Gray and Color Doppler Ultrasonography in differentiation between chronic viral hepatitis and compensated early stage cirrhosis

Abstract

Aim. To assess the value of Gray scale (GS) and Colour Doppler Ultrasonography (CDU) in differentiating the progression of chronic viral hepatitis (CVH) and compensated liver cirrhosis (CIR). Patients and methods. Seventy-two patients and 32 normal individuals used as controls were studied. Forty-four patients suffered from CVH and 28 from CIR. All patients underwent liver biopsy. Multiple qualitative and quantitative variables were studied with GS and CDU in the Liver, Portal Vein (PV), Hepatic Artery (HA) and spleen. On the basis of the obtained Doppler data several known indexes were calculated. Alternative indexes [PV diameter (D)/time average maximum velocity (V-MAX), PV diameter/time average mean velocity (V-TAM), HA/PV V-TAM ratio] derived from them were calculated. Results. ROC analysis showed that PV Congestion Index, PV D/V-TAM and HA/PV V-TAM indexes had the best sensitivity and specificity in discriminating CVH from CIR. Stepwise discriminant analysis selected as significant predictors 3 qualitative and 4 quantitative variables that correctly classify 88.9% of the original grouped cases. In CVH patients that underwent biopsy we found statistically significant changes in those at fibrotic stage 5 compared to fibrotic stages 1-4. Conclusion. We found significant differences in haemodynamic parameters and indexes for CVH patients at fibrosis stage 5 compared to all other stages. Simple GS and CDU parameters may discriminate CVH from CIR. The alternative Doppler indexes suggested that accurate differentiation between CVH and CIR is possible. These indexes could be useful for monitoring CVH and avoiding unnecessary biopsies.