Role of Ultrasound in Chronic Liver Disease: Is There Something New?
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- Category: Vol. 85, March 2017
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Role of Ultrasound in Chronic Liver Disease: Is There Something New?, WAFAA M. ABDALLAH, SHERIF F. ABD EL-RAHMAN, REDA S. ABD EL-LATIF and GAMAL ESMAT
Abstract
Background: Ultrasound is a non-invasive, widely used imaging method in the assessment and follow-up of patients with chronic liver disease. New advances in ultrasound such as Real Time Elastography (RTE) have been studied as a recent non-invasive method for liver fibrosis assessment.
Aim of the Study: To determine the diagnostic accuracy of routine clinical ultrasound in the staging of liver fibrosis in chronic viral hepatitis, and assess the possible role of RTE as a new method of quantitative analysis of liver fibrosis.
Methods: This study included sixty patients with Chronic Hepatitis C (CHC) and compensated cirrhosis that underwent liver biopsy. Conventional abdominal ultrasound and RTE were performed to all patients in addition to a group of twenty healthy volunteers. Findings were compared to the pathological liver fibrosis staging.
Results: The sensitivities of three ultrasound features (surface nodularity, liver edge, and parenchymal echotexture), assembled as a grading system, were evaluated as an indicator of the presence of liver fibrosis. Sensitivities were: 63%, 22% and 29.4% for F1, F2 and F3/4 respectively. F3/4 group was further evaluated for another feature (caudate/right lobe ratio) and cirrhosis (F4) was diagnosed with a sensitivity 75%. Conventional ultrasound was able to reach a correct diagnosis in regard to histological fibrosis stage in 44.4% of cases. Meanwhile, RTE highly correlated with the stage of liver fibrosis (r=0.746, p<0.001), with a high diagnostic accuracy for F>3 (AUROC 0.96, sensitivity 94%, and specificity 93%), and for F>!2 (AUROC 0.93, sensitivity 84.6%, and specificity 85.4%), however, it showed a lower accuracy for F³ 1 (AUROC 0.87, sensitivity 83%, and specificity 71.4%).
Conclusion: Conventional US cannot differentiate accu-rately the different fibrosis stages, yet, it can be useful in confirming presence of cirrhosis. RTE can be a new reliable tool for liver fibrosis assessment in patients with CHC, being able to differentiate absence and mild fibrosis from advanced fibrosis and cirrhosis.