Sizing up portal hypertension: Better noninvasive methods are needed

The “congestion index” is used to mean the ratio between the cross-sectional area (cm²) and the blood flow velocity (cm/sec) of the portal vein, as determined by a duplex Doppler system. The indices as determined in normal subjects and patients with liver disease were as follows: normal subjects (n = 85), 0.070 ± 0.029 cm × sec; acute hepatitis (n = 11), 0.071 ± 0.014 cm × sec; chronic active hepatitis (n = 42), 0.119 ± 0.084 cm × sec; cirrhosis (n = 72), 0.171 ± 0.075 cm × sec; and idiopathic portal hypertension (n = 11), 0.180 ± 0.107 cm × sec. There was a statistically significant difference between the congestion indices from the normal subject group and indices obtained from patients with chronic hepatitis, cirrhosis, and idiopathic portal hypertension. A weak positive correlation was obtained between the congestion index and the portal venous pressure, measured simultaneously through a percutaneously placed catheter (n = 64, r = 0.45, p < 0.01). It is suggested that the congestion index reflects the pathophysiological hemodynamics of the portal venous system in portal hypertension.