To Study the Role of Duplex Sonography in Cases of Portal Hypertension

BACKGROUND New techniques like elastography and hepatic vein transit time (HVTT) for diagnosing portal hypertension are costly, invasive, time-consuming and not easily available. CT/MRI are now easily available modalities, but they cannot establish flow pattern in portal venous system. Ultrasound (grey scale and colour doppler) though widely available are still not accepted as a definite tool to establish early PHT. We wanted to determine the role of ultrasound (greyscale and colour Doppler) as a definitive modality to diagnose early PHT, thus preventing absolute liver damage by fibrosis. METHODS This is a prospective cross-sectional study undertaken in the Department of Radiodiagnosis, Government Medical College, Amritsar, between February 2018 to May 2018, conducted among 50 patients clinically diagnosed/suspected as PHT. All these patients were given a sonographic examination. Sonographic findings including colour Doppler of blood flow pattern were studied. In addition, clinical and biochemical findings were also correlated. Findings were tabulated, subjected to statistical analysis and inferences were drawn. RESULTS Our study found a good correlation with the assessment of spleen size (>= 13 cms) showing a p-value of 0.003. p-value of ascites is 0.008 while diameter of portal vein (p-value 0.005) also show strong correlation. Splenic vein was found to be highly specific (77.4%) but not sensitive. Decrease in velocity of portal vein correlated significantly, more with portal hypertension, as compared to increase in splenic vein velocity. Various collaterals showed 100% sensitivity with p-values for coronary collaterals of 0.001 and paraumbilical collaterals to be of 0.000. CONCLUSIONS Colour Doppler is still the best modality of choice for diagnosing portal hypertension at very early stages. Doppler helps by diagnosing direction of flow as well as velocity of portal venous system. It can also help in evaluating collaterals and portosystemic shunts. Other information provided by pulsed Doppler includes detection of veno-occlusive disease.