Correlation between ultrasonographic and pathologic diagnosis of liver fibrosis due to chronic virus hepatitis

Abstract

INTRODUCTIONChronic hepatitis virus B or C infection results in damage to hepatocytes and may eventually lead to liver fibrosis, cirrhosis and/or hepatocellular carcinoma [1][2][3] . The diagnosis of liver fibrosis and cirrhosis in patients with chronic virus hepatitis is of therapeutic and prognostic importance.Although histologic examination of percutaneous biopsy specimens is the gold criterion for the severity of fibrosis and cirrhosis, biopsy is invasive and cannot be used repeatedly in follow-up. Moreover, liver biopsy can yield false negative results in nearly 20-30% of cases [4][5][6][7] . Therefore, it is important to use noninvasive methods in differentiation between liver fibrosis and cirrhosis.Ultrasonography (US) is a noninvasive and inexpensive procedure for diagnosis of focal and diffuse parenchymal disease of liver. Although US cannot detect minute changes, it can show liver cirrhosis in patients with decompensated liver function [8][9][10][11] . However, correlation between US and histologic diagnosis has not been fully investigated in large series of patients. We conducted a prospective study to evaluate the validity of US for diagnosis of liver fibrosis in patients with chronic liver hepatitis without clinical or biochemical evidence of cirrhosis. Abstract AIM: To evaluate the validity of ultrasonographic and pathologic diagnosis of liver fibrosis in patients with chronic viral hepatitis. MATERIALS AND METHODS Patients METHODS:The liver fibrosis status in 324 patients was evaluated by both needle biopsy and ultrasonography. Liver fibrosis was divided into S0 -S4 stages. S4 stage was designated as definite cirrhosis. The ultrasonographic examination included qualitative variables, description of liver surface and parenchyma, and quantitative parameters, such as diameter of vessels, blood flow velocity and spleen size.

Ultrasonography in differentiation between chronic viral hepatitis and compensated early stage cirrhosis

“…In our study, the portal vein diameter (D) was significantly enlarged at end-stage fibrosis patients, which is consistent with the reported data [31] . Walsh et al [29] found that hepatic artery blood flow (BF) and DPI are increased in CVH C patients at different fibrosis stages, while portal vein CI values remain unchanged.…”

“…In our study, spleen volume was increased in CVH and cirrhotic patients compared with the controls, which is consistent with the findings in other studies [19,20,22,[24][25][26][28][29][30][31]38] . It is well known that a relative interobser ver variability may limit the value for gray scale and Doppler ultrasonography [33][34][35][36] .…”

“…The second major finding is that there were differences in anatomic, haemodynamic parameters and indexes www.wjgnet.com infiltration and fibrosis, have produced conflicting results [31,45] , probably related to the different US criteria employed in the studies, such as distribution of the parenchymal echoes and attenuation of the ultrasonic beam. In our study, liver parenchymal changes were simply described and classified by yes or no (1 or 0).…”

“…However, the use of biopsy in clinical practice has some limitations related to sample errors with an estimated false negative percentage of 24% morbidity and mortality in series of blind biopsies [6] and complications [7] . The non-invasive assessment of chronic liver disease has been attempted by various research groups using either clinical signs [8,9] , gray scale [10][11][12][13][14][15] and colour Doppler ultrasound (CDU) signs and indexes [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] , or biochemical parameters in the blood [9] . The use of CDU in diagnosis and staging of chronic viral liver disease has been based on the hypothesis that alteration in liver haemodynamics due to chronic inflammatory changes may indirectly reflect histological alterations.…”

Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update

“…US can identify diffuse parenchymal disease, but cannot reliably distinguish fat from fibrosis. Some investigators rely on a single US parameter to detect early cirrhosis (Table 11) [91], while the others try to test single or combined US parameters to distinguish each stage of significant fibrosis (F2-F4; Table 12) [92]. The use of conventional US to distinguish fibrosis stages remains problematic.…”