Hepatic Doppler Protocol

Vessel/ Scan Label Landmarks Image Stored

Structure Plane
Sagittal MPV Porta Gray scale of the portal vein at the porta
hepatis of hepatis (if enlarged, include AP diameter
liver measurement)
Main
Main portal Color Doppler of the portal vein at the
Portal
vein porta hepatis
Vein
Color and spectral Doppler with PSV
measurement of the portal vein at the
porta hepatis
Right Sagittal RPV Mid Rt lobe Color Doppler of right portal vein
Portal of liver
Vein Color and spectral Doppler with PSV of
Rt portal right portal vein
vein
Left Sagittal LPV Mid Lt lobe Color Doppler of left portal vein
Portal of liver
Vein Color and Spectral Doppler with PSV of
Lt portal left portal vein
vein
Sagittal HEPATIC Liver at Color Doppler of the hepatic artery at the
Hepatic ARTERY porta porta hepatis
Artery hepatis Color and spectral Doppler with PSV and
Hepatic EDV of the hepatic artery at the porta
Artery hepatis
Transver FALCIFO Pancreas Gray scale image of the falciform
se RM head ligament
Falciform LIGAMEN Color image of the falciform ligament
LT lobe of
Ligament T Color and spectral Doppler if flow is
liver
in Liver present within the ligament
Falciform
ligament
Sagittal RHV Rt lobe of Gray scale of right hepatic vein
Right liver
Color Doppler of the right hepatic vein
Hepatic Rt hepatic
Vein vein Color and spectral Doppler of the right
hepatic vein
Sagittal MHV Liver Gray scale of middle hepatic vein
Middle Color Doppler of the middle hepatic vein
Middle hepatic vein
Hepatic Color and spectral Doppler of the middle
Vein hepatic vein
Sagittal LHV Lt lobe of Gray scale of left hepatic vein
liver
Left Color Doppler of the left hepatic vein
Lt hepatic
Hepatic vein Color and spectral Doppler of the left
Vein hepatic vein
Sagittal IVC IVC Gray scale of the intrahepatic IVC

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 Hepatic Doppler Protocol

IVC Liver Color Doppler of the intrahepatic IVC

Color and spectral Doppler of the
intrahepatic IVC
Sagittal SPLENIC Pancreas tail Color Doppler of Splenic vein at the tail of
VEIN Splenic vein the pancreas
Color and spectral Doppler at the tail of
Splenic the pancreas
Vein Splenic Color Doppler of the Splenic vein at the
hilum hilum of the spleen
Splenic vein Color and spectral Doppler of the Splenic
vein at the hilum of the spleen

Tips
You must always evaluate the entire organ first before you store an image
You should understand completely why you stored the image and identify
everything in the image
Have the patient take in a deep breath and hold it. This may bring the liver
subcostal (below the ribs) allowing you to have a better acoustic window to
evaluate the liver vasculature
If a velocity measurement is obtained (such as in portal veins and hepatic
artery), you should use angle-correct. If a velocity measurement is not
obtained (such as in splenic and hepatic veins), it is not necessary to use
angle correct.
Exam will depend on physicians order and patients symptoms. The 3 more
common exams include :
o Hepatic Doppler for cirrhosis includes all images listed in protocol
o Hepatic Doppler for Budd Chiari includes all images of hepatic veins
& portal vein
o Hepatic Doppler for TIPS (Transjugular intrahepatic portosystemic
shunts) includes all images listed in protocol and the following
additional images:

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 Hepatic Doppler Protocol

Structure Scan Label Landmarks Image Stored

Plane
Sagittal TIPS Liver Gray scale of the entire TIPS
TIPS
TIPS Liver Color Doppler of the entire TIPS
TIPS
TIPS AT RT Liver Gray scale of the TIPS at the level of
HV Rt HV the right hepatic vein
TIPS
TIPS AT RT Liver Color and spectral Doppler with PSV
Liver with HV measurement of the TIPS at the level
Rt HV
TIPS of the right hepatic vein
TIPS
TIPS MID Liver Color and spectral Doppler with PSV
Mid TIPS measurement of the Mid TIPS
TIPS AT Liver Gray scale of the TIPS at the level of
PORTAL Portal Vein the portal vein
VEIN TIPS
TIPS AT Liver Color and spectral Doppler with PSV
PORTAL Portal Vein measurement of the TIPS at the level
VEIN TIPS of the portal vein

Color & Spectral Doppler image of Portal Vein

o Flow should be towards the liver (hepatopetal)
o Slight phasic appearance on spectral analysis
o Average flow velocity is 20-40 cm/sec and AP measurement of the
vessel should be <13mm
o BE VERY CAUTIOUS inverting when performing any type of abdominal
study

Color & Spectral Doppler image of Hepatic Veins

o Flow should be away from the liver (hepatofugal) into the IVC
o Very chaotic flow on spectral analysis

Color & Spectral Doppler image of TIPS

o Flow should be towards the liver (hepatopetal) through the TIPS and
into the right hepatic vein at the level of the IVC
o Must use angle correct
o Angle correct must be less than 60 degrees
o Gate (SV length) must be in center of vessel & small width
o Adjust your PRF (scale) to display a large waveform that has a clear
spectral window and measure the highest velocity
o Set the PRF(scale) appropriately for the velocities imaged. If the PRF is
set too high with velocities well below the maximum, this may result in
the automatic velocity detection selecting a mirror image waveform
rather than the true waveform-avoid this by reducing your PRF.
o Normal flow velocities are > 100cm/sec

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o Compare all flows to any previous studies

o Patency and direction of flow must be documented in all vessels
o In the main portal vein, if there is an increase of flow 33% greater than
the previous study, then suspect a stenosis

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