ABSTRACT
Purpose@#This study investigated the impact of liver stiffness measurements (LSM) made using 2-dimensional (2D) shear wave elastography (SWE) on the diagnosis and grading of hepatic fibrosis and liver cirrhosis (LC) using grayscale ultrasonography (US). @*Methods@#This retrospective study included 46 patients who underwent liver biopsy for chronic liver disease and 33 non-biopsied subjects with no or mild fibrosis (an aspartate aminotransferase-to-platelet ratio index <0.50 and a Forns score <4.21). Two abdominal radiologists reviewed randomized grayscale hepatic sonogram sets with and without LSM, separated by a 4-week interval. They graded the features of echogenicity, echotexture, surface nodularity, and edge blunting and classified patients by fibrosis grade. Interobserver agreement and correlations with the fibrosis grades were compared before and after the reviewers were informed regarding LSM, and the impact of LSM on diagnostic performance was evaluated. @*Results@#The standard diagnoses were no or mild fibrosis (F0-1, n=39), moderate to advanced fibrosis (F2-3, n=23), or LC (n=17). The correlations between US and the diagnostic reference standard increased significantly with LSM incorporation (0.499 and 0.312 to 0.782 and 0.804, P<0.01 for both reviewers), as did interobserver agreement (0.318 to 0.753, P<0.01). The areas under the receiver operating characteristic curve (AUCs) for the diagnosis of significant fibrosis increased when LSM was included (0.682 and 0.591 to 0.855 and 0.907, P<0.01 for both reviewers), while the AUCs for the diagnosis of LC did not change significantly (0.891 and 0.783 to 0.904 and 0.900, P=0.849 and P=0.166). @*Conclusion@#Incorporating LSM values obtained by 2D-SWE improved the diagnostic accuracy and interobserver agreement of grayscale US for hepatic fibrosis.
ABSTRACT
Background/Aims@#Both hepatic venous pressure gradient (HVPG) and liver stiffness (LS) are useful tools for predicting mortality in patients with cirrhosis. We investigated the combined effect of HVPG and LS on long-term mortality in patients with cirrhosis. @*Methods@#We retrospectively collected data from 103 patients with cirrhosis, whose HVPG and LS were measured between November 2009 and September 2013. The patients were divided into four groups according to the results of the HVPG and LS measurements. Long-term mortality and the risk factors for mortality were analyzed. @*Results@#Of the 103 patients, 35 were in group 1 (low HVPG and low LS), 16 in group 2 (high HVPG and low LS), 24 in group 3 (low HVPG and high LS), and 28 in group 4 (high HVPG and high LS). Over a median follow-up of 47.3 months, 18 patients died. The mortality rate of patients in group 4 was significantly higher than in the other three groups (vs. group 1, p = 0.005; vs. group 2, p = 0.049; vs. group 3, p = 0.004), but there were no significant differences in survival between groups 1, 2, and 3. In multivariable analyses, both HVPG and LS were identified as independent risk factors for mortality (hazard ratio [HR], 1.127, p = 0.018; and HR, 1.062, p = 0.009, respectively). @*Conclusions@#In patients with cirrhosis, those with concurrent elevation of HVPG and LS had the highest long-term mortality rates. However, when either HVPG or LS alone was elevated, mortality did not increase significantly.
ABSTRACT
BACKGROUND/AIMS: Clinical validation is required to determine whether Doppler measurements are comparable before and after administering ultrasound contrast agent (USCA). The purpose of this study is to explore whether the use of USCA affects spectral Doppler analysis in recipients of liver transplantation (LT). METHODS: For this study, 36 patients were examined using Doppler ultrasonography (US) along with a contrast-enhanced US for surveillance of vascular complications after LT. The following spectral Doppler US parameters were measured before and after administration of USCA: peak systolic velocity, end-diastolic velocity, resistive index, and systolic acceleration time of the graft hepatic artery; peak flow velocity of the graft portal vein; and peak flow velocity and venous pulsatility index of the graft hepatic vein. RESULTS: The mean peak systolic and end-diastolic velocities of the hepatic artery and the peak flow velocity of the portal and hepatic veins were increased after intravenously administration of the USCA, ranging from 10% to 13%. However, the changes were not statistically significant (P=0.097, 0.103, 0.128, and 0.190, respectively). There were no significant differences in other measured parameters, including the resistive index (P=0.205) and systolic acceleration time (P=0.489) of the hepatic artery and venous pulsatility index (P=0.494) of the hepatic vein. CONCLUSIONS: The measured velocities of graft hepatic vessels tended to increase after administration of USCA, but without statistical significance. The comparison of serial Doppler parameters with or without injection of USCA is valid during Doppler surveillance in recipients of LT.