A Novel Splenic Vein Flow Volume to the Portal Vein Flow Velocity Index as a Predictor for the Degree of Esophageal Varices in Liver Cirrhosis Patients

Abstract

Bleeding esophageal varices (EV) have the highest mortality rate from all complications of liver cirrhosis (LC). Several Doppler ultrasound (DUS) studies have been done on the splenic or portal vein (PV) to evaluate the hemodynamic of the esophageal vein. Our study focused on finding a better index using the ratio from two parameters correlated with EV, splenic vein flow volume (SFV), and PV flow velocity. In this study, 28 patients with LC were evaluated using DUS to compare the SFV to PV flow velocity/speed (Sv/Ps) index and other measured DUS parameters with the EV degree. Afterward, the receiver operating characteristic (ROC) curve analysis was performed on statistically significant DUS parameters. Mean Sv/Ps index value in the group of nonvarices was 9.89 ± 3.56; 19.50 ± 5.56 in the small esophageal varices (SEV) and 74.12 ± 29.37 in the large esophageal varices (LEV) group with p < 0.001. ROC curve analysis generated an optimal cutoff point of 16.5 (90% sensitivity and 100% specificity) to predict the presence of EV and the cutoff point of 46.7 (100% sensitivity and specificity) to predict the presence of LEV. In conclusion, the Sv/Ps index measured using DUS can be used as a noninvasive method to predict the presence of EV, especially in predicting LEV.

Keywords: Doppler ultrasound; Esophageal varices; Liver cirrhosis; Portal vein flow velocity; Splenic vein flow volume; Splenoportal ratio.

Fig. 1

Representative images from patients with the Sv/Ps index of 67.03 (top) and 11.77 (bottom). On endoscopy, it was revealed that the former had LEV, and the latter had no varices. From left to right are PV flow velocity, splenic vein diameter, and splenic vein flow velocity measurements as the components to calculate Sv/Ps index.