title: Liver microbubble transit time compared with histology and Child-Pugh score in diffuse liver disease: a cross sectional study.
abstract: BACKGROUND
  A previous pilot study showed that early arrival time of a microbubble in a hepatic vein is a sensitive indicator of cirrhosis.
  
  
  OBJECTIVE
  To see if this index can also grade diffuse liver disease.
  
  
  METHODS
  Thirty nine fasted patients with histologically characterised disease were studied prospectively. Nine patients had no evidence of liver fibrosis, 10 had fibrosis without cirrhosis, and 20 had cirrhosis (five Child's A, seven Child's B, and eight Child's C).
  
  
  METHODS
  Bolus injections of a microbubble (Levovist; Schering, Berlin) were given intravenously, followed by a saline flush. Time intensity curves of hepatic vein and carotid artery spectral Doppler signals were analysed. Hepatic vein transit time (HVTT) was calculated as the time after injection at which a sustained signal increase >10% of baseline was seen. Carotid delay time (CDT) was calculated as the difference between carotid and hepatic vein enhancement.
  
  
  RESULTS
  Diagnostic studies were achieved in 38/39 subjects. Both HVTT and CDT became consistently shorter with worsening disease, as follows (means (SD)): HVTT: no fibrosis 44 (25) s, fibrosis 26 (8) s, Child's A 21 (1) s, Child's B 16 (3) s, and Child's C 16 (2) s; CDT: no fibrosis 31 (29) s, fibrosis 14 (6) s, Child's A 8 (1) s, Child's B 4 (4) s, and Child's C 3 (3) s. These differences were highly significant (p<0.001, ANOVA comparison). A HVTT <24 s and a CDT <10 s were 100% sensitive for cirrhosis (20/20 and 18/18, respectively) but not completely specific: 2/8 subjects with fibrosis had CDT values <10 s and 3/9 had HVTT <24 s.
  
  
  CONCLUSIONS
  This minimally invasive test shows promise not only in diagnosing cirrhosis but also in assessing disease severity.
authors.affiliation: Imaging Sciences Department, Clinical Sciences Division, Faculty of Medicine, Imperial College, Hammersmith Hospital Campus, Du Cane Rd, London, UK. m.blomley@imperial.ac.uk
authors.forename: M J K
authors.initials: MJ
authors.lastname: Blomley
authors.forename: A K P
authors.initials: AK
authors.lastname: Lim
authors.forename: C J
authors.initials: CJ
authors.lastname: Harvey
authors.forename: N
authors.initials: N
authors.lastname: Patel
authors.forename: R J
authors.initials: RJ
authors.lastname: Eckersley
authors.forename: R
authors.initials: R
authors.lastname: Basilico
authors.forename: R
authors.initials: R
authors.lastname: Heckemann
authors.forename: A
authors.initials: A
authors.lastname: Urbank
authors.forename: D O
authors.initials: DO
authors.lastname: Cosgrove
authors.forename: S D
authors.initials: SD
authors.lastname: Taylor-Robinson
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003287:Contrast Media / Q000493:pharmacokinetics; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000000981:diagnostic imaging*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D011134:Polysaccharides / Q000493:pharmacokinetics; D011446:Prospective Studies; D018608:Ultrasonography, Doppler
chemical_list: D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508