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Doppler ultrasonography devices, including elastography, allow for accurate diagnosis of severe liver fibrosis

Abstract :

OBJECTIVES: Advanced chronic liver disease is frequent yet largely underdiagnosed. Doppler-US is a common examination and we recently identified three simple Doppler-US signs associated with severe liver fibrosis. Recent Doppler-US devices include elastography modules, allowing for liver stiffness measurement (LSM). Our aim was to assess whether the use of elastography following positive simple Doppler-US signs improves the detection of severe liver fibrosis in a single Doppler-US examination.

METHODS: 514 patients with chronic liver disease who consecutively underwent percutaneous liver biopsy were included in the study. All patients had a Doppler-US examination and LSM with Virtual Touch Quantification (VTQ) on the same day as a liver biopsy. A subset of 326 patients also had LSM with 2D shear wave elastography (SSI). Severe fibrosis was defined as Metavir F ≥ 3 on liver biopsy.

RESULTS: Multivariate analysis confirmed our three simple Doppler-US signs (liver surface irregularity, splenomegaly ≥110 mm, and demodulation of hepatic veins) as independently associated with severe fibrosis. The presence of at least one of these three signs showed 85.6% sensitivity and 36.1% specificity for the diagnosis of severe liver fibrosis. Using VTQ (≥1.59 m/s) where there was a positive Doppler-US sign increased the specificity to 80.8%, at the cost of a decrease in sensitivity (73.7%). Similar results were obtained with SSI (≥9.5 kPa), with 73.3% specificity and 81.5% sensitivity.

CONCLUSION: Elastography improves the accuracy of Doppler-US in the detection of severe fibrosis. This two-step procedure will help radiologists to accurately identify patients who need to be referred to specialist hepatologists during routine Doppler-US examinations.

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Soumis le : vendredi 29 mai 2020 - 09:33:41
Dernière modification le : jeudi 20 janvier 2022 - 12:18:02




Jean Delahaye, Paul Bazeries, Adrien Lannes, Jérôme Lebigot, Victoire Cartier, et al.. Doppler ultrasonography devices, including elastography, allow for accurate diagnosis of severe liver fibrosis. European Journal of Radiology, 2018, 108, pp.133-139. ⟨10.1016/j.ejrad.2018.09.019⟩. ⟨hal-02648421⟩



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