Color Doppler Ultrasound Examination Of The Main Portal Vein And Inferior Vena Cava In Normal Malaysian Adult Population: A Fasting And Post Prandial Evaluation

摘要

Aims: The aim of this study was to evaluate hemodynamic changes in the main portal vein and inferior vena cava (IVC) in adult population after liquid meal ingestion. Methods: Color Doppler was used to measure hemodynamic changes in the main portal vein and IVC in response to meal ingestion and posture changing, in 48 healthy adults (23 males and 25 females), which consists of three ethnics groups (Malay, Chinese and Indian). Results: Mean blood velocity portal vein was significantly increased from a baseline value of 21.17±8.15 cm/s to a maximum value of 28.48±7.79 cm/s, 30 minutes after a meal (p0.05). No significant changes were found in diameter and venous pulsatility index for main portal vein and diameter, velocity and venous pulsatility index for inferior vena cava (IVC). There are also no significant differences between sex, age and ethnic groups except venous pulsatility index of main portal vein, which found to be higher in males (3.08±4.25) (p0.05). Posture change from supine to sitting significantly reduced portal venous velocity (16.87±5.54cm/s) from the baseline value (21.17±8.15cm/s) (p0.05), while others parameter changes were not statistically significant. Conclusions: There was no evidence of a prandial effect in healthy adults on diameter, flow velocity and pulsatility index for IVC. No significant differences were found in the diameter and flow velocity between sex, age, ethnic groups and posture changing. Venous pulsatility index was higher in males than in females, whereas velocity of portal vein was decreased after posture changing from supine to sitting. Introduction Doppler ultrasound remains as minority imaging until introduction of color Doppler in 1982. Color-Doppler imaging or color-flow imaging has enable the vascular blood flow coded with different color, to indicate the direction of blood flow relative to the selected angle of Doppler detection [1]. The use of color Doppler flow imaging is described for the vessels of the neck and extremities, upper abdomen and abdominal transplants, obstetrics and gynecology, dialysis fistulas, and testicular and penile flow imaging. Color Doppler units capable of displaying regional physiologic and pathophysiologic arterial and venous flow in familiar anatomic format of grey-scale sonographic image [2]. Doppler parameters such as portal venous blood flow and hepatic arterial resistive index have been used to measure the effects of pharmacologic intervention, patient positioning, and disease states [3,4,5,6,7,8]. Accurate characterization of portal venous blood flow provides valuable information to aid assessment of hepatic physiology, portal hypertension, and pharmacologic alteration of hepatic circulation [9]. For instances, previous studies have shown that the flow of hepatic and portal veins is altered in patients with liver cirrhosis, portal vein thrombosis, Budd-Chiari syndrome, and vascular malformations [7,10,11,12].Previous studies have showed hemodynamic changes in portal venous flow after a meal in healthy subjects. These studies did not, however, examine the effect of the meal on portal venous pulsatility and so far, no Doppler study has been conducted to evaluate effect of meal on inferior vena cava (IVC) diameter, blood flow, and pulsatility. The purpose of this study was to investigate the effect of meal ingestion on parameters that measures on healthy subjects beside made comparison of parameter between age groups, ethnic groups, genders and positions. Methods The study population were a selection of 48 healthy volunteers (23 men, 25 women) aged 21 and above. Subject from different ethnic groups have been randomly chosen from Kuala Lumpur. No subject had a history of liver, cardiac disease; portal hypertension, hypertension, Malaria history, ever gone through cholescyctectomy or cardiac operation.Ultrasound Doppler equipment studies were performed with 2 identical American units (Hawks 2101 Exl & ATL 5000) and curvilinear transducers