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1 Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College
London, Hammersmith Hospital, Du Cane Rd., London W12 0HS, UK.
2 Department of Medicine A, Faculty of Medicine, Imperial College London,
Hammersmith Hospital, London W12 0HS, UK.
3 Department of Medical Imaging, Kaohsiung Medical University, Kaohsiung,
Taiwan.
4 Department of Histopathology, Faculty of Medicine, Imperial College London,
St. Mary's Hospital, Praed St., London W12 1NY, UK.
5 Department of Medicine, Faculty of Medicine, Imperial College London, St.
Mary's Hospital, London W12 1NY, UK.
OBJECTIVE. 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.
SUBJECTS AND METHODS. 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 
2 and
NI 3), moderate or severe hepatitis (3 F < 6 or NI 
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.
RESULTS. 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.
CONCLUSION. 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.
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