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Noninvasive diagnosis of the degree of hepatic fibrosis using ultrasonography in patients with chronic liver disease due to hepatitis C virus

Authors


Third Department of Internal Medicine, Ehime University School of Medicine, Ehime, Japan (M. Hirata, Sk. Md. F. Akbar, N. Horiike, M. Onji).Correspondence to: Mami Hirata, MD, Third Department of Internal Medicine, Ehime University School of Medicine, Shigenobu-Cho, Ehime 791–0295, Japan. Tel.: 81 89 9605308; fax: 81 89 9605310; e-mail: akbar@m.ehime-u.ac.jp

Abstract

Background Chronic liver disease is characterized by progressive hepatic fibrosis and changes in hepatic haemodynamics. This study has addressed the possibility of a noninvasive diagnosis of the degree of hepatic fibrosis by evaluating the velocity of blood in the hepatic vasculature.

Materials and methods The maximum velocity of blood at the portal vein and hepatic artery was measured in 80 patients with chronic liver diseases (19 with liver cirrhosis; 61 with chronic hepatitis) and in 20 normal volunteers by Doppler ultrasonography. The arterio-portal ratio (A/P ratio) was calculated by dividing the maximum velocity of blood (Vmax) in the hepatic artery with the Vmax in the portal vein. Multivariate analysis was used to disclose the independent predictors of the degree of hepatic fibrosis.

Results The levels of A/P ratio were significantly higher in patients with liver cirrhosis (LC) compared to those with chronic hepatitis (CH) and normal controls. Probit analysis revealed that the value of A/P ratio at which CH becomes LC was A/P ≥ 3·5. The levels of A/P ratio were also significantly higher in patients with severe fibrosis compared with mild (P < 0·0001) and moderate (P < 0·0001) fibrosis. Multivariate analysis disclosed right A/P ratio (P = 0·0001), left A/P ratio (P = 0·013), and platelet counts (P = 0·0172), as the only independent predictors of the degree of hepatic fibrosis.

Conclusions A/P ratio may be used for the noninvasive diagnosis of the degree of hepatic fibrosis in patients with chronic liver diseases.

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