Ultrasonographic Evaluation of Portal Hypertension and Liver Cirrhosis

Nowadays, ultrasonography is widely available in medical practice for the evaluation of liver cirrhosis and portal hypertension. Real-time ultrasonography (RTUS) is very convenient and is valuable in the detection of liver cirrhosis by demonstrating liver surface nodularity, splenomegaly and right lobe atrophy. Although RTUS is also utilized in the evaluation of portal hypertension by measuring the dimension of the main portal vein and visualizing the portosystemic collaterals, color Doppler ultrasonography (CDUS) and duplex Doppler ultrasonography (dDU) are undoubtedly superior to RTUS in this respect. With CDUS, the flow direction of the portal system can be clearly demarcated, and the collaterals, especially the gastroesophageal, the paraumbilical, the splenorenal and the gastrorenal veins, can be easily detected. With dDU, the measurement of portal flow velocities has been performed for the last two decades; yet, there is inter-equipment and interobserver variation. However, with the combination of the measurements relating to dimension and flow velocity of the main portal vein and changes in the right hepatic vein waveform, dDU is believed to be of value in the assessment of portal hypertension. In addition, several indices such as the congestion index, the portal hypertension index and the “liver cirrhosis index” have been applied in the evaluation of portal hypertension, with increasing evidence of simplicity and diagnostic accuracy. On the whole, ultrasonography is a modern imaging modality which plays an important role in the first-line diagnosis of liver cirrhosis and portal hyper-tension, because it is reliable, noninvasive and cost-effective.