High‑frequency skin ultrasound possibilities in terms of diagnosing liver cirrhosis

Abstract

Liver cirrhosis is a serious disease that is accompanied by microcirculatory disorders. High‑frequency ultrasound examination of the skin allows for the detection of changes in its structure and blood supply, which can be used as a non‑invasive method for additional diagnosis of liver cirrhosis. Purpose of the study. To assess the potential of using high‑frequency ultrasound examination of the palm skin in a comprehensive diagnostic algorithm for patients with liver cirrhosis. Patients and methods. The study was conducted involving 216 gastroenterology patients with liver cirrhosis in 2019–2024. The control group included 204 patients without liver cirrhosis, the comparison group included 50 patients without liver cirrhosis and fibrosis. All patients were examined according to a unified diagnostic algorithm consisting of 2 stages – clinical and laboratory, multiparametric ultrasound (including liver parenchyma examination in B‑mode, two‑dimensional shear‑wave elastography, and high‑frequency skin examination using 24 and 48 MHz probes). The following parameters were evaluated: epidermal thickness, dermal thickness, pixel‑ index. Artificial intelligence was used for additional semi‑quantitative assessment of echograms. Results. According to shear wave elastography data, the percentage of color impulses from the vascular bed in patients without liver cirrhosis was 7.4 times higher than in patients with cirrhosis during skin examination with a 24 MHz probe. In patients with‑out liver cirrhosis, the Pixel‑index was higher in most skin layers, suggesting the absence of microcirculatory disturbances. This is especially evident in the layers that include the epidermis, where the average values were higher, and the variability of the results was greater compared to patients with cirrhosis. Patients with liver cirrhosis demonstrated lower and more unstable Pixel‑index values, with greater variability between measurements, especially in the dermis (papillary and reticular layers), which may indicate predominant microcirculatory disorders in this area. Conclusion. High‑frequency ultrasound examination of the skin in the thenar region (region with the most significant differences in qualitative, semi‑quantitative, and quantitative parameters) can be used as a main method in the comprehensive diagnosis of liver cirrhosis, considering the Pixel‑index in the dermal area (papillary and reticular layers) with a probe of 48 MHz or higher, and an additional method with qualitative analysis of the microcirculatory bed using a probe of 24 MHz or higher and artificial intelligence.