Hepatic involvement in Osler-Weber-Rendu disease: findings on pulsed and color Doppler sonography
The purpose of this study was to compare the hemodynamics of the liver vasculature as determined by Doppler sonography for patients with Osler-Weber-Rendu disease and for healthy subjects. Real-time color Doppler sonography and pulsed Doppler sonography were used to study 10 patients with Osler-Weber-Rendu disease and 25 healthy subjects. Vessel diameter and flow velocity in the hepatic artery and its branches as well as in the portal vein and its segmental branches were determined. Flow patterns in the hepatic veins were analyzed. The clinical manifestations of the disease were correlated with the Doppler sonographic findings. The hepatic artery and its branches were dilated and tortuous, and flow velocity was greater in patients than in healthy subjects; hepatic artery velocities (mean +/- SD) were 153 +/- 65.2 cm/sec versus 64.9 +/- 11.4 cm/sec (p < .005). The resistive index measured in the hepatic artery did not differ significantly between the two groups (p was not significant). No intrahepatic arteriovenous shunt sites were detected by color Doppler sonography. However, arterioportal shunts were observed in two patients, one of whom also had a portovenous shunt. A portovenous shunt and multiple shunts between hepatic veins were found in another patient. Portal venous flow was similar in both groups. No relationship between Doppler sonographic changes and clinical manifestations was found. The multiple microscopic arteriovenous shunts found in Osler-Weber-Rendu disease were not detected in our patients but resulted in dilatation and increased flow velocity in the hepatic artery. Flow velocity in the portal vein appeared to be undisturbed. Large intrahepatic shunts were easily outlined by Doppler sonography.