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

Abstract

-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.

Doppler ultrasonography: A non‐invasive method used to diagnose and follow up patients with chronic hepatitis C

“…21 This last finding is probably due to the great interpersonal variability of these indices. 23 The PVPI cut-off point for this purpose was higher in the present study, with higher sensitivity and specificity. 22 The data of hepatic artery pulsatility index (Table 1) showed values significantly higher in the group with hepatic fibrosis (F2/F3/F4), with a linear association between data obtained through elastography, with a mean of 1.22 in the group with significant hepatic fibrosis.…”

“…The PVPI of patients with chronic hepatitis C presented significantly lower values when compared with a healthy control group, independent of the degree of fibrosis (mean PVPI, 0.23 ± 0.009; P < 0.0001), and a cut-off point of PVPI = 0.28 was determined for the detection of hepatic fibrosis ≥ F2, which, compared with the biopsy, had a sensitivity of 73.5% and a specificity of 71.1%. 23 The PVPI cut-off point for this purpose was higher in the present study, with higher sensitivity and specificity. Data regarding the use of portal vein resistance index for non-invasive assessment of liver fibrosis were not found in the literature.…”

Measuring Fibrosis: Is Seeing Really Believing?

“…Early investigations have focused on the diameter, flow, waveform, and undulation of the three major vessels (the portal vein, hepatic vein and the hepatic artery). Few studies however, focus on distinguishing significant fibrosis (METAVIR stage CF2) from those with less fibrosis (F0-F1), important in determining time to initiate antiviral therapy (Table 1) [3][4][5][6][7][8][9][10][11][12][13].…”

Padrões hemodinâmicos hepáticos na esteatose não alcóolica: avaliação pela ultrassonografia com doppler e estudo histológico

“…A veia porta foi avaliada hemodinamicamente pelo cálculo do índice de pulsatilidade venosa portal (IVP). Este parâmetro tem como principal vantagem não depender da angulação para obtenção de velocidades reais, o que o torna mais reprodutível (Rocha et al, 2012). O fato de o paciente interromper os movimentos respiratórios durante o exame da veia porta previne as flutuações da onda devido a respiração o que proporciona medidas mais acuradas (Karasin et al, 2014).…”

“…Achados semelhantes foram descritos também em publicações que abordaram outras doenças hepáticas crônicas. Um estudo que avaliou a influência da fibrose sobre o IVP em pacientes portadores de hepatite C encontrou média de 0,33 ± 0,07 para o grupo controle e 0,23 ± 0,09 para o grupo com esteatose (Rocha et al, 2012). Em outra publicação que avaliou pacientes com hipertensão portal foram encontradas 0,39 ± 0,10 e 0,23 ± 0,08 com médias para o grupo controle e grupo com esteatose, respectivamente .…”