Flow pattern in the right hepatic vein reflects fatty infiltration of the liver in patients with chronic hepatitis C
Dietrich CF., Stryick-Kaminska D., Braden B., Caspary WF., Herrmann G., Zeuzem S.
The flow pattern in hepatic veins depends on cardiac physiology and liver histology. Aim of the present study was to determine the dependance of the flow pattern in relation to histology in HCV-infected patients with normal cardiac function. In 114 patients with chronic hepatitis C (pHCV, 71 male, 43 female; 39±9 years [range: 20-59]) and 75 healthy controls (hc, 47 male, 28 female; 37±9 years [range: 26-66], no histology), the Doppler spectrum was evaluated in the right hepatic vein (V 328, Acuson 128, 3.5 MHz). The flow pattern was classified as triphasic (tp), biphasic (bp), or monophasic (mp). At the same occasion liver biopsy was performed. Histology was classified according to the histology activity index (HAI) and the hepatic fat content was semiquantitatively evaluated. Of all histological parameters, the hepatic fat content was best correlated with the flow pattern in the right hepatic vein. In pHCV, no or only slight fat deposition in the hepatocytes was found in 73/114 (64.0%) and fatty infiltration in 41/114 (36.0%). In pHCV with minimal fat deposition the flow pattern was mp in 2/73 (2.7%), bp in 17/73 (23.3%), and tp in 54/73 (74.0%). In contrast, in pHCV with significant fat deposition the flow pattern was mp in 37/41 (90.2%), bp in 2/41 (4.9%), and tp in 2/41 (4.9%). In hc the flow pattern was mp in 12/75 (16.0%), bp in 7/75 (9.3%), and tp in 56/75 (74.7%). The normal flow pattern in the right liver vein is triphasic, rarely mono- or biphasic. Fatty infiltration of the liver in patients with chronic hepatitis C is best related to monophasic flow pattern and less related to fibrosis. No strong correlation of the flow pattern with the degree of portal inflammation, necrosis, or cirrhosis was observed.