Doppler ultrasonography combined with transient elastography improves the non-invasive assessment of fibrosis in patients with chronic liver diseases.
OBJECTIVE
Accurate clinical assessment of liver fibrosis is essential and the aim of our study was to compare and combine hemodynamic Doppler ultrasonography, liver stiffness by transient elastography, and non-invasive serum biomarkers with the degree of fibrosis confirmed by liver biopsy, and thereby to determine the value of combining non-invasive method in the prediction significant liver fibrosis.


METHODS
We included 102 patients with chronic liver disease of various etiology. Each patient was evaluated using Doppler ultrasonography measurements of the velocity and flow pattern at portal trunk, hepatic and splenic artery, serum fibrosis biomarkers, and transient elastography. These parameters were then input into a multilayer perceptron artificial neural network with two hidden layers, and used to create models for predicting significant fibrosis.


RESULTS
According to METAVIR score, clinically significant fibrosis (≥F2) was detected in 57.8% of patients. A model based only on Doppler parameters (hepatic artery diameter, hepatic artery systolic and diastolic velocity, splenic artery systolic velocity and splenic artery Resistance Index), predicted significant liver fibrosis with a sensitivity and specificity of75.0% and 60.0%. The addition of unrelated non-invasive tests improved the diagnostic accuracy of Doppler examination. The best model for prediction of significant fibrosis was obtained by combining Doppler parameters, non-invasive markers (APRI, ASPRI, and FIB-4) and transient elastography, with a sensitivity and specificity of 88.9% and 100%.


CONCLUSIONS
Doppler parameters alone predict the presence of ≥F2 fibrosis with fair accuracy. Better prediction rates are achieved by combining Doppler variables with non-invasive markers and liver stiffness by transient elastography.
School of Medicine, University of Belgrade, Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Serbia. tamara.alempijevic@med.bg.ac.rs.
Tamara
T
Alempijevic
School of Medicine, University of Belgrade, Serbia.
Simon
S
Zec
School of Medicine, University of Belgrade, Serbia.
Vladimir
V
Nikolic
Faculty of Mathematics, University of Belgrade, Belgrad, Serbia.
Aleksandar
A
Veljkovic
Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Serbia.
Zoran
Z
Stojanovic
Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Serbia.
Vera
V
Matovic
School of Medicine, University of Belgrade, Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Serbia.
Tomica
T
Milosavljevic
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000097:blood / Q000000981:diagnostic imaging*; D008107:Liver Diseases / Q000097:blood / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler; D055815:Young Adult