Hepatic Doppler evaluation

HCC can be represented on US as a hypo- or hyperechogenic mass depending on the amount of fat, or even as a heterogeneous mass with ill-defined borders located in the hepatic parenchyma. It may look identical to a hepatoblastoma. The presence of shadowing fod within the tumor will suggest intra-tumor calcifications. Evaluation of vascular invasion and dilatation of the portal vein will be seen with color Doppler with conventional gray-scale US (Siegel 2000) (Fig. 4.10a). 

Duplex Doppler ultrasound has been described as a non-invasive means of evaluating veno-occlu-sive disease. However, various investigators have demonstrated inconsistent findings in the diagnosis of radiation induced hepatitis [17]. Decreased or reversed to and fro flow can be seen [18]. 

Brown BP, Abu-Yosef M, Earner R, LaBrecque D, Ginrich R (1990) Doppler sonography a non-invasive method for evaluation of hepatic venoocclusive disease. Am J Radiol 154 721-724... 

Results of duplex and color Doppler sonography in the neck and arms are useful to demonstrate the presence or absence of venous flow,but overlying bone and lung severely hamper examination of mediastinal veins. The SVC can also be evaluated with transesophageal Doppler US, but the modality has a small field of view and is to some degree invasive and time-consuming (SvENSSON et al. 1991). Examination of the iliac veins and IVC is easier with duplex ultrasound, including demonstration of the hepatic and renal veins. 

For postoperative evaluation of donors and recipients, gray-scale and Doppler US are the initial imaging modalities used because US is cost-effective, avoids the use of ionizing radiation, and can be performed at the patient s bedside and repeatedly. When complications occur, patients can be further imaged with CT or MRI. Microbubble contrast has been reported to improve the detection of hepatic vessels when they are poorly or not visualized or when patency is suspect, and may be useful in the assessment of parenchymal complications and neoplastic disease recurrence (Berry and Sidhu 2004). 

Ko EY, Kim TK, Kim PN et al (2003) Hepatic vein stenosis after living donor liver transplantation evaluation with Doppler US. Radiology 229(3) 806-810 Ko GY, Sung KB, Yoon HK et al (2002) Endovascular treat-... 

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