Liver microbubble transit time compared with histology and Child-Pugