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. 2019 Jul;98(27):e16270.
doi: 10.1097/MD.0000000000016270.

Ultrasound is highly specific in diagnosing compensated cirrhosis in chronic hepatitis C patients in real world clinical practice

Yi-Hao Yen  1 , Fang-Ying Kuo  2 , Chien-Hung Chen  1 , Tsung-Hui Hu  1 , Sheng-Nan Lu  1 , Jing-Houng Wang  1 , Chao-Hung Hung  1
Affiliations

Ultrasound is highly specific in diagnosing compensated cirrhosis in chronic hepatitis C patients in real world clinical practice

Yi-Hao Yen et al. Medicine (Baltimore). 2019 Jul.

Abstract

Ultrasound is routinely used during the evaluation of liver cirrhosis. Inter-observer variability is considered a major drawback. This retrospective study investigated the accuracy of ultrasound in diagnosing compensated cirrhosis (i.e., modified Knodell F3, F4) in chronic hepatitis C (CHC) patients in real world clinical practice. Consecutive treatment-naive CHC patients who underwent liver biopsy (LB) prior to interferon therapy from 1997 to 2010 were enrolled. Ultrasound was performed by 30 hepatologists prior to LB. Ultrasound-identified cirrhosis was defined as small liver size, nodular liver surface and coarse liver parenchyma. LB was used as a reference, and the diagnostic accuracy of ultrasound was assessed and compared. Fibrosis was scored according to the modified Knodell classification. A cohort comprising 1738 patients, including 922 men and 816 women with a mean age of 52.5 years, was analyzed in the present study. The distribution of the patients' modified Knodell scores was F0 = 336, F1 = 489, F2 = 165, F3 = 315, F4 = 433. Ultrasound-identified cirrhosis was noted in 283 patients. Using ultrasound-identified cirrhosis to predict compensated cirrhosis, the sensitivity was 34.0%, the specificity was 97.1%, the positive predictive value was 89.8%, the negative predictive value was 66.1%, the positive likelihood ratio was 11.6, and the negative likelihood ratio was 0.68. The area under the ROC curve (AUROC) was 0.66.Despite being affected by inter-observer variability, ultrasound is highly specific in diagnosing compensated cirrhosis in CHC patients in real world clinical practice. However, the sensitivity is low.

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Conflict of interest statement

The authors have no conflicts of interest relevant to this article.

Figures

Figure 1
Figure 1
The inclusion and exclusion of subjects for this study.
Figure 2
Figure 2
Example of nodular liver surface: Longitudinal view of the left lobe liver, liver surface appears as a dotted or irregular line (arrow).
Figure 3
Figure 3
Example of coarse liver parenchyma: intercostal view of the right lobe liver, liver parenchyma shows areas of different echogenicity (arrows), reflecting underlying nodularity.
See this image and copyright information in PMC

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