Doppler Analysis of Hepatic Venous Waveforms: A Reliable Way to Diagnose and Guess the Size of Esophageal Varices in People with Cirrhosis of the Liver

Sehrish Azam; Rizwan Azam; Saerah Iffat Zafar; Iram Mohsin; Hafsa Sadiq; Syeda Fatima

doi:10.51253/pafmj.v74i3.9861

Authors

Sehrish Azam Department of Radiology, Combined Military Hospital Skardu/National University of Medical Sciences (NUMS) Pakistan
Rizwan Azam Department of Pulmonology, Combined Military Hospital Quetta/National University of Medical Sciences (NUMS) Pakistan
Saerah Iffat Zafar Department of Radiology, Combined Military Hospital Abbottabad/National University of Medical Sciences (NUMS) Pakistan
Iram Mohsin Department of Radiology, Combined Military Hospital Quetta/National University of Medical Sciences (NUMS) Pakistan
Hafsa Sadiq Department of Radiology, Armed Forces Institute of Radiology & Imaging/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Syeda Fatima Department of Pulmonology, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i3.9861

Keywords:

Esophageal varices, Hepatic vein waveforms, Liver cirrhosis

Abstract

Objective: To determine the diagnostic accuracy of Doppler assessment of hepatic venous waveforms for predicting large esophageal varices in patients with cirrhosis, keeping esophagogastroduodenoscopy as a gold standard.

Study Design: Cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Radiology & Imaging, Rawalpindi Pakistan, from Jan 2021 to Jan 2022.

Methodology: According to the Child-Pugh classification, 157 cases of liver cirrhosis were included in this study. With a convex probe operating at 3.5 to 5 MHz, a Doppler ultrasound was executed. If quiet breathing wasn't an option, the spectral waveform was captured at the end of the inhalation phase while holding your breath. This was roughly 3–6 cm from where it connects to the inferior vena cava. All patients underwent an esophagogastroduodenoscopy.

Results: In Doppler USG-positive patients, 84 (true positive) developed significant esophageal varices on endoscopy, while 4 (false positive) did not. Among 69 individuals with negative Doppler USG results, six (false negative) had significant esophageal varices on endoscopy, whereas 63 (true negative) did not (p=0.0001). We found that the overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of Doppler evaluation of hepatic venous waveforms were 93.33%, 94.0%, 95.45%, 91.30%, and 93.6% for finding large esophageal varices in cirrhotic patients using esophagogastroduodenoscopy as the gold standard.

Conclusion: This study proved that using Doppler to look at hepatic vein waveforms is a very sensitive and accurate noninvasive way to tell if someone with cirrhosis will get big esophageal varices.

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