E-ISSN 1305-3612
Abdominal Imaging - Original Article
Radiology-pathology correlation in staging of liver fibrosis using superb microvascular imaging
1 Department of Radiology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey  
2 Department of Pathology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey  
Diagn Interv Radiol ; : -


PURPOSE: Progression of liver fibrosis to end-stage disease can potentially be prevented with antiviral treatment. Thus, diagnosis of fibrosis is important in determining treatment protocols. This study aims first, to determine the sensitivity of a novel Doppler method, superb microvascular imaging (SMI), in comparison to other Doppler methods, in detecting small vascular structures of the liver; and second, to choose the best method among these Doppler applications to determine the morphological changes that occur due to chronic fibrosis. By doing so, the study would be able to provide an ultrasound grading that might differentiate and predict mild and severe liver fibrosis, thus giving rise to a possible alternative to biopsy.


METHODS: 43 patients diagnosed with chronic hepatitis and scheduled for liver biopsy were included. Color Doppler, Power Doppler, ADF (advanced dynamic flow) Doppler, cSMI (color SMI) and mSMI (monochrome SMI) Doppler was performed in subcapsular areas of right anterior lobe. Depth from the capsule of the most peripherally located detectable vessel was measured for each Doppler subgroup. ANOVA test was applied after than Levene’s test was used to homogeneity of variance and Student-Newman-Keuls test was applied as post-hoc tests. Appearance of the vascular tree was categorized into four groups, and correlated with pathology results. ROC curve analysis was used to determine if this Doppler classification was statistically significant in differentiating mild and severe forms of fibrosis. Finally, multiple regression analysis determined which of the Doppler parameter was statistically significant in predicting severity.


RESULTS: mSMI and cSMI were found to be superior to other Doppler techniques in detecting the most superficially located vessels of the liver; 4.4 mm and 3.3 mm deep from the capsule, respectively (P < 0.001). Among the changes identified in the vascular tree, small vessel blunting was the most prevalent finding in predicting the presence of severe fibrosis; multiple regression test, (t=5.969, P < 0.0001). ROC analysis identified that the presence of at least two pathological findings in the vascular tree was highly predictive of severe fibrosis; AUC= 0.881, sensitivity 86.67%, specificity 89.29%, positive and negative predictive values 8.09 and 0.15, respectively.


CONCLUSION: Our study proves that SMI is superior to other Doppler techniques in detected the smallest vessels visible to ultrasound. Using this method, it is possible to determine the vascular changes in terms of blunting and tortuosity and thus predict the severity of fibrosis. This method might be a practical alternative to biopsy.

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