Noninvasive diagnosis of hepatic fibrosis in patients with chronic hepatitis C by splenic Doppler impedance index.
OBJECTIVE
The value of Doppler ultrasonography to evaluate the severity of hepatic fibrosis in patients with chronic hepatitis C (CHC) remains controversial.


METHODS
Consecutive histologically proven patients with CHC over a 4-year period were divided into training (n = 335) and validation (n = 168) sets. Hepatic Doppler impedance index, splenic Doppler impedance index, and mean portal vein velocity were evaluated for all patients before liver biopsies. Multivariate logistic regression was performed to find the independent factors to predict patients with significant fibrosis (>/=F2) and cirrhosis (F4) in the training set. Receiver operating characteristic curves were constructed for these factors to evaluate the diagnostic accuracy of significant hepatic fibrosis and cirrhosis in the training set, and in the validation set to evaluate the reproducibility.


RESULTS
Multivariate logistic regression revealed that the splenic arterial pulsatility index (SAPI) and the mean portal vein velocity were predictive of significant fibrosis (>/=F2) and cirrhosis (F4). Receiver operating characteristic analysis showed the areas under the curves of regression models and SAPI were comparable in predicting significant fibrosis (0.88 vs 0.87, P = .22) and cirrhosis (0.92 vs 0.90, P = .12) in the training set. Areas under the curves of SAPI were 0.89 and 0.92 in predicting significant hepatic fibrosis and cirrhosis in the validation set. By choosing optimized cut-off levels, 54% and 76% of the patients with significant hepatic fibrosis and cirrhosis could be predicted correctly.


CONCLUSIONS
SAPI is accurate and reproducible for assessing the severity of hepatic fibrosis in patients with CHC. Applying this simple Doppler index can decrease the need for staging liver biopsy.
Liu
Chen-Hua
CH
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Hsu
Shih-Jer
SJ
Lin
Jou-Wei
JW
Hwang
Juey-Jen
JJ
Liu
Chun-Jen
CJ
Yang
Pei-Ming
PM
Lai
Ming-Yang
MY
Chen
Pei-Jer
PJ
Chen
Jun-Herng
JH
Kao
Jia-Horng
JH
Chen
Ding-Shinn
DS
D001706:Biopsy; D001783:Blood Flow Velocity; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008099:Liver / Q000473:pathology / Q000601:surgery; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D013157:Splenic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*; D014655:Vascular Resistance / Q000502:physiology*