Résumé
L’échographie Doppler, en permettant une exploration vélocimétrique des structures vasculaires abdominales, devrait trouver sa place dans le bilan de la cirrhose et de l’hypertension portale. L’analyse quantitative des paramètres Doppler s’avère décevante et seule la vitesse circulatoire portale semble présenter un intérêt pronostique. L’analyse qualitative identifie la présence et le sens du flux dans le système porte et recherche d’éventuelles voies de dérivation. Le Doppler dépiste ainsi des anomalies (inversion de flux, thrombus) qui confortent une impression clinique de gravité. Dès que les études des facteurs pronostiques de la cirrhose et les estimations de la perfusion hépatique auront été précisées, le bilan de l’hypertension portale passera probablement par une évaluation Doppler de première intention, du fait du caractère peu coûteux et non invasif de cette méthode.
Summary
Doppler ultrasonography allows an evaluation of blood flow velocity into the main abdominal vessels on patients with liver cirrhosis and portal hypertension. However, numerous pitfalls limit the accuracy of quantitative analysis. From these parameters, portal venous velocity seems to be the only acceptable value for survival prediction. Doppler qualitative analysis allows the determination of presence and direction of portal flow. Furthermore, spontaneous portosystemic shunt, portal vein thrombosis and reversed portal flow can be easily detected. Further studies are still necessary to define the value of Doppler ultrasonography before this non invasive and low cost imaging technique becomes an effective tool for the screening of cirrhosis and portal hypertension.
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Fouque, P., Genin, G., Garcia, P. et al. Echographie doppler couleur dans l’exploration de l’hypertension portale des cirrhoses. Acta Endosc 25, 377–384 (1995). https://doi.org/10.1007/BF02963255
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DOI: https://doi.org/10.1007/BF02963255