The use and limitations of ultrasonography in the diagnosis of liver morbidity attributable to Schistosoma mansoni infection in community-based surveys

Abstract

ultrasonography had a limited value in estimating schistosomal liver morbidity in our population-based study where early grades of liver morbidly were prevalent. The criteria of diagnosing grade I portal fibrosis need to be revised as well as the staging system proposed by the Cairo Meeting on ultrasonography in schistosomiasis.

Schistosomiasis mansoni in low transmission areas: abdominal ultrasound

“…Moreover, using this classification it is difficult to establish the differences between periportal thickening grades 0 and I. In consequence, for the diagnosis of early pathology the sensitivity and specificity are lower (Boisier et al 1995, Nooman et al 1995, Thomas et al 1997, Richter 2000. However, these precocious lesions are the most important to be identified because are more prevalent among the population living in endemic areas.…”

Morbidity associated with Schistosoma mansoni infection determined by ultrasound in an endemic area of Brazil, Caatinga do Moura.

“…1,3,14 Since periodic treatment with schistosomicidal drugs has reduced the prevalence of the most severe forms of schistosomiasis, the evaluation of schistosomiasis morbidity by clinical examination is losing its predictive value. 9,[15][16][17] Previous studies demonstrate the usefulness of ultrasonography in determination of schistosomiasis morbidity by comparing the ultrasonographic findings with liver biopsy 18,19 and hemodynamic parameters. 13 The present study shows a direct correlation between the PT1 and portal vein diameter, PT1 and proximal spleen vein diameter, and PT1 and spleen size, validating the ultrasonographic classification of hepatic fibrosis.…”

Schistosoma mansoni infection in a recently exposed community in Senegal: lack of correlation between liver morphology in ultrasound and connective tissue metabolites in serum

“…This difference is probably due to the facts that a different ultrasound machine was used and that the cursor markers for electronic measurements vary between scanners. It has to be noted that generally roughly 50% of grade 0 according to Cairo classification is found in community-based surveys, whether in regions endemic for S. mansoni (Boisier et al 1995;El-Hawey et al 1995) or not (Nooman et al 1995). A significant correlation between the degree of fibrosis according to the Cairo classification and the Managil classification was found, but cases of moderate and severe fibrosis (grade PPF2 and PPF3 according to Managil) were mostly only grade I according to Cairo classification (Table 3).…”

“…This system is based on measurements of the diameters of peripheral portal branches, without clearly defining where to measure the peripheral portal branches and without taking into consideration age or height of the patients. As could be expected, interobserver variation for the distinction of low level periportal fibrosis seems to be rather high (Doehring-Schwerdtfeger et al 1992;Kardorff et al 1996) and suggestions for a modification of the Cairo classification were made (Nooman et al 1995;Boisier et al 1995;Lanuit et al 1996;Kardorff et al 1997;Yazdanpanah et al 1997;Gerspacher-Lara et al 1997).…”