Echographic Characteristics of the Surface Structures of the Liver in Chronic Forms of Organ Pathology in Children

Abstract

Chronic liver disease (CLD) is characterized by a progressive course, the formation of fibrosis and cirrhosis. Existing echographic criteria for assessing pathological changes fail to allow to determine accurately the severity of fibrosis, and sometimes, cirrhosis. A liver biopsy carries the risk of non-informative biopsies and the development of complications. In this regard, additional diagnostic criteria are needed to judge the state of the liver tissue, in particular, its surface structures, in both cases without liver involvement and CLD patients. Materials and methods. 75 CLD patients were included in the main group and 73 children without liver pathology - in the control group. An ultrasound system of the expert class was used to perform an echographic assessment of the surface structures of the liver: the thickness of the Glisson’s capsule, the presence of its stratification and nodularity, increased subcapsular blood flow, and the shape of the edge of the liver. In order to assess the severity of pathological changes, all patients of the main group underwent an edge biopsy of the liver under laparoscopic control, followed by histological examination of biopsy specimens. The obtained ultrasound data in CLD patients were compared with the results of a morphological study. Fibrosis stages were calculated using the METAVIR scale. Results. The thickness of the liver capsule in patients of the main group was found to be significantly greater than in the control group (p = 0.000). The degree of thickening of the surface structures in CLD patients increases significantly with the age when compared with healthy children. Significant differences were found in the incidence of stratification and heterogeneity of the surface structures of the liver in CLD children. The presence of echographic changes in the liver capsule was detected in 29 out of the 75 patients of the main group. In these patients, rounding of the edge of the liver was often noted - 27 cases and stratification of the surface structures - 26 cases. Changes in the surface structures of the liver were detected primarily in patients with cirrhosis (stage F4). Stratification of the surface structures of the liver was often noted in them, and capsule heterogeneity and asynchronous movement of the capsule and visceral peritoneum were detected in more than half of cases among all echographic changes in CLD children. Conclusion The echographic heterogeneity of the liver capsule and the asynchronous movements of the capsule and visceral peritoneum in CLD children are informative criteria for organ pathology and can be used for diagnosis.