Assessment of portal venous index as a non-invasive method for diagnosing liver fibrosis in patients with chronic hepatitis C

CONTEXT: Hepatitis C is an important cause of chronic liver disease worldwide. The grading of hepatic fibrosis in chronic hepatitis C is important for better clinical management. However, until now, liver biopsy is the only test accepted for this purpose, despite their contraindications and complications. New methods for non-invasive assessment of hepatic fibrosis are under investigation. One proposal is the Doppler ultrasound, as a non-invasive, widely available and inexpensive. OBJECTIVE: To compare Doppler parameters of portal vein in patients with chronic hepatitis C with a healthy control group and to correlate these parameters with fibrosis degree obtained by liver biopsy. METHODS: Fifty patients with chronic hepatitis C submitted to liver biopsy and 44 healthy controls had Doppler of the portal vein performed, with the calculation of the portal venous index. We conducted a comparison between the averages of the two groups of portal venous index. For the correlation between portal venous index and fibrosis was employed the Spearman test. RESULTS: There was a difference between the average portal venous index between controls (0.33 ± 0.07) and patients (0.23 ± 0.09) with P<0.001. No difference was observed between the portal venous index in patients with chronic hepatitis C who have significant fibrosis or not. The correlation between the portal venous index and fibrosis degree was reverse and moderate (r =-0.448 P<0.001). The area under the ROC curve was 78.4% (95% CI: 68.8% to 88%). The cutoff for the portal venous index was 0.28 with sensitivity of 73.5% and specificity of 71.1%. CONCLUSION: The portal venous index was useful in distinguishing healthy patients from patients with CHC. However, there was no significant difference in the quantification of degree of fibrosis.

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Can Combinations of Non-Invasive Parameters Replace Liver Biopsy in the Diagnosis of Hepatic Fibrosis in Egyptian Patients with Chronic Hepatitis C

British Microbiology Research Journal ◽

10.9734/bmrj/2013/3323 ◽

2013 ◽

Vol 3 (3) ◽

pp. 259-271 ◽

Cited By ~ 1

Author(s):

Walid Dayem

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Liver Biopsy ◽

Chronic Hepatitis C ◽

Hepatic Fibrosis ◽

Non Invasive ◽

Egyptian Patients

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Liver Biopsies for Chronic Hepatitis C: Should Nonultrasound-Guided Biopsies Be Abandoned?

Canadian Journal of Gastroenterology ◽

10.1155/2009/370651 ◽

2009 ◽

Vol 23 (6) ◽

pp. 425-430 ◽

Cited By ~ 9

Author(s):

Jennifer A Flemming ◽

David J Hurlbut ◽

Ben Mussari ◽

Lawrence C Hookey

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Liver Biopsy ◽

Chronic Hepatitis C ◽

Hcv Infection ◽

Significant Difference ◽

The Us ◽

Chronic Hcv Infection ◽

Liver Biopsies ◽

Chronic Hcv

BACKGROUND/OBJECTIVE: Liver biopsy has been the gold standard for grading and staging chronic hepatitis C virus (HCV)-mediated liver injury. Traditionally, this has been performed by trained practitioners using a nonimage-guided percutaneous technique at the bedside. Recent literature suggests an expanding role for radiologists in obtaining biopsies using an ultrasound (US)-guided technique. The present study was undertaken study to determine if the two techniques produced liver biopsy specimens of similar quality and hypothesized that at our institution, non-US-guided percutaneous liver biopsies for HCV would be of higher quality than US-guided specimens.METHODS: Liver biopsies from 100 patients with chronic HCV infection (50 consecutive US-guided and 50 consecutive non-US-guided), were retrospectively identified using a hospital histopathology database. All original biopsy slides were coded and prospectively reanalyzed by a single hepatopathologist who was blinded to the technique used in obtaining the biopsy. Additionally, all liver biopsies for chronic HCV infection completed at the centre from 1998 to 2007 were identified and the technique used was recorded. Biopsy quality was determined primarily by the number of complete portal tracts (CPTs) identifiable in the slides. The total length of specimen and the degree of fragmentation were secondary outcome measures.RESULTS: There was a slight difference observed between the US-guided and non-US-guided groups in mean age (46.3 years versus 42.5 years, repectively; P=0.018) but no differences in sex, presence of cirrhosis, bilirubin, creatinine, international normalized ratio, and grade or stage of disease. Biopsies obtained using the US-guided technique produced higher quality specimens than the non-US-guided technique based on our primary outcome of number of CPTs in the biopsy (11.8 versus 7.4; P<0.001). US-guided specimens also were longer (24.4 mm versus 19.7 mm; P=0.001), had less fragmentation (P=0.016), and a higher overall histopathological quality assessment (P=0.026) than the non-US-guided biopsies. However, there was no significant difference between the two groups in the ability to grade and stage the disease (96% US-guided versus 90% in non-US-guided (P=0.20). Over a 10-year period, 763 biopsies for chronic HCV infection were identified with an obvious trend toward the increased use of US-guided technique observed at 2% in 1998 to 85% in 2007.CONCLUSIONS: US-guided liver biopsies for chronic HCV are the most common method of obtaining specimens at the Kingston General Hospital, Kingston, Ontario, and are of higher quality than non-US-guided specimens. However, there is no significant difference in the two techniques in the ability to grade and stage chronic HCV.

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Nem invazív fibrosisdiagnosztika hepatitis C-vírus-infekcióban: szerepe a kezelés indikációjában, követésében és a prognózis megítélésében

Orvosi Hetilap ◽

10.1556/650.2015.30173 ◽

2015 ◽

Vol 156 (21) ◽

pp. 855-861 ◽

Cited By ~ 1

Author(s):

Alajos Pár ◽

Áron Vincze ◽

Gabriella Pár

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Virus Infection ◽

Liver Biopsy ◽

Chronic Hepatitis C ◽

Antiviral Treatment ◽

Hepatitis C Virus Infection ◽

Non Invasive ◽

Chronic Hepatitis C Virus

Chronic hepatitis C virus infection associated with necroinflammation predisposes to liver fibrosis and cirrhosis, which lead to severe end-stage complications. Staging of fibrosis is of basic importance for the indication of antiviral treatment, for monitoring the response and predicting the prognosis of patients with hepatitis C virus related liver disease. Since liver biopsy, the “gold standard” diagnosis of fibrosis is invasive and it has some other limitations, non-invasive methods have been developed and widely used in the clinical practice. Serum biomarkers and physical approaches measuring liver stiffness by elastography as well as combination algorithms have been gradually been integrated into guidelines resulting in a reduction of the need for liver biopsy. The authors review these non-invasive fibrosis markers and discuss their role in the indication of treatment, follow-up, and assessment of prognosis of patients with chronic hepatitis C virus infection. Orv. Hetil., 2015, 156(21), 855–861.

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