ABSTRACT
Duplex-doppler ultrasound is a non-invasive method for the assessment of hepatic haemodynamics beyond conventional gray-scale imaging. The clinical values of the methods used for the grading and staging of chronic hepatitis C virus [HCY] infection and the prediction of hepatic steatosis still have to be determined. Was to study the predictive value of pulse wave Doppler ultrasonography in Egyptian patients treated with interferon and Ribavirin through comparing the heamodynamics before and after treatment as well as the detection of the differences in Doppler parameters in IFN-SYR and IFN-NR patients. This study included 50 Hey patients treated with PEG-IFN and Ribavirin. Thirty six patients showed SYR while the remaining 14 patients were non responders. Real time abdominal ultrasonography was done with special concern on abdominal Doppler. Doppler was done by a single ultrasonographer pre and post treatment with special emphasis on liver heamodynamics [Portal vein diameter, Portal vein flow and mean velocities [PVPV] and [PVMV], portal vein circumference and area, hepatic artery resistance and pulsatility indices [HARI] and [HAPI], as well as splenic vein diameter, splenic artery resistance and pulsatility indices [SARI] and [SAPI]]. Hepatic veins phasicity: [triphasic, biphasic, or monophasic], congestion index [in cm/s], modified hepatic vascular index [in cm/s] [MHI], hepatic vascular index and portal hypetiension index were also measured. All the patients were treated by Pegylated interferon 180 microg/week and Ribavirin 13-15 mg/kg/day for 48 weeks [IfPCR still was positive after 24 weeks of treatment, treatment was discontinued, but the patient remained on follow up]. All patients in the study gave an informed consent. Liver biopsies were done for all patients prior to interferon therapy and at 72 weeks [6 months after the end of treatment] with histopathological grading according to METAYIR score. The chronic Hey infected patients in whom IFN and Ribavirin treatment resulted in complete response [SYR] showed that the mean PVPV was [17.59 +/- 5.79 cm/s] while post treatment was [16.39 +/- 3.76 cm/ s]. HAPI pre treatment was [1.77 +/- 0.7 cm/s], and post treatment was [1.62 +/- 0.46 cm/s], and the HARI pre treatment was [0.61 +/- 0.16 cm/s], while post treatment was [0.61 +/- 0.18 cm/s], with no statistical significant difference in the responder group, while the SVMV showed statistical significant difference pre [18.8 +/- 7.37 cm/s], and post treatment [15.2 +/- 4 cm/s]. Also the SVMV pre treatment was [14.7 +/- 5.71 cm/s], while post treatment was[12 +/- 3.74 cm/s], and this was statistically significant [p<0.05]. Pulse wave Doppler ultrasonography is an easy and non-invasive procedure for evaluating the chronic HCY liver disease, but not effective nor valid to estimate the effect and response to anti-viral therapy