Hepatic vein Doppler studies: variability of flow pattern in normal children
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Published on: January 20, 2023
Sigrid Jequier1, Jean-Claude Jequier, Sylviane Hanquinet
1Department of Paediatric Radiology, University Hospital of Geneva, Children's Hospital, 6 rue Willy Donzé, 1112 Geneva 14, Switzerland. sigrid.jequier@hcuge.ch
Insights
Hepatic vein (HV) flow patterns in children vary with age, with younger children showing less triphasic flow. These variations are generally reproducible, establishing normal limits for assessing liver disease.
Area of Science:
- Pediatric radiology
- Hepatology
- Vascular ultrasound
Background:
- Loss of triphasicity in hepatic vein (HV) flow on Doppler ultrasonography (US) is linked to adult liver diseases like cirrhosis.
- Establishing normal HV flow patterns in children is crucial for diagnosing liver pathology.
Purpose of the Study:
- To document physiological variations in HV flow patterns in normal children across different age groups.
- To assess the influence of age, sex, body position, measurement site, exercise, and food intake on HV flow.
- To determine the reproducibility of Doppler US findings for HV flow assessment.
Main Methods:
- Thirty-two children were divided into four age groups and underwent repeated HV Doppler US examinations.
- HV flow patterns were categorized (triphasic, diphasic, monophasic) at three sites within each major HV.
- Flow patterns were recorded in supine, sitting, post-exercise, and post-meal states, with assessments by two radiologists.
Main Results:
- Hepatic vein (HV) flow patterns varied between individual HVs within the same child, with the right HV showing less triphasic flow.
- Age was a significant factor, with younger children exhibiting less triphasic HV flow.
- Sex and position influenced the right HV, likely due to examination difficulties; exercise and food intake did not alter flow triphasicity.
Conclusions:
- Hepatic vein (HV) flow patterns in children are age-dependent and can vary between different HVs in a normal liver.
- Doppler US interpretation of HV flow is generally reproducible between radiologists.
- Age is a key determinant of normal HV flow patterns, essential for accurate liver disease assessment in pediatric patients.
Background:
Loss of triphasicity of hepatic venous flow on Doppler US has been correlated with hepatic parenchymal disease such as cirrhosis and graft rejection in adults.
Objective:
To document physiological variations of hepatic vein (HV) flow patterns in normal children of different age groups, the influence of age, sex, body position, site of measurements within a given vein, exercise and food intake. Also, to document the reproducibility of the Doppler US findings in the three major HVs, in order to establish the limits of normal flow against which to assess liver pathology giving rise to abnormal flow pattern.
Materials And Methods:
Thirty-two children, divided into four age groups: less than 1 year, 1-5 years, 5-12 years and 12-16 years, with four boys and four girls in each group, underwent repeated US examinations of their HVs. The HV flow pattern was recorded as triphasic = 4, diphasic = 3, monophasic = 2 or uninterpretable = 1 at three sites in each vein: peripheral, middle and proximal in the supine position in the fasting state. One recording was then obtained in the midportion of each vein in the sitting position, another one after exercise, then after a meal and lastly one by a second radiologist. Statistical analysis of variance was done of each variable alone, in combination two by two and three by three.
Results:
HV flow pattern was different from one vein to another in the majority of the children, the right HV having the least triphasic flow. Age was highly significant, the HV flow being less triphasic in young children. Sex and position were significant for the right HV only, which was the most difficult to examine. Exercise and food intake did not change the triphasicity of flow.
Conclusions:
HV flow pattern differs with age and can differ from one HV to another within an apparently normal liver. Interpretation is generally reproducible from one radiologist to another. A difference of sex, seen mostly for the right HV, may be due to unfavourable Doppler angle and difficulty of interpretation. The site of measurements within a given vein, body position, exercise and food intake do not influence the triphasicity of HV flow.
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