title: New Doppler ultrasound signs improve the non-invasive diagnosis of cirrhosis or severe liver fibrosis.
abstract: OBJECTIVE
  To determine whether ultrasound and, particularly, new Doppler signs increased the diagnostic accuracy of the most accurate, currently available markers for the diagnosis of cirrhosis or severe fibrosis.
  
  
  METHODS
  Thirty-two clinical (n = 4), biochemical (n = 11) and Doppler ultrasound (n = 17) variables were recorded in 106 patients with compensated chronic liver disease. Diagnostic accuracy was evaluated by discriminant analysis; first, globally, using all variables then by stepwise analysis.
  
  
  RESULTS
  (A) Diagnosis of cirrhosis. Using Doppler ultrasound, diagnostic accuracy was 92% (95% confidence interval 81-98) globally, and 89% (76-95) with three variables (spleen length, hepatic vein spectrum and maximum portal vein velocity). Based upon clinical signs, diagnostic accuracy was 86% (77-92) globally, and 85% (76-91) with one variable (firm liver). Based upon biochemical parameters, diagnostic accuracy was 80% (70-88) globally, and 81% (72-88) with two variables (hyaluronate and platelet count). Based upon all parameters, diagnostic accuracy was 91% (79-96.5) globally, and 91% (79-96.5) with four variables (firm liver, hyaluronate, platelet and hepatic vein spectrum). On an intention to diagnose basis, Doppler ultrasound provided a lower independent contribution due to missing data. (B) In the diagnosis of severe fibrosis, diagnostic accuracy was 83% (69-92) globally, and 77% (62-87) with one variable.
  
  
  CONCLUSIONS
  Cirrhosis can be correctly diagnosed in approximately 90% of patients with compensated chronic liver disease using a few Doppler ultrasound signs including a new sign, the hepatic vein spectrum. Doppler ultrasound could be used for the first line diagnosis and biochemical markers, such as hyaluronate, in patients with missing Doppler ultrasound data.
authors.affiliation: Département de Radiologie, Laboratoire HIFIH (UPRES), Service d'Hépato-Gastroentérologie, and Laboratoire d'Anatomie-Pathologique, CHU et Université, Angers, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Aubé
authors.forename: Betsy
authors.initials: B
authors.lastname: Winkfield
authors.forename: Frédéric
authors.initials: F
authors.lastname: Oberti
authors.forename: Eric
authors.initials: E
authors.lastname: Vuillemin
authors.forename: Marie C
authors.initials: MC
authors.lastname: Rousselet
authors.forename: Christine
authors.initials: C
authors.lastname: Caron
authors.forename: Paul
authors.initials: P
authors.lastname: Calès
mesh_terms: D000328:Adult; D005260:Female; D005355:Fibrosis; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler