Large scale evaluation of WHO's ultrasonographic staging system of schistosomal periportal fibrosis in Ethiopia

Abstract

Summaryobjectives To evaluate the recent WHO's ultrasonographic diagnostic staging system of schistosomal periportal thickening/fibrosis and to assess intra/inter-observer variation associated with its use.methods Local standard of portal branch wall thickness (PBWT) for height was established using 150 healthy subjects. Intra and inter-observer variation in image pattern identification and PBWT measurements were assessed in 94 and 35 subjects, respectively, with differing stages of periportal thickening fibrosis. WHO's diagnostic criteria were evaluated in 2451 community members (1277 males, 1174 females; mean age 18.8 years) with an overall Schistosoma mansoni prevalence estimate of 65.9%.results There were no significant inter/intra-observer variations in image pattern identification and PBWT measurements. Based on Ethiopian PBWT-for-height standard, 128/2451 (5.2%) had insipient, 46/2451 (1.9%) had possible/probable and 112/2451 (4.6%) had definite/advanced periportal thickening/fibrosis. Comparable figures were obtained using the Senegalese PBWT-for-height standard and there was good agreement between Ethiopian and Senegalese healthy control-based diagnostic criteria in classifying the 286 subjects into stages of periportal thickening/fibrosis (j ¼ 0.87, P < 0.001).conclusions With further improvement, the WHO's ultrasonographic diagnostic criteria can be used in health institutions and community surveys. Image pattern based assessment is simple and more reproducible than PBWT based assessment of periportal thickening/fibrosis. The latter is, however, more useful in clarifying the status of an individual with doubtful image pattern, and in monitoring posttreatment outcome of periportal thickening/fibrosis. Considering the comparability of PBWT-for-height standards, setting one international standard of PBWT-for-height is more practical than developing local standards for each endemic area.

Histological confirmation of periductal fibrosis from ultrasound diagnosis in cholangiocarcinoma patients

“…The bile ducts are accompanied with the portal vein in the periportal space [16] and in clonorchiasis, PDF appears along the periportal space with evidence of increased echogenicity of the intrahepatic bile duct wall or IPE was interpreted as cholangitis and periductal fibrosis [17], but histopathological proof is not available. With respect to the ultrasonographic pattern of periportal fibrosis (PPF) in ultrasound studies of schistosomiasis [13,[30][31][32][33][34][35], we applied and used the first three grades of WHO classification in our study. Non-invasive imaging by ultrasound to detect PDF was used in our study as a sonographic marker for CCA surveillance in a high risk group in the endemic area of Ov infection.…”

The Impact of Schistosoma japonicum Infection and Treatment on Ultrasound-Detectable Morbidity: A Five-Year Cohort Study in Southwest China

“…Periportal fibrosis was rare in this population and could not be associated with S. japonicum infection, although it did decline significantly following the initiation of targeted treatment. Others have used image-based classification to assess periportal fibrosis [34,35], which has been shown to have better reproducibility for S. mansoni-related fibrosis, perhaps because it does not require the ultrasonographer to measure narrow vessel widths [36]. Our measures of periportal fibrosis were not height adjusted, as Chinese standards for the diameter of portal vein branches as measured here have not been published.…”

Chronic Hepatosplenomegaly in African School Children: A Common but Neglected Morbidity Associated with Schistosomiasis and Malaria

“…However, following fully the Niamey protocol to analyse data, with comparisons being made to S. mansoni uninfected Senegalese who serve as a standard reference population, 28% of the children examined were classed as having portal hypertension. In a later cross-sectional study, due to ongoing debate as to the suitability of the Senegalese reference population and the reproducibility of some of the more difficult measurements [9], [65], [66], inter- and intra-observer robust portal vein diameter measurements [65], standardised internally for height, were used and were both greatest amongst children who had hepatosplenomegaly, and related to Pfs-IgG3 levels and S. mansoni infection intensities [67]. The long-term consequences of this dilation of the portal vein are poorly understood, but previous findings that ascites and varices can be present in the absence of periportal fibrosis indicates that “subtle” morbidity, in this case hepatosplenomegaly, may have health consequences that are far from subtle.…”