Abstract:
HTML
Purpose: Many authors have claimed Doppler ultrasound (US) indices are of value in grading and assessing diffuse liver disease however there is much controversy regarding the reliability and reproducibility of these techniques. We have performed a prospective study to evaluate whether these methods can grade disease in a well stratified cohort of patients with hepatitis C virus (HCV)-related liver disease.
Methods and Materials: 65 patients with biopsy proven HCV-related liver disease were recruited and Doppler ultrasound was performed by one operator (NP) on a Sequoia (Siemens, Acuson) machine. They were classified based on the Ishak histological fibrosis (F) and necroinflammatory(NI) scores as: mild hepatitis (F £ 2 and NI £ 3), moderate/severe hepatitis (3 £ F < 6 or NI ³ 4) or cirrhosis (F = 6/6). We calculated the following Doppler indices: main hepatic artery velocity (Vmax) and resistive index (RI), main portal vein velocity (Vmax), maximal portal vein diameter and circumference and Portal vein congestive index (portal vein area/portal vein velocity). The ratio of the hepatic artery velocity (Vmax) to the portal vein velocity (Vmax) was also calculated and the phasicity (triphasic, biphasic or monophasic) of the hepatic veins of each patient were recorded. Two other indices were also measured which included maximal spleen length longitudinally and the ratio of the caudate lobe to left lobe of liver in longitudinal section.
Results: There were 20 patients with mild hepatitis, 25 with moderate/severe hepatitis and 20 with cirrhosis. Optimal hepatic arterial traces were only obtained in 30 patients and portal vein circumference in 18 patients. No significant differences were observed in the Doppler indices with increasing severity of liver disease. 5/17 (29%) patients with mild hepatitis had an abnormal hepatic vein trace (i.e. biphasic or monophasic) in comparison with 11/20 (55%) patients with moderate/severe hepatitis and 12/20 (60%) of patients with cirrhosis. There was a significant difference amongst the groups in splenic length measurement (ANOVA p=0.01), but there was no clear separation.
Conclusion: The ultrasound Doppler-derived indices which have previously been reported able to assess severity in chronic liver disease, are difficult to reproduce reliably. Doppler ultrasonography is not a reliable marker of cirrhosis and cannot assess the severity of fibrosis or inflammation in viral related chronic liver disease.
Questions about this event email: a.lim@ic.ac.uk
Cosgrove MBBCh, MSc, D,
Can Doppler Ultrasound-derived Indices Assess the Severity of Chronic Liver Disease? A Prospective Study with Histologic Correlation. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3103166.html
