Arrival time parametric imaging of the hemodynamic balance changes between the hepatic artery and the portal vein during deep inspiration, using Sonazoid-enhanced ultrasonography: A case of Budd‑Chiari syndrome

Wakui,Noritaka; Takayama,Ryuji; Matsukiyo,Yasushi; Kamiyama,Naohisa; Kobayashi,Kojiro; Mukozu,Takanori; Nakano,Shigeru; Ikehara,Takashi; Nagai,Hidenari; Igarashi,Yoshinori; Sumino,Yasukiyo

doi:10.3892/etm.2013.1105

Arrival time parametric imaging of the hemodynamic balance changes between the hepatic artery and the portal vein during deep inspiration, using Sonazoid-enhanced ultrasonography: A case of Budd‑Chiari syndrome

Authors:
- Noritaka Wakui
- Ryuji Takayama
- Yasushi Matsukiyo
- Naohisa Kamiyama
- Kojiro Kobayashi
- Takanori Mukozu
- Shigeru Nakano
- Takashi Ikehara
- Hidenari Nagai
- Yoshinori Igarashi
- Yasukiyo Sumino
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Affiliations: Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo 143‑8541, Japan, Ultrasound General Imaging, GE Healthcare, Tokyo 191-8503, Japan
Published online on: May 9, 2013 https://doi.org/10.3892/etm.2013.1105
Pages: 15-21

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Abstract

This case report concerns a 40‑year‑old male who had previously been treated for an esophageal varix rupture, at the age of 30 years. The medical examination at that time revealed occlusion of the inferior vena cava in the proximity of the liver, leading to the diagnosis of the patient with Budd-Chiari syndrome. The progress of the patient was therefore monitored in an outpatient clinic. The patient had no history of drinking or smoking, but had suffered an epileptic seizure in 2004. The patient's family history revealed nothing of note. In February 2012, color Doppler ultrasonography (US) revealed a change in the blood flow in the right portal vein branch, from hepatopetal to hepatofugal, during deep inspiration. Arrival time parametric imaging (At-PI), using Sonazoid-enhanced US, was subsequently performed to examine the deep respiration‑induced changes observed in the hepatic parenchymal perfusion. US images captured during deep inspiration demonstrated hepatic parenchymal perfusion predominantly in red, indicating that the major blood supply was the hepatic artery. During deep expiration, the portal venous blood flow remained hepatopetal, and hepatic parenchymal perfusion was displayed predominantly in yellow, indicating that the portal vein was the major source of the blood flow. The original diagnostic imaging results were reproduced one month subsequently by an identical procedure. At‑PI enabled an investigation into the changes that were induced in the hepatic parenchymal perfusion by a compensatory mechanism involving the hepatic artery. These changes occurred in response to a reduction in the portal venous blood flow, as is observed in the arterialization of hepatic blood flow that is correlated with the progression of chronic hepatitis C. It has been established that the peribiliary capillary plexus is important in the regulation of hepatic arterial blood flow. However, this case demonstrated that the peribiliary capillary plexus also regulates acute changes in portal venous blood flow, in addition to the chronic reduction in blood flow that is observed in patients with chronic hepatitis C.

