Improved investigation of portal-hepatic veins by echo-enhanced Doppler sonography

Microbubbles of air released from a galactose vehicle (Levovist) amplify the intensity of Doppler signals. They survive both pulmonary and systemic capillary passage, leading to echo enhancement in the entire vascular system. The aim of this study was to investigate this agent in patients with liver disease and insufficient Doppler signals. A total of 275 Doppler examinations were performed in 176 patients; 20 of these patients could not be studied conventionally due to bowel gas, obesity or noncompliance. They received Levovist to examine portal or hepatic veins or TIPS patency. Angiography, computed tomography (CT) scan or magnetic resonance tomographic angiography (MRTA) was performed subsequently as a control. After administration of Levovist, portal or hepatic veins and TIPS patency could be unequivocally assessed in 18 of the 20 patients. In two patients, suspected occlusion of the portal vein was disproved because the diagnosis was not confirmed later. Only minor adverse effects were encountered. Echo-enhanced Doppler sonography with Levovist is well tolerated. Further study of the value of Levovist for the assessment of portal-hepatic vessels not amenable to conventional Doppler sonography is justified.