Role of Colour Doppler Ultrasound in the Diagnosis and Grading of Liver Cirrhosis Compared with Transient Elastograpgy (Fibroscan)

The purpose of this study was to determine the morphological changes in hepatic vasculature and the flow hemodynamics in portal vein, hepatic veins and hepatic artery using various Doppler parameters in cirrhotic patients and to evaluate the variation in Doppler flow hemodynamics within cirrhotic livers as compared to liver stiffness measured by transient elastography. Study sample of 100 eligible patients with compensated liver cirrhosis were enrolled. All were examined with a pulsed Doppler flowmeter with a 3.75 MHz convex and sector probe. Liver texture, splenic size, portal and splenic vein diameters, portal vein velocity, hepatic artery resistive index and waveform of the hepatic vein were evaluated in all subjects comparing results with liver stiffness measured by transient elastography. All the data were collected, tabulated and statistically analyzed using an IBM personal computer with Statistical Package of Social Science version 22. The mean age of the patients was found to be 51.8 ± 10.2 years. The mean value of liver stiffness was 39.7 ± 18.0 kPa. The echotexture of liver was coarse with irregular margin in 69 patients (69.0%), coarse with smooth margin in 24 patients (24.0 %) and normal in 7 patients (7.0 %). The size of spleen was enlarged in 92.0 % of patients. Portal vein diameter was enlarged in 66.0 % of patients. Portal vein velocity shows abnormality in 65.0 % of patients. Hepatic vein waveform in 7.0% of patients was triphasic and non-triphasic in 93.0%. Hepatic artery restrictive index increased above normal range in 69.0 % of patients. Splenic vein diameter was enlarged in 92.0 %. There were statistically highly significant relations (P value < 0.001) between liver stiffness measured by transient elastography and liver texture, hepatic vein waves in colour Doppler US. A highly significant negative correlation (P value < 0.001) was found between Fibroscan results and portal vein velocity in our included cirrhotic patients. Fibroscan results had highly significant positive correlations (P value < 0.001) with splenic size, portal vein diameter, HARI and splenic vein diameter. Colour Doppler US play an important role in the diagnosis of the morphological changes in hepatic vasculature and the flow hemodynamics in portal vein, hepatic veins and hepatic artery. Fibroscan could predict changes in intrahepatic vascular resistance and it improves the accuracy of Doppler US in the detection of cirrhosis.