Non-invasive assessment of fibrosis using color Doppler ultrasound in patients with hepatitis C virus in the Amazon rainforest, Brazil

Measurement of portal vein indices and splenic index by ultrasound and their association with gastroesophageal varices in cirrhosis of liver

Background and Objectives

Esophageal and gastric fundic varices are common in liver cirrhosis patients. Ultrasound with the Doppler study assesses liver cirrhosis severity, measuring portal vein and splenic indices' association with gastroesophageal varices.

Methodology

This study was conducted on 64 subjects with sonographic features of chronic liver disease who were referred for routine follow-up scans. Portal vein diameter, average velocity, splenic index, congestion index (CI), and portal vein area and velocity were measured.

Result

Subjects with gastroesophageal varices had significantly larger portal vein diameters (14.7±1.64 mm) compared to those without varices (12.05±1.26 mm) (P<0.05). Conversely, subjects without varices exhibited a higher portal vein velocity of (17.9±0.6 cm/s) than with varices (13.91±2.01 cm/s) (P=0.0005). The splenic index was higher in subjects with varices (1120±494 cm3) than those without varices (419 cm3) (P<0.05). The CI was also higher in subjects with varices. Portal vein velocity showed the highest sensitivity (94%) with a cutoff of 19 cm/s, while the CI had the highest diagnostic accuracy (93.75%) with a cutoff of 0.10 cm xsec. The splenic index demonstrated a sensitivity of 92.85% and diagnostic accuracy of 92.18% with a cutoff of 480 cm3. The splenic index followed by the CI is found to be a better predictor of esophageal varices (area under the curve of 96.8 and 96%, respectively).

Conclusion

Ultrasonographic assessment of the portal vein and spleen is a reliable, noninvasive method for predicting gastroesophageal varices in liver cirrhosis. The splenic index and CI have high diagnostic accuracy.

Doppler ultrasonography: A non-invasive method used to diagnose and follow up patients with chronic hepatitis C

BACKGROUND AND AIM

This study aimed to investigate the association between the findings of Doppler ultrasonography and transient elastography using FibroScan and to determine the cut-off points, sensitivity, and specificity of resistance indices, and pulsatility of the hepatic vessels to predict significant hepatic fibrosis.

METHODS

This is a transversal, observational, and analytical study that includes 30 patients with chronic hepatitis C who were admitted at a public referral hospital. Transient elastography and ultrasonographic data were collected, and the linear association between these methods was evaluated using the Pearson test. Various Doppler velocimetric indices were compared according to the presence/absence of significant (≥ F2) fibrosis.

RESULTS

There was a moderate-strong linear association between the FibroScan data and the Doppler velocimetric indices and splenic index in the hepatic vessels; the mean values of the indices differed between groups with absent/mild (F0/F1) and significant (≥ F2) hepatic fibrosis. There was an association between the monophasic and biphasic wave pattern of the suprahepatic veins and the stratification of hepatic fibrosis estimated by the values of kilopascal in FibroScan.

CONCLUSION

Doppler ultrasonography is a non-invasive method used to evaluate liver fibrosis, and it presents acceptable sensitivity/specificity for the prediction of fibrosis ≥ F2 in patients with chronic hepatitis C.

Indirect prediction of liver fibrosis by quantitative measurement of spleen stiffness using the FibroScan system

OBJECTIVES

To evaluate quantitative measurement of spleen stiffness for indirect assessment of liver fibrosis in patients with chronic hepatitis B and to correlate spleen stiffness with liver stiffness using pathologic examination as a reference standard.

METHODS

Sixty patients with clinically confirmed chronic hepatitis B (n = 54) and liver cirrhosis (n = 6) were enrolled. Quantitative stiffness measurements (kilopascals) were obtained from spleen and liver parenchyma with the FibroScan system (Echosens, Paris, France). Correlation analyses were performed between spleen and liver stiffness and between spleen stiffness and liver fibrosis stages. The diagnostic performance of spleen stiffness for indirect prediction of liver fibrosis was estimated by receiver operating characteristic curves.

RESULTS

Both spleen and liver stiffness increased as liver fibrosis progressed. Spleen stiffness values had a positive correlation with liver stiffness values in all patients (Pearson r = 0.810; P < .001). The correlation between spleen stiffness and fibrosis stages was statistically significant (Spearman r = 0.833; P < .001). The areas under the receiver operating characteristic curves for spleen stiffness were 0.902 (95% confidence interval [CI], 0.825-0.978) for stage S1 (fibrous portal expansion and limited perisinusoidal or lobular fibrosis) or higher, 0.927 (95% CI, 0.852-1.0) for S2 (periportal fibrosis and few fibrous septa but intact architecture) or higher, 0.962 (95% CI, 0.918-1.0) for S3 (numerous fibrous septa with architectural distortion but no obvious cirrhosis) or higher, and 0.983 (95% CI, 0.957-1.0) for S4 (cirrhosis) (all P < .001). The differences between the areas under the curves for spleen and liver stiffness in liver fibrosis staging were not statistically significant (P = .115-.756).

CONCLUSIONS

Quantitative measurement of spleen stiffness is a feasible and promising technique for estimating liver fibrosis. The overall diagnostic performance of spleen stiffness for liver fibrosis staging is comparable with that of liver stiffness.