Portal Venous Pulsatility Index as a predictor of fibrosis in patients with non-alcoholic fatty liver disease.

INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) is a growing public health issue. Non-invasive methods to assess the fibrosis stage are limited, and biopsy remains the gold standard. The objective of our study was to assess whether the portal venous pulsatility index (VPI) can be used as a predictor of high-risk NAFLD at a tertiary referral centre for liver transplantation. METHODS: We retrospectively reviewed patients with biopsy-proved NAFLD who had undergone a liver ultrasound scan within 1 year of biopsy at our centre from 2011 to 2019. RESULTS: We did not find a significant correlation between the VPI and the NAFLD risk category or correlation between the VPI and degree of steatosis (P > 0.05 for both). CONCLUSION: Since VPI can be easily obtained on routine liver ultrasound and since other studies do report a positive association with significant fibrosis, more studies are needed before it can be recommended or not in risk-stratifying NAFLD patients into high- vs. low-risk NAFLD.

Ultrasound liver imaging reporting and data system®: Considerations for routine practice.

Hepatocellular carcinoma (HCC) is a growing problem worldwide. In Australia, both the incidence and mortality of HCC have sharply increased over the last few decades. Unless detected in its early stage, prognosis of HCC is grim. Ultrasound represents the main screening tool for surveillance programmes worldwide and is recommended in the guidelines by all relevant bodies. The American College of Radiology introduced the first edition of Ultrasound Liver Imaging Reporting and Data System (US LI-RADS) in 2017 to propose an algorithm for reporting ultrasound studies performed in the setting of HCC screening and to provide technical recommendations. The algorithm has two components: detection scores and visualisation scores. More recently at our institution, we introduced a visualisation score to our routine work to assess visualisation of the liver. The score, which is applied by the sonographer performing the ultrasound study at the time of examination, comprises three categories that are not dissimilar to the score introduced by US LI-RADS; adequate, adequate with limitations and inadequate. We believe that adopting a visualisation score is easy and important. It provides clinicians with information regarding the quality of the ultrasound study and the confidence in excluding HCC based on ultrasound alone. Attempts to improve ultrasound screening efficiency such as applying targeted liver ultrasounds and recording of a visualisation score are encouraged with the aim of improving patients' outcomes.