.11 and 1.16 { 0.28; cirrhotic patients with 1035-1040.) surgical decompression of splenic vein system (n Ć
21), 0.54 { 0.07 and 0.76 { 0.15; patients with liver transplantation (n Ć
31), 0.50 { 0.08 and 0.70 { 0.15. Both RI
The introduction of duplex Doppler ultrasonography and PI were significantly higher in cirrhotic patients with hepatopetal portal flow compared with controls (P (DDU) has been an important breakthrough in the Ƶ .0001), and even higher in cirrhotic patients with porevaluation of splanchnic hemodynamics. This new tal vein thrombosis (P Ƶ .004 and P Ƶ .001 in comparison technique is being widely used, particularly for the aswith RI and PI values of cirrhotic patients). In patients sessment of portal hypertension. 1,2 with noncirrhotic portal vein thrombosis, splenic imped-Since the introduction of DDU, new splanchnic heance indices were higher than those in controls (RI and modynamic parameters of portal hypertension have PI P Ƶ .0001). Cirrhotic patients who underwent surgery been introduced: at first portal blood flow velocity and for the therapy of portal hypertension showed splenic the congestion index of the portal vein, 1,3-6 and more recently, the arterial hemodynamic parameters, i.e., the so-called impedance or resistance indices. [7][8][9] The Abbreviations: DDU, duplex Doppler ultrasonography; PI, pulsatility index; evaluation of these indices could be relevant, because RI, resistive index; PBV, portal blood flow mean velocity; PBF, portal blood splanchnic arterial resistance is involved in the deterflow volume; HVPG, hepatic venous pressure gradient.