Reliability of the estimation of total hepatic blood flow by Doppler ultrasound in patients with cirrhotic portal hypertension

Background & Aims: Hepatic blood flow (HBF) is best estimated by the Fick's method during indocyanine green constant infusion (ICG-HBF) on hepatic vein catheterization. We investigated the consistency and agreement of HBF measured by Doppler ultrasound (US-HBF) as compared with ICG-HBF in portal hypertensive patients with cirrhosis. Methods: In 50 patients observed for HVPG measurement (56% compensated; Child score 7 +/- 2; HVPG 16.6 +/- 6.0 mmHg; varices in 75%) US-HBF (Sequoia-512-Acuson; 4.5-7 MHz convex probe; US-HBF = hepatic artery blood flow + portal vein blood flow) and ICG-HBF (Fick's method after an equilibration period of at least 45 min of ICG bolus of 5 mg + constant rate infusion of 0.2 mg/min). Intraclass correlation coefficient (ICC) for consistency and absolute agreement between US-HBF and ICG-HBF were calculated. Results: Mean ICG-HBF and US-HBF were similar, being respectively 1004 +/- 543 ml/min and 994 +/- 494 ml/min (p = 0.661 vs. ICG-HBF). However, results in individual patients disclosed marked differences between the two methods (386 +/- 415 ml/min) and showed only moderate consistency (ICC 0.456; p <0.0001), absolute agreement (ICC 0.461; p <0.0001) and linear correlation (R = 0.464; p <0.0001). The discrepancy between the two methods was maximal in patients with poor liver function, high HBF by any technique and more arterialized liver circulation. Hepatic artery blood flow >= 40% of US-HBF indicated, with 90% specificity, a discrepancy >= 20% between US-HBF and ICG-HBF. Conclusions: HBF estimations by Doppler-ultrasound and ICG are significantly correlated, but their discrepancy in individual cases is high. Estimation of HBF by Doppler-US should be considered unreliable in patients with poor hepatic function and large liver arterialization. (C) 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.