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1.	Kleber G, Steudel N, Behrmann C, et al: Hepatic arterial flow volume and reserve in patients with cirrhosis: use of intra-arterial Doppler and adenosine infusion. Gastroenterology. 116:906–914. 1999.PubMed/NCBI
2.	Rocheleau B, Ethier C, Houle R, Huet PM and Bilodeau M: Hepatic artery buffer response following left portal vein ligation: its role in liver tissue homeostasis. Am J Physiol. 277:G1000–G1007. 1999.PubMed/NCBI
3.	Leen E, Goldberg JA, Anderson JR, et al: Hepatic perfusion changes in patients with liver metastases: comparison with those patients with cirrhosis. Gut. 34:554–557. 1993. View Article : Google Scholar : PubMed/NCBI
4.	Lautt WW: Mechanism and role of intrinsic regulation of hepatic arterial blood flow: hepatic arteial buffer response. Am J Physiol. 249:G549–G556. 1985.PubMed/NCBI
5.	Menon KV, Shah V and Kamath PS: The Budd-Chiari syndrome. N Engl J Med. 350:578–585. 2004. View Article : Google Scholar : PubMed/NCBI
6.	Iwao T, Toyonaga A, Oho K, et al: Value of Doppler ultrasound parameters of portal vein and hepatic artery in the diagnosis of cirrhosis and portal hypertension. Am J Gastroenterol. 92:1012–1017. 1997.PubMed/NCBI
7.	Wakui N, Takayama R, Kanekawa T, et al: Usefulness of arrival time parametric imaging in evaluating the degree of liver disease progression in chronic hepatitis C infection. J Ultrasound Med. 31:373–382. 2012.PubMed/NCBI
8.	Wakui N, Takayama R, Mimura T, et al: Drinking status of heavy drinkers detected by arrival time parametric imaging using Sonazoid-enhanced ultrasonography: study of two cases. Case Rep Gastroenterol. 5:100–109. 2011. View Article : Google Scholar : PubMed/NCBI
9.	Wakui N, Takayama R, Matsukiyo Y, et al: Visualization of segmental arterialization with arrival time parametric imaging using Sonazoid-enhanced ultrasonography in portal vein thrombosis: A case report. Exp Ther Med. 5:673–677. 2013.PubMed/NCBI
10.	Wakui N, Fujita M, Oba N, et al: Endoscopic nasobiliary drainage improves jaundice attack symptoms in benign recurrent intrahepatic cholestasis: A case report. Exp Ther Med. 5:389–394. 2013.PubMed/NCBI
11.	Shunichi S, Hiroko I, Fuminori M and Waki H: Definition of contrast enhancement phases of the liver using a perfluoro-based microbubble agent, perflubutane microbubbles. Ultrasound Med Biol. 35:1819–1827. 2009. View Article : Google Scholar : PubMed/NCBI
12.	Smith HJ, Grøttum P and Simonsen S: Ultrasonic assessment of abdominal venous return. I Effect of cardiac action and respiration on mean velocity pattern, cross-sectional area and flow in the inferior vena cava and portal vein. Acta Radiol Diagn (Stockh). 26:581–588. 1985.PubMed/NCBI
13.	Moreno AH, Burchell AR, Van der Woude R and Burke JH: Respiratory regulation of splanchnic and systemic venous return. Am J Physiol. 213:455–465. 1967.PubMed/NCBI
14.	Rabinovici N and Navot N: The relationship between respiration, pressure and flow distribution in the vena cava and portal and hepatic veins. Surg Gynecol Obstet. 151:753–763. 1980.PubMed/NCBI
15.	Sugano S, Yamamoto K, Sasao K and Watanabe M: Portal venous blood flow while breath-holding after inspiration or expiration and during normal respiration in controls and cirrhotics. J Gastroenterol. 34:613–618. 1999. View Article : Google Scholar : PubMed/NCBI
16.	Rappaport AM, Black RG, Lucas CC, Ridout JH and Best CH: Normal and pathologic microcirculation of the living mammalian liver. Rev Int Hepatol. 16:813–828. 1966.PubMed/NCBI
17.	Rappaport AM: Hepatic blood flow: morphologic aspects and physiologic regulation. Int Rev Physiol. 21:1–63. 1980.PubMed/NCBI
18.	Ekataksin W and Kaneda K: Liver microvascular architecture: an insight into the pathophysiology of portal hypertension. Semin Liver Dis. 19:359–382. 1999. View Article : Google Scholar : PubMed/NCBI
19.	Nakata K, Leong GF and Brauer RW: Direct measurement of blood pressures in minute vessels of the liver. Am J Physiol. 199:1181–1188. 1960.PubMed/NCBI
20.	Rhodin JA: The ultrastructure of mammalian arterioles and precapillary sphincters. J Ultrastruct Res. 18:181–223. 1967. View Article : Google Scholar : PubMed/NCBI
21.	Tochio H, Kudo M, Nishiuma S and Okabe Y: Intrahepatic spontaneous retrograde portal flow in patients with cirrhosis of the liver: reversal by food intake. AJR Am J Roentgenol. 177:1109–1112. 2001. View Article : Google Scholar : PubMed/NCBI
22.	Kessler RE, Tice DA and Zimmon DS: Retrograde flow of portal vein blood in patients with cirrhosis. Radiology. 92:1038–1042. 1969. View Article : Google Scholar : PubMed/NCBI
23.	Okuda K, Moriyama M, Yasumoto M, Jinnouchi S and Shimokawa Y: Roentgenologic demonstration of spontaneous reversal of portal blood flow in cirrhosis and primary carcinoma of the liver. Am J Roentgenol Radium Ther Nucl Med. 119:419–428. 1973. View Article : Google Scholar : PubMed/NCBI
24.	Foster DN, Herlinger H, Miloszewski KJ and Losowsky MS: Hepatofugal portal blood flow in hepatic cirrhosis. Ann Surg. 187:179–182. 1978. View Article : Google Scholar : PubMed/NCBI
25.	Takayasu K, Takashi M, Musha H, et al: Spontaneous reversal of portal blood flow demonstrated by percutaneous transhepatic catheterization: report of two cases. Gastroenterology. 82:753–757. 1982.
26.	Sarfeh IJ, Rypins EB, Conroy RM and Mason GR: Portacaval H-graft: relationships of shunt diameter, portal flow patterns and encephalopathy. Ann Surg. 197:422–426. 1983. View Article : Google Scholar : PubMed/NCBI
27.	Tanabe T, Tobe K, Koide N, et al: Blood flow dynamics of the portal venous system in liver diseases studied by the ultrasonic pulsed doppler method. Kanzo. 26:65–73. 1985.(In Japanese).
28.	Ohnishi K, Saito M, Sato S, et al: Direction of splenic venous flow assessed by pulsed Doppler flowmetry in patients with a large splenorenal shunt. Relation to spontaneous hepatic encephalopathy. Gastroenterology. 89:180–185. 1985.
29.	Kawasaki T, Moriyasu F, Nishida O, et al: Analysis of hepatofugal flow in portal venous system using ultrasonic Doppler duplex system. Nihon Shokakibyo Gakkai Zasshi. 84:1655–1660. 1987.(In Japanese).
30.	Nishida O, Nishikawa K, Seko S, et al: Two cases of reverse portal blood flow: clinical course and changes in hemodynamics. Journal of Medical Ultrasonics. 24:1663–1670. 1997.