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[Echographic parameters in the evaluation of the degree of portal hypertension]
Insights
Ultrasonography can identify portal hypertension (HTP) in ascites patients. Longitudinal spleen diameter effectively detects HTP, while transverse diameter helps rule out high HTP levels when the albumin gradient is elevated.
Area of Science:
- Hepatology
- Radiology
- Gastroenterology
Background:
- Ascites is a common complication of portal hypertension (HTP).
- Accurate assessment of HTP is crucial for patient management.
- Ultrasonography is a non-invasive imaging modality with potential for evaluating HTP.
Purpose of the Study:
- To investigate the correlation between ultrasonographic parameters and the presence/level of HTP in ascites patients.
- To determine the diagnostic value of specific ultrasonographic measurements for HTP detection.
Main Methods:
- Prospective study of 31 hospitalized ascites patients.
- Assessment of ultrasonographic parameters including spleen dimensions (longitudinal and transverse diameters) and portal/splenic vein diameters.
- Determination of HTP level using the serum-to-ascites albumin concentration gradient (GRAD-Alb).
Main Results:
- Ultrasonographic splenomegaly (longitudinal diameter) demonstrated a high positive predictive value (94.4%) for detecting HTP.
- Transverse spleen diameter showed a high negative predictive value (91.7%) in patients with elevated GRAD-Alb (> or = 2.35 g/dl), suggesting its utility in excluding high HTP levels.
- Changes in portal and splenic vein diameters did not effectively discriminate HTP presence.
- No significant association was found between elevated GRAD-Alb levels and spleen measurements.
Conclusions:
- Longitudinal spleen diameter is a valuable ultrasonographic marker for identifying portal hypertension in ascites.
- Transverse spleen diameter may serve as a parameter to help rule out high levels of portal hypertension.
- Standard portal and splenic vein diameter measurements lack discriminatory power for HTP in this cohort.
Abstract:
We did a prospective study in thirty one patients with ascites who were hospitalized at Cayetano Heredia Hospital (H.N.C.H.). We investigated the association and correlation between ultrasonographic parameters of portal hypertension (HTP) and the presence and level of HTP (determinate by the serum-to-ascites albumin concentration gradient). In our study, we demonstrated that ultrasonographic splenomegaly studied by longitudinal diameter of the spleen discriminate patients with HTP with a high positive predictive value (94.4%), although it didn't happen with transverse diameter of the spleen. However patients with elevated measurements of high GRAD-Alb (> or = 2.35 +/- 0.05 g/dl) had alterations in the transversal diameter of the spleen with a high negative predictive value (91.7%), these findings were suggested its use like a parameter for reject high levels of HTP. In our study, we demonstrated that the existence of changes at diameters of portal vein and splenic vein could not discriminate patients with HTP. By the way, we didn't find association between degree of high GRAD-Alb and the different splenic measurements.