Schneider A R J, Teuber G, Kriener S, Caspary W F
Medical Department I, University Hospital, Frankfurt/Main, Germany.
Liver Int. 2005 Dec;25(6):1150-5. doi: 10.1111/j.1478-3231.2005.01164.x.
Duplex-Doppler ultrasound is a noninvasive method for the assessment of hepatic hemodynamics beyond conventional gray-scale imaging. The clinical value of the method for the grading and staging of chronic hepatitis C virus (HCV) infection and the prediction of hepatic steatosis still has to be determined. This study aimed to compare Duplex-Doppler and ultrasound with the histologic staging and the estimation of hepatic steatosis in chronic HCV infection.
One hundred and nineteen consecutive patients with chronic HCV infection underwent both liver biopsy and ultrasound with Duplex-Doppler. Maximum portal venous blood flow velocity, portal venous flow undulation, hepatic venous flow pattern and spleen size were assessed and compared with histologic findings. Histologic grading and staging was performed according to the modified HAI and hepatic steatosis was estimated.
Doppler ultrasound was unable to discriminate between different degrees of fibrosis. Sensitivity/specificity of portal venous flow and undulations for the diagnosis of hepatic cirrhosis was 74.5%/53% and 76.5%/100%. The PPV and NPV of reduced undulations was 100% and 96.2%. Mono- or biphasic hepatic venous flow indicated advanced hepatic steatosis (sensitivity 88.2%, specificity 74.5%, PPV 36.6%, NPV 97.5%). Spleen size was significantly enlarged both in patients with cirrhosis and steatosis.
Although Duplex-Doppler of the portal and hepatic veins is not a substitute for histologic grading and staging, portal vein undulations can predict liver cirrhosis with considerable accuracy. Moreover, triphasic patterns of hepatic venous flow virtually exclude significant fatty liver disease. Additional studies should perform intraindividual follow-up investigations to further define the role of Duplex-Doppler ultrasound in chronic HCV infection.
双功多普勒超声是一种超越传统灰阶成像用于评估肝脏血流动力学的非侵入性方法。该方法在慢性丙型肝炎病毒（HCV）感染分级和分期以及肝脂肪变性预测方面的临床价值仍有待确定。本研究旨在比较双功多普勒超声和超声检查与慢性HCV感染的组织学分期及肝脂肪变性评估。
119例连续的慢性HCV感染患者接受了肝活检及双功多普勒超声检查。评估最大门静脉血流速度、门静脉血流波动、肝静脉血流模式和脾脏大小，并与组织学结果进行比较。根据改良的HAI进行组织学分级和分期，并评估肝脂肪变性。
多普勒超声无法区分不同程度的纤维化。门静脉血流及波动对肝硬化诊断的敏感性/特异性分别为74.5%/53%和76.5%/100%。血流波动减少的阳性预测值（PPV）和阴性预测值（NPV）分别为100%和96.2%。单峰或双峰肝静脉血流提示重度肝脂肪变性（敏感性88.2%，特异性74.5%，PPV 36.6%，NPV 97.5%）。肝硬化和脂肪变性患者的脾脏大小均显著增大。
尽管门静脉和肝静脉的双功多普勒超声不能替代组织学分级和分期，但门静脉波动可相当准确地预测肝硬化。此外，肝静脉血流的三相模式实际上可排除明显的脂肪性肝病。应进行进一步的个体随访研究，以进一步明确双功多普勒超声在慢性HCV感染中的作用。
