Liver fibrosis in chronic viral hepatitis: an ultrasonographic study.
OBJECTIVE
To select valuable ultrasonographic predictors for the evaluation of hepatic inflammation and fibrosis degree in chronic hepatitis, and to study the value of ultrasonography in the evaluation of liver fibrosis and compensated liver cirrhosis in comparison with serology and histology.


METHODS
Forty-four ultrasonographic variables were analyzed and screened using color Doppler ultrasound system in 225 patients with chronic viral hepatitis and compensated liver cirrhosis. The valuable ultrasonographic predictors were selected on the basis of a comparison with histopathological findings. The value of ultrasonography and serology in the evaluation of liver fibrosis degree and the diagnosis of compensated liver cirrhosis was also studied and compared. Meanwhile, the influencing factors on ultrasonographic diagnosis of compensated liver cirrhosis were also analyzed.


RESULTS
By statistical analysis, the maximum velocity of portal vein and the degree of gall-bladder wall smoothness were selected as the valuable predictors for the inflammation grade (G), while liver surface, hepatic parenchymal echo pattern, and the wall thickness of gall-bladder were selected as the valuable predictors for the fibrosis stage (S). Three S-related independent ultrasonographyic predictors and three routine serum fibrosis markers (HA, HPCIII and CIV) were used to discriminate variables for the comparison of ultrasonography with serology. The diagnostic accuracy of ultrasonography in moderate fibrosis was higher than that of serology (P<0.01), while there were no significant differences in the general diagnostic accuracy of fibrosis as well as between mild and severe fibrosis (P<0.05). There were no significant differences between ultrasonography and serology in the diagnosis of compensated liver cirrhosis. However, the diagnostic accuracy of ultrasonography was higher in inactive liver cirrhosis and lower in active cirrhosis than that of serology (both P<0.05). False positive and false negative results where found when the diagnosis of compensated liver cirrhosis was made by ultrasonography.


CONCLUSIONS
There are different ultrasonographic predictors for the evaluation of hepatic inflammation grade and fibrosis stage of chronic hepatitis. Both ultrasonography and serology have their own advantages and disadvantages in the evaluation of liver fibrosis and compensated liver cirrhosis. Combined application of the two methods is hopeful to improve the diagnostic accuracy.
Zheng
Rong-Qin
RQ
Department of Ultrasound, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China. zhengrongqin@hotmail.com
Wang
Qing-Hui
QH
Lu
Ming-De
MD
Xie
Shi-Bin
SB
Ren
Jie
J
Su
Zhong-Zhen
ZZ
Cai
Yin-Ke
YK
Yao
Ji-Lu
JL
D000293:Adolescent; D000328:Adult; D015415:Biomarkers; D002648:Child; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D019694:Hepatitis B, Chronic / Q000000981:diagnostic imaging* / Q000473:pathology; D019698:Hepatitis C, Chronic / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D014463:Ultrasonography
D015415:Biomarkers