Doppler ultrasonography combined with transient elastography improves the non-invasive assessment of fibrosis in patients with chronic liver diseases

Abstract

Aims: 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. Material and 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%. Conclusion: 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.

Value of hepatic artery resistive index in evaluation of liver fibrosis related to non-alcoholic fatty liver diseases

“…On the contrary, Alempijevic et al found that HARI has no significant correlation with significant liver fibrosis and cirrhosis. This discrepancy may be due to the small sample size and presence of various etiologies in that study, unlike homogeneity in the etiologies of other studies 28 .…”

“…Better prediction rates are obtained by combining Doppler variables with non-invasive markers and transient elastography of liver stiffness. Combining Doppler parameters, non-invasive markers (APRI, ASPRI, and FIB-4) and transient elastography yielded the best model for predicting significant fibrosis, with sensitivity and specificity of 88.9 percent and 100 percent, respectively, 28 . On the other hand, we observe less accuracy of HARI in the evaluation of early degrees of fibrosis.…”