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Contrast-Enhanced Doppler Perfusion Index

Clinical and Experimental Evaluation

Departments of Medical Physics (K.V.R.) and Surgery (C.S.M.), University of Edinburgh, Edinburgh, Scotland; and Department of Radiology (E.L.) and University Department of Surgery (K.O., W.J.A.), Royal Infirmary, Glasgow, Scotland.

Address correspondence and reprint requests to Kumar V. Ramnarine, PhD, Department of Medical Physics, Leicester Royal Infirmary, Sandringham Building, Leicester, LE1 5WW, England.

Objective. To assess the potential of the power Doppler signal intensity rate of enhancement due to contrast agent wash-in for assessment of hepatic hemodynamics. Methods. With the use of standardized settings, power Doppler sonography was performed before and after administration of a contrast agent. Video-recorded examinations were digitized for offline analysis on a personal computer. The temporal changes of the power Doppler signal intensity were quantified to provide contrast agent wash-in curves. The contrast-enhanced Doppler perfusion index was defined by the ratio of the wash-in gradient of the hepatic artery and portal vein as contrast-enhanced Doppler perfusion index = hepatic artery gradient/(hepatic artery gradient + portal vein gradient). The contrast-enhanced Doppler perfusion index was evaluated at 4 contrast agent doses in each of 14 patients with liver metastases and 3 patients with hemangiomas. An in vitro flow model was used to determine the relationships between the power Doppler rate of enhancement and flow in vessels of 4, 8, and 12 mm in diameter. Results. In vivo, there was a significantly higher (P < .0001) mean contrast enhanced Doppler perfusion index in patients with liver metastases (mean, 0.59; 95% confidence interval, 0.54–0.63), compared with patients with hemangiomas (mean, 0.33; 95% confidence interval, 0.24–0.41). The corresponding coefficients of variations were 25% for patients with liver metastases and 31% for patients with hemangiomas. In vitro, the power Doppler rate of enhancement was proportional to flow speed and independent of vessel diameter. Conclusions. Measurement of the contrast-enhanced Doppler perfusion index may have potential in assessment of hepatic hemodynamics and focal liver disease.

Key Words: contrast-enhanced Doppler sonography • contrast media • liver neoplasm • power Doppler studies • sonography

Abbreviations: BMF, blood-mimicking fluid • CEDPI, contrast-enhanced Doppler perfusion index • DPI, Doppler perfusion index • HAG, hepatic artery gradient • PDSI, power Doppler signal intensity • PVG, portal vein gradient

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