Lim Adrian K P, Patel Nayna, Eckersley Robert J, Kuo Yu-Ting, Goldin Robert D, Thomas Howard C, Cosgrove David O, Taylor-Robinson Simon D, Blomley Martin J K
Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, Du Cane Rd., London W12 0HS, UK.
AJR Am J Roentgenol. 2005 Jun;184(6):1848-53. doi: 10.2214/ajr.184.6.01841848.
Many authors have claimed that Doppler sonography indexes are of value in grading and assessing diffuse liver disease. However, there is much controversy regarding the reliability and reproducibility of these techniques. We performed a prospective study to evaluate whether these methods can grade disease in a well-stratified cohort of patients with hepatitis C virus (HCV)-related liver disease.
Sixty-five patients with biopsy-proven HCV-related liver disease were recruited, and Doppler sonography was performed by one operator. The patients were classified into one of the following three groups on the basis of the Ishak-modified histologic activity index (HAI) fibrosis (F) and necroinflammatory (NI) scores: mild hepatitis (F < or = 2 and NI < or = 3), moderate or severe hepatitis (3 < or = F < 6 or NI > or = 4), or cirrhosis (F = 6/6). We measured the following Doppler indexes: main hepatic artery peak velocity (Vmax) and resistive index, main portal vein peak velocity (Vmax), and maximal portal vein diameter and circumference that allowed calculation of the portal vein congestive index (portal vein area and portal vein velocity). The ratio of the hepatic artery velocity (Vmax) to the portal vein velocity (Vmax) was also calculated, and the phasicity (triphasic, biphasic, or monophasic) of the hepatic veins of each patient was recorded. We also measured the maximal spleen length longitudinally.
A total of 65 patients with liver disease (mild hepatitis, n = 20; moderate or severe hepatitis, n = 25; cirrhosis, n = 20) with biopsy-proven HCV-related liver disease were studied. Optimal hepatic arterial traces were obtained in only 30 patients and portal vein circumference in 18 patients. No significant differences were observed in the Doppler indexes with increasing severity of liver disease. Five (29%) of 17 patients with mild hepatitis had an abnormal hepatic vein trace (i.e., biphasic or monophasic) compared with 11 (55%) of 20 patients with moderate or severe hepatitis and 12 (60%) of 20 patients with cirrhosis. The only index to show a significant intergroup difference was splenic length (analysis of variance, p < 0.001), but there was still overlap between the groups.
Doppler-derived indexes, which have previously been recommended for the assessment of severity in chronic liver disease, are difficult to reproduce reliably and therefore have a limited clinical role in the noninvasive assessment of hepatic fibrosis or inflammation.
许多作者声称，多普勒超声检查指标在评估弥漫性肝病的分级和严重程度方面具有价值。然而，这些技术的可靠性和可重复性存在诸多争议。我们进行了一项前瞻性研究，以评估这些方法能否对一组分层良好的丙型肝炎病毒（HCV）相关肝病患者的疾病进行分级。
招募了65例经活检证实为HCV相关肝病的患者，由一名操作人员进行多普勒超声检查。根据Ishak改良组织学活动指数（HAI）的纤维化（F）和坏死性炎症（NI）评分，将患者分为以下三组之一：轻度肝炎（F≤2且NI≤3）、中度或重度肝炎（3≤F＜6或NI≥4）或肝硬化（F = 6/6）。我们测量了以下多普勒指标：肝固有动脉峰值流速（Vmax）和阻力指数、门静脉主干峰值流速（Vmax）、门静脉最大直径和周长，以便计算门静脉充血指数（门静脉面积和门静脉流速）。还计算了肝动脉流速（Vmax）与门静脉流速（Vmax）的比值，并记录了每位患者肝静脉的血流相位（三相、双相或单相）。我们还纵向测量了脾脏最大长度。
共研究了65例经活检证实为HCV相关肝病的患者（轻度肝炎20例；中度或重度肝炎25例；肝硬化20例）。仅30例患者获得了最佳肝动脉血流图，18例患者获得了门静脉周长。随着肝病严重程度的增加，多普勒指标未见显著差异。17例轻度肝炎患者中有5例（29%）肝静脉血流图异常（即双相或单相），而20例中度或重度肝炎患者中有11例（55%），20例肝硬化患者中有12例（60%）。唯一显示出显著组间差异的指标是脾脏长度（方差分析，p＜0.001），但各组之间仍有重叠。
先前推荐用于评估慢性肝病严重程度的多普勒衍生指标难以可靠地重复，因此在肝纤维化或炎症的无创评估中临床作用有限。
