Accuracy of ultrasound in the detection of liver fibrosis in chronic viral hepat

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Radiol Med (Torino). 2005 Oct;110(4):341-348.

Accuracy of ultrasound in the detection of liver fibrosis in chronic viral

hepatitis.

D'Onofrio M, Martone E, Brunelli S, Faccioli N, Zamboni G, Zagni I,

Fattovich G, Pozzi Mucelli R.

1Istituto di Radiologia, Policlinico Universitario ''G. B. Rossi'', Verona,

Italy.

PURPOSE: To assess the accuracy of ultrasonography (US) in the

identification and grading of hepatic fibrosis in patients afflicted with

chronic viral liver disease, compared to histological examination as a gold

standard. MATERIALS AND METHODS: We prospectively studied 105 patients (32

F, 73 M) affected by chronic viral liver disease in 36 months. Patients were

studied with B-mode US and then underwent US-guided liver biopsy. All the

patients were studied with conventional US with a Sequoia 512, 6.0 (Acuson,

Mountain View CA, USA). We evaluated the following US parameters: liver

margins, parenchymal echotexture, portal vein caliber and spleen diameter.

The four B-mode US parameters were used for the US grading (from 0 to 4).

Scheuer's grading (from 0 to 4) was used for the histological score. Grades

3 and 4 were considered as positive for fibrosis. Sensitivity, specificity,

positive and negative predictive values and accuracy were calculated in the

case of absence, positivity of one or all the US parameters. The correlation

between US and histological scores was evaluated with Spearman's test.

RESULTS: At histology seventy-seven patients (73%) had absent grade 0 (1

patient; 1%), low-moderate grade 1 (35 patients; 33%) or grade 2 (41

patients; 39%) liver fibrosis. Twenty-eight patients (27%) had severe grade

3 (16 patients; 15%) or grade 4 (12 patients; 11%) fibrosis. In the case of

absence of US parameters sensitivity was 32%, specificity 32%, positive

predictive value 15%, negative predictive value 57% and accuracy 32%. In the

case of positivity of at least one of the US parameters the values were 68%,

68%, 43%, 84% and 69%. In the case of presence of all the US signs the

results were 25%, 100%, 100%, 79% and 80%. None of the 77 patients with a

healthy liver or with low-grade fibrosis was positive for all the US

parameters. All the patients positive for all of the ultrasonographic

parameters had high-grade fibrosis or cirrhosis at liver biopsy. Correlation

between B-mode and histological scores was not statistically significant

(Rs=0.45; p=0.0001). CONCLUSIONS: US identification of liver fibrosis in

chronic liver disease is possible with 25% sensitivity, 100% specificity,

100% positive predictive value and 79% negative predictive value, with an

80% diagnostic accuracy.

PMID: 16292241 [PubMed - as supplied by publisher]

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