Hepatic transit time of ultrasound contrast in biopsy characterized liver disease

Purpose: To study the hepatic transit time of an ultrasound contrast agent in patients with liver disease, and to evaluate the mechanism(s) of the wellestablished shorter cubital vein to hepatic vein transit time in cirrhosis. Material and Methods: Thirtyfour patients scheduled for Menghini liver biopsy were studied by ultrasound after injection of 2.5g Levovist (Schering, Berlin, Germany) into an arm vein. The time from injection until the first appearance of contrast echoes in the hepatic artery and hepatic veins was registered. Hepatic transit time was the difference between the two. Results: Biopsy showed cirrhosis in 9 patients, other diffuse hepatic pathology in 23 patients, and normal liver in 2 patients. Mean hepatic vein arrival time was earlier in cirrhosis than in other liver disease (19.4s versus 26.0s; P = 0.013), and hepatic transit time was shorter (6.6s versus 11.6s; P = 0.024). A hepatic transit time <10s was found in all patients with cirrhosis, but also in 10 of 23 patients with other liver pathology. Conclusion: Hepatic transit time measurement could not be used to distinguish between cirrhosis and other hepatic pathology, but a transit time = 10s excluded cirrhosis. The earlier hepatic vein arrival time in cirrhosis is apparently mainly caused by intrahepatic shunting rather than by early arrival of contrast to the liver.