Histopathological and doppler findings in children with liver cirrhosis : a correlation study

ABSTRACT

Cirrhosis is an end stage state of virtually any chronic liver disease. There is great clinical interest in establishing the diagnosis of liver cirrhosis in children by non-invasive means. The aim of this work is to study the correlation between Doppler ultrasound parameters and hepatic histopathological findings in children with liver cirrhosis in an attempt to test the efficacy of these parameters as non-invasive means in diagnosis of cirrhosis. Patients and methods: Twenty two children admitted to Liver Institute, Menoufiya university for evaluation of unknown liver disease were examined prospectively and blindly with Doppler ultrasound prior to liver biopsy. Doppler studies were also preformed on 20 control subjects. Patients only were later subjected to liver biopsy. Histopathological examination of the biopsy specimens showed established cirrhosis in 11 of 22, early cirrhosis in 5 of 22. and no cirrhosis in 6 of 22 children. In patients group, the portal vein velocity was decreased [p < 0.05], the hepatic artery velocity was increased [p<0.05], and the arterio-portal velocity ratio was increased [p< 0.05] relative to the controls. Also, loss of reverse flow component was present in all established cirrhotic patients. For the criteria of the early and established cirrhotic patients, the sensitivities of the loss of reverse flow component in the hepatic vein, portal vein velocity being less than 20 cm/ s,hepatic artery velocity being more than 60 cm/s, arterio-portal velocity ratio being greater than 3.0 were 68.7%, 68.7%, 87.5% and 81.2% respectively. In established cirrhotic patients, the sensitivities of all parameters were 100%. In early cirrhotic patients, the sensitivities of hepatic artery velocity being more than 60 cm/s and arterio-portal velocity ratio being greater than 3.0 were 60% and 40% respectively. Indicators of parenchymal compliance [LRFC], outflow obstruction [decreased PVV] and arterialization [increased HAV, alteration in APVR] were accurate in the diagnosis of established cirrhosis. Also, HAV and APVR were useful in the diagnosis of early cirrhosis. We believe that on the basis of our data, afferent and efferent flow abnormalities monitored with Doppler ultrasound may be useful in the assessment of Patients with liver cirrhosis