title: Screening for significant chronic liver disease by using three simple ultrasound parameters.
abstract: OBJECTIVE
  Chronic liver diseases remain asymptomatic for many years. Consequently, patients are diagnosed belatedly, when cirrhosis is unmasked by lifethreatening complications. We aimed to identify simple ultrasound parameters for the screening of patients with unknown significant chronic liver disease.
  
  
  METHODS
  Three hundred and twenty seven patients with chronic liver disease, liver biopsy, and ultrasound examination were included in the derivation set. 283 consecutive patients referred for ultrasound examination were included in the validation set; those selected according to the ultrasound parameters identified in the derivation set were then referred for specialized consultation including non-invasive fibrosis tests and ultimately liver biopsy if liver fibrosis was suspected.
  
  
  RESULTS
  In the derivation set, three ultrasound parameters were independent predictors of severe fibrosis: liver surface irregularity, spleen length (>110mm), and demodulation of hepatic veins. The association of ≥2 of the three above parameters provided 49.1% sensitivity and 86.9% specificity. In the validation set, at ≥2 of the three parameters were present in 23 (8%) of the patients. Among these patients, 8 had liver fibrosis (F≥1), 5 had significant fibrosis (F≥2) and two cirrhosis.
  
  
  CONCLUSIONS
  The generalized search of three simple ultrasound signs in patients referred for abdominal ultrasound examination may be an easy way to detect those with silent but significant chronic liver disease.
authors.affiliation: Department of Radiology, LUNAM Université, France Université d'Angers, CHU Angers, Angers F-49100, France.
authors.forename: Grégoire
authors.initials: G
authors.lastname: Lignon
authors.affiliation: Department of Hepatology, LUNAM Université, France Université d'Angers, CHU Angers, Angers F-49100, France; Laboratory HIFIH, UPRES 3859, LUNAM Université, France Université d'Angers, CHU Angers, Angers F-49100, France.
authors.forename: Jérome
authors.initials: J
authors.lastname: Boursier
authors.affiliation: Department of Radiology, LUNAM Université, France Université d'Angers, CHU Angers, Angers F-49100, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Delumeau
authors.affiliation: Department of Pathology, LUNAM Université, France Université d'Angers, CHU Angers, Angers F-49100, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Michalak-Provost
authors.affiliation: Department of Radiology, LUNAM Université, France Université d'Angers, CHU Angers, Angers F-49100, France.
authors.forename: Jérome
authors.initials: J
authors.lastname: Lebigot
authors.affiliation: Department of Hepatology, LUNAM Université, France Université d'Angers, CHU Angers, Angers F-49100, France; Laboratory HIFIH, UPRES 3859, LUNAM Université, France Université d'Angers, CHU Angers, Angers F-49100, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Oberti
authors.affiliation: Department of Radiology, LUNAM Université, France Université d'Angers, CHU Angers, Angers F-49100, France; Laboratory HIFIH, UPRES 3859, LUNAM Université, France Université d'Angers, CHU Angers, Angers F-49100, France. Electronic address: ChAube@chu-angers.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Aubé
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D055815:Young Adult
keywords: Cirrhosis; Fibrosis; Liver; Screening; Ultrasound