title: Contrast-enhanced ultrasonography could be a non-invasive method for differentiating none or mild from severe fibrosis in patients with biopsy proven non-alcoholic fatty liver disease.
abstract: OBJECTIVE
  The gold standard for diagnosing fibrosis stage in non-alcoholic fatty liver disease (NAFLD) is liver biopsy. The aim of this study was to determine whether contrast-enhanced ultrasonography (CEUS) with transit time measurements could be a non-invasive alternative for differentiating none or mild from severe fibrosis in NAFLD patients. Various serum markers and clinical variables were also evaluated.
  
  
  METHODS
  Fifty-eight patients with NAFLD underwent CEUS prior to liver biopsy. All patients were also evaluated according to the Göteborg University Cirrhosis Index (GUCI), the AST-Platelet Ratio Index (APRI), the NAFLD fibrosis score, and the FIB-4 and BARD score.
  
  
  RESULTS
  The hepatic vein arrival time (HV) was shorter in patients with severe fibrosis (25.9 ± 4.8 vs 29.5 ± 4.7 s, p = 0.023), and the difference between the hepatic and portal vein (ΔHV-PV) was shorter (2.3 ± 2.8 vs 6.4 ± 2.8 s, p < 0.0001) while the difference in arrival time between the portal vein and hepatic artery (ΔPV-HA) arrival time was significantly longer (6.0 ± 2.2 vs 3.6 ± 1.6 s, p < 0.0001). The area under receiver operating characteristics curve values for HV, ΔHV-PV and ΔPV-HA to separate none or mild from severe fibrosis was 0.71, 0.83 and 0.84, respectively. The corresponding figures for GUCI, APRI, NAFLD fibrosis score, FIB-4 and BARD score were 0.93, 0.92, 0.86, 0.90 and 0.77, respectively.
  
  
  CONCLUSIONS
  CEUS and non-invasive scoring systems could exclude severe fibrosis in NAFLD patients.
authors.affiliation: a The Faculty of Medicine and Health Sciences, Department of Medical and Health Sciences (IMH) , Linköping University , Linköping , Sweden.
authors.forename: Patrik
authors.initials: P
authors.lastname: Nasr
authors.affiliation: a The Faculty of Medicine and Health Sciences, Department of Medical and Health Sciences (IMH) , Linköping University , Linköping , Sweden.
authors.forename: Annette
authors.initials: A
authors.lastname: Hilliges
authors.affiliation: a The Faculty of Medicine and Health Sciences, Department of Medical and Health Sciences (IMH) , Linköping University , Linköping , Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Thorelius
authors.affiliation: a The Faculty of Medicine and Health Sciences, Department of Medical and Health Sciences (IMH) , Linköping University , Linköping , Sweden.
authors.forename: Stergios
authors.initials: S
authors.lastname: Kechagias
authors.affiliation: a The Faculty of Medicine and Health Sciences, Department of Medical and Health Sciences (IMH) , Linköping University , Linköping , Sweden.
authors.forename: Mattias
authors.initials: M
authors.lastname: Ekstedt
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D012372:ROC Curve; D012720:Severity of Illness Index; D013548:Sweden; D018608:Ultrasonography, Doppler
chemical_list: D015415:Biomarkers; D003287:Contrast Media
keywords: Contrast-enhanced ultrasonography; fibrosis; fibrosis scores; non-alcoholic fatty liver disease