Document Detail


Liver involvement in a large cohort of patients with hereditary hemorrhagic telangiectasia: echo-color-Doppler vs multislice computed tomography study.
MedLine Citation:
PMID:  18321607     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND/AIMS: Hepatic arterio-venous malformations (HAVMs) have been found in 74% of hereditary hemorrhagic telangiectasia (HHT) patients with multislice CT (MSCT). This single-blind study aimed to compare the diagnostic accuracy of echo-color-Doppler with MSCT and identify the most sensitive ultrasound criteria indicating hepatic shunts. METHODS: One hundred and fifty-three HHT patients were systematically screened for HAVMs by biological tests, abdominal MSCT and echo-color-Doppler. Twenty-five normal subjects and 15 cirrhotic patients were also included as control groups. Both intrahepatic ("color spots" and hypervascularization) and extrahepatic parameters (diameter, flow velocity and tortuosity of hepatic artery and diameter and flow velocity of portal/hepatic vein) were utilized. "Color-spots" are defined as subcapsular vascular spots with a high-velocity arterial blood flow and low resistivity index and can identify extremely small HAVMs. RESULTS: CT was positive in 128/153 (84%) patients and Doppler color spots were found in 131/153 (86%) patients. The sensitivity, specificity and diagnostic accuracy of "color spots" compared to MSCT were 95.3%, 68.0% and 91.8%, respectively. The "color-spot" showed a greater correlation to CT (V(index)=0.655; p<0.0001) than extrahepatic criteria (V=0.317). In 20/29 (69%) subjects, echo-color-Doppler, confirmed by CT, identified the third criterion for definite HHT diagnosis. CONCLUSIONS: Intrahepatic criteria was superior to extrahepatic criteria for identification of HAVMs. A new Doppler parameter ("color-spots") with an optimal accuracy for detecting HAVMs is proposed for easy periodic screening of HHT patients.
Authors:
Paolo Buonamico; Patrizia Suppressa; Gennaro M Lenato; Giovanna Pasculli; Francesco D'Ovidio; Maurizio Memeo; Arnaldo Scardapane; Carlo Sabbà
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-02-14
Journal Detail:
Title:  Journal of hepatology     Volume:  48     ISSN:  0168-8278     ISO Abbreviation:  J. Hepatol.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-03-27     Completed Date:  2008-08-12     Revised Date:  2009-01-13    
Medline Journal Info:
Nlm Unique ID:  8503886     Medline TA:  J Hepatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  811-20     Citation Subset:  IM    
Affiliation:
Unit of Internal Medicine, Department of Internal Medicine and Public Health, Interdepartmental HHT Centre, University of Bari-Policlinico, Piazza Giulio Cesare 11, Bari, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Arteriovenous Malformations / diagnosis*,  radiography,  ultrasonography
Cohort Studies
Female
Hepatic Artery / abnormalities*
Hepatic Veins / abnormalities*
Humans
Male
Middle Aged
Telangiectasia, Hereditary Hemorrhagic / diagnosis*,  radiography,  ultrasonography
Tomography, X-Ray Computed
Ultrasonography, Doppler, Color
Comments/Corrections
Comment In:
J Hepatol. 2008 Oct;49(4):658-9; author reply 659-61   [PMID:  18674842 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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