DOPPLER ULTRASOUND OF HEPATIC HAEMODYNAMICS FOR NON-INVASIVE EVALUATION OF LIVER FIBROSIS
Noura Abd el Hafeez Ahmed Ali;
Abstract
Liver fibrosis is a major health problem. It is a common pathway for several liver injuries e.g. viral, autoimmune, hereditary, metabolic and toxin-mediated liver diseases.
An accurate and objective assessment of hepatic fibrosis is essential to provide clinically useful information for the monitoring of chronic hepatitis C progression and therapy. Staging liver fibrosis in patients with chronic liver disease (CLD) is essential for patients management as it allows: to identify the severity of liver damage in order to decide whether or not to start treatment (chronic viral liver disease) to avoid progression to cirrhosis when fibrosis becomes significant (≥ F2); to assess progression or regression of liver fibrosis during treatment; to institute specific monitoring to screen for and treat complications (HCC, esophageal varices) in patients suffering from cirrhosis and even severe fibrosis (≥ F3).
Liver biopsy is still the gold standard for staging liver fibrosis; however, it has some well-documented drawbacks. Based on the abundant literature, alternative non-invasive methods can now be used instead of liver biopsy to assess liver disease severity. Liver stiffness measurement can be used. Well established panels of biomarkers of fibrosis can also be applied. Both liver stiffness measurement and biomarkers perform well in identification of no fibrosis or cirrhosis but they perform less well in resolving intermediate degrees of fibrosis. The combination of blood biomarkers or the combination of liver stiffness measurement and a blood test (diagnostic algorithms) improves accuracy and reduce the need for liver biopsy.
Ultrasound has been used for many years for the workup of patients with chronic liver disease because of its ease of use and wide availability. Recent technological advances have allowed liver fibrosis staging.
Doppler ultrasound of the liver is a non-invasive, operator dependent, technique which may provide relevant information in the study of blood flow pattern in liver vessels and effect of liver diseases on this pattern. Normal and abnormal waveforms for each of the major hepatic vessels (hepatic artery, hepatic vein, portal vein) have been well-described.
The value of Doppler parameters as non-invasive predictors for the stage of liver fibrosis was assessed in this study.
The present study was performed on 55 patients with chronic liver disease who were subjected to full history taking, thorough clinical examination, routine laboratory investigations, liver function tests, abdominal ultrasound and Duplex Doppler ultrasound of hepatic vessels.
Patients were divided according to presence or absence of cirrhosis into 2 groups:
Group 1: 32 patients with chronic hepatitis without cirrhosis and undergone percutaneous liver biopsy. Subsequent analysis of fibrosis stage according to METAVIR scoring system revealed that they were F0 (1 patient: 1.8%), F1 (19 patients: 34.6%), F2 (8 patients: 14.5%), F3 (4 patients: 7.3%).
Group 2: 23 patients diagnosed with established cirrhosis (Child-Pugh class A). They were F4.
On analyzing laboratory data, patients with established cirrhosis; group (2); had lower serum albumin, lower liver enzymes, higher bilirubin, lower platelet count, higher INR than patient in group (1) with a significant difference between the 2 studied groups.
The ability of hepatic vein waveform to predict cirrhosis (F4) and significant fibrosis (F ≥2) was evaluated in this study and revealed that HV waveform was the most accurate measured parameter for predicting significant fibrosis and cirrhosis. It showed the highest degree of agreement with METAVIR score. There was also a highly significant relation between HV waveform and albumin, bilirubin, platelet count, INR.
There was a significant increase in HARI parallel to the increase in METAVIR score. SARI did not significantly increase with the advance in liver fibrosis METAVIR score. Accordingly, HARI was proved to be more specific and sensitive than SARI to predict cirrhosis (F4). However, both HARI and SARI were not predictive of significant fibrosis (F ≥ 2).
An accurate and objective assessment of hepatic fibrosis is essential to provide clinically useful information for the monitoring of chronic hepatitis C progression and therapy. Staging liver fibrosis in patients with chronic liver disease (CLD) is essential for patients management as it allows: to identify the severity of liver damage in order to decide whether or not to start treatment (chronic viral liver disease) to avoid progression to cirrhosis when fibrosis becomes significant (≥ F2); to assess progression or regression of liver fibrosis during treatment; to institute specific monitoring to screen for and treat complications (HCC, esophageal varices) in patients suffering from cirrhosis and even severe fibrosis (≥ F3).
Liver biopsy is still the gold standard for staging liver fibrosis; however, it has some well-documented drawbacks. Based on the abundant literature, alternative non-invasive methods can now be used instead of liver biopsy to assess liver disease severity. Liver stiffness measurement can be used. Well established panels of biomarkers of fibrosis can also be applied. Both liver stiffness measurement and biomarkers perform well in identification of no fibrosis or cirrhosis but they perform less well in resolving intermediate degrees of fibrosis. The combination of blood biomarkers or the combination of liver stiffness measurement and a blood test (diagnostic algorithms) improves accuracy and reduce the need for liver biopsy.
Ultrasound has been used for many years for the workup of patients with chronic liver disease because of its ease of use and wide availability. Recent technological advances have allowed liver fibrosis staging.
Doppler ultrasound of the liver is a non-invasive, operator dependent, technique which may provide relevant information in the study of blood flow pattern in liver vessels and effect of liver diseases on this pattern. Normal and abnormal waveforms for each of the major hepatic vessels (hepatic artery, hepatic vein, portal vein) have been well-described.
The value of Doppler parameters as non-invasive predictors for the stage of liver fibrosis was assessed in this study.
The present study was performed on 55 patients with chronic liver disease who were subjected to full history taking, thorough clinical examination, routine laboratory investigations, liver function tests, abdominal ultrasound and Duplex Doppler ultrasound of hepatic vessels.
Patients were divided according to presence or absence of cirrhosis into 2 groups:
Group 1: 32 patients with chronic hepatitis without cirrhosis and undergone percutaneous liver biopsy. Subsequent analysis of fibrosis stage according to METAVIR scoring system revealed that they were F0 (1 patient: 1.8%), F1 (19 patients: 34.6%), F2 (8 patients: 14.5%), F3 (4 patients: 7.3%).
Group 2: 23 patients diagnosed with established cirrhosis (Child-Pugh class A). They were F4.
On analyzing laboratory data, patients with established cirrhosis; group (2); had lower serum albumin, lower liver enzymes, higher bilirubin, lower platelet count, higher INR than patient in group (1) with a significant difference between the 2 studied groups.
The ability of hepatic vein waveform to predict cirrhosis (F4) and significant fibrosis (F ≥2) was evaluated in this study and revealed that HV waveform was the most accurate measured parameter for predicting significant fibrosis and cirrhosis. It showed the highest degree of agreement with METAVIR score. There was also a highly significant relation between HV waveform and albumin, bilirubin, platelet count, INR.
There was a significant increase in HARI parallel to the increase in METAVIR score. SARI did not significantly increase with the advance in liver fibrosis METAVIR score. Accordingly, HARI was proved to be more specific and sensitive than SARI to predict cirrhosis (F4). However, both HARI and SARI were not predictive of significant fibrosis (F ≥ 2).
Other data
| Title | DOPPLER ULTRASOUND OF HEPATIC HAEMODYNAMICS FOR NON-INVASIVE EVALUATION OF LIVER FIBROSIS | Other Titles | أشعةالدوبلرعلى الديناميكية الدموية الكبدية للتقييم الغير- اختراقى لتليف الكبد | Authors | Noura Abd el Hafeez Ahmed Ali | Issue Date | 2015 |
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