title: Noninvasive diagnosis of hepatic fibrosis in patients with chronic hepatitis C by splenic Doppler impedance index.
abstract: 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.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chen-Hua
authors.initials: CH
authors.lastname: Liu
authors.forename: Shih-Jer
authors.initials: SJ
authors.lastname: Hsu
authors.forename: Jou-Wei
authors.initials: JW
authors.lastname: Lin
authors.forename: Juey-Jen
authors.initials: JJ
authors.lastname: Hwang
authors.forename: Chun-Jen
authors.initials: CJ
authors.lastname: Liu
authors.forename: Pei-Ming
authors.initials: PM
authors.lastname: Yang
authors.forename: Ming-Yang
authors.initials: MY
authors.lastname: Lai
authors.forename: Pei-Jer
authors.initials: PJ
authors.lastname: Chen
authors.forename: Jun-Herng
authors.initials: JH
authors.lastname: Chen
authors.forename: Jia-Horng
authors.initials: JH
authors.lastname: Kao
authors.forename: Ding-Shinn
authors.initials: DS
authors.lastname: Chen
mesh_terms: 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*