Non‐invasive prediction of the degree of liver fibrosis in patients with hepatitis C using an ultrasound contrast agent. A pilot study

Abstract

It has been shown that the severity of hepatic fibrosis in patients with hepatitis C can be predicted non-invasively by measuring intrahepatic circulatory time (IHCT) using a microbubble agent with spectral Doppler analysis. The aim of this study was to assess whether this technique is reproducible using a third-generation microbubble agent and contrast harmonic imaging, which are becoming the standard ultrasound techniques in all radiology departments. Twenty-three untreated patients with hepatitis C, who had undergone a recent liver biopsy, were studied prospectively. Based on their histological fibrosis score, patients were divided into four groups (fibrosis levels 1-4). Contrast harmonic imaging was carried out after an intravenous bolus of a microbubble agent (Optison; Amersham Health, Milwaukee, WI, USA). IHCT was calculated by measuring the difference between the hepatic vein and hepatic artery microbubble arrival times. The IHCT was compared with the degree of fibrosis. Significant differences were shown between the groups for IHCT. There were significant differences between fibrosis levels 1 and 3 and between fibrosis levels 1 and 4. This study has shown that calculation of IHCT using a third-generation microbubble agent and contrast harmonic imaging can differentiate mild fibrosis from more severe degrees of fibrosis in patients with hepatitis C.

Liver fibrosis staging with contrast-enhanced ultrasonography: prospective multicenter study compared with METAVIR scoring

“…The method can also be used to assess the severity of hepatic fibrosis in patients with hepatitis C [3,4,9]. Recently, Searle et al [10], using a latestgeneration UCA, demonstrated significant differences between fibrosis stages 1 and 3 and 1 and 4 in measures of the difference between the hepatic vein and hepatic artery UCA arrival times, although their study population was only 23 patients.…”

Assessment of portal venous index as a non-invasive method for diagnosing liver fibrosis in patients with chronic hepatitis C

“…In addition, there are certain contraindications and adverse events. Some have reported mortality rates after liver biopsy at 3 in 10,000 procedures (4,19,22) . Given the importance of assessing liver fibrosis in hepatitis C patients, coupled with the limitations of biopsy, a non-invasive assessment of liver fibrosis based on laboratory tests (19) and imaging (22) needs to be developed.…”

“…Some have reported mortality rates after liver biopsy at 3 in 10,000 procedures (4,19,22) . Given the importance of assessing liver fibrosis in hepatitis C patients, coupled with the limitations of biopsy, a non-invasive assessment of liver fibrosis based on laboratory tests (19) and imaging (22) needs to be developed. Imaging methods such as ultrasound, computerized tomography and magnetic resonance imaging can provide useful information on morphological changes in the diseased liver (21,22) .…”

“…Given the importance of assessing liver fibrosis in hepatitis C patients, coupled with the limitations of biopsy, a non-invasive assessment of liver fibrosis based on laboratory tests (19) and imaging (22) needs to be developed. Imaging methods such as ultrasound, computerized tomography and magnetic resonance imaging can provide useful information on morphological changes in the diseased liver (21,22) . Elastography is a new method that is the most effective at differentiating between cirrhosis and non-cirrhosis and is considered to be a quick and easy, non-invasive procedure for diagnosing cirrhosis.…”

Liver Contrast Enhanced Ultrasound Perfusion Imaging in the Evaluation of Chronic Hepatitis C Fibrosis: Preliminary Results

“…Indeed, CEUS-derived time-acoustic intensity curves reflects the tissue-of-interest hemodynamics by measuring the changes of intensity of the harmonic frequencies versus time (Krix 2005). The majority of the previously published CEUS studies in patients with chronic diffuse liver disease places great emphasis on the hepatic artery-tovein time-acoustic intensity curves (Staub et al 2009;Searle et al 2008;Ridolfi et al 2007;Lim et al 2005;Blomley et al 2003;Albrecht et al 1999;Pedersen et al 2005). However, there are limited data to date on liver CEUS perfusion imaging in patients with diffuse liver disease (Kaneko et al 2005) CEUS-related perfusion parameters include time to enhancement (ET), time to peak intensity (PIT), peak signal intensity (PSI), enhancement duration (ED) and area under the curve (AUC).…”