Cerebral pulsatility index by transcranial Doppler sonography predicts the prognosis of patients with fulminant hepatic failure

• Published in: Clinical imaging Vol. 34; no. 5; pp. 327 - 331
• Main Authors: Kawakami, Manri, Koda, Masahiko, Murawaki, Yoshikazu
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2010; Elsevier; Elsevier Limited
• Subjects: Adult; Biological and medical sciences; Cardiovascular system; Cerebral pulsatility index; Cerebrovascular Disorders - diagnostic imaging; Cerebrovascular Disorders - etiology; Fatal Outcome; Female; Fulminant hepatic failure; Gastroenterology. Liver. Pancreas. Abdomen; Hemodynamics; Hepatitis B - complications; Humans; Investigative techniques, diagnostic techniques (general aspects); Liver Failure, Acute - complications; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Longitudinal Studies; Male; Medical sciences; Middle Aged; Middle Cerebral Artery - diagnostic imaging; Other diseases. Semiology; Predictive Value of Tests; Prognosis; Pulsatile Flow; Radiology; Transcranial Doppler sonography; Ultrasonic investigative techniques; Ultrasonography, Doppler, Transcranial - methods; Young Adult; Cerebral pulsatility index; Transcranial Doppler sonography; Fulminant hepatic failure; Doppler ultrasound study; Sonography; Human; Prognosis; Central nervous system; Prediction; Hepatic disease; Fulminant; Encephalon; Transcranial route; Liver failure; Echography; Digestive diseases; Predictive factor
• ISSN: 0899-7071; 1873-4499; 1873-4499
• DOI: 10.1016/j.clinimag.2009.09.006

Cerebral hemodynamic derangement is well known in patients with fulminant hepatic failure. The advent of transcranial Doppler sonography (TCD) enabled noninvasive observation of cerebral hemodynamics. To evaluate its clinical usefulness, we examined longitudinal cerebral hemodynamic parameters in patients with fulminant hepatic failure and severe acute hepatitis. The six subjects were four patients with fulminant hepatic failure, one with severe acute hepatitis and one with severe acute exacerbation on chronic hepatitis. The pulsatility indices of the right middle cerebral artery were used as parameters of cerebral hemodynamics. The pulsatility indices of the two patients with a deteriorating course had elevated to >1.00, whereas those of the two patients undergoing recovery were within normal limits, as well as of the patients with acute hepatitis or acute exacerbation on chronic hepatitis. Cerebral pulsatility measured by TCD may be a real-time and useful tool to assess and monitor patients with fulminant hepatic failure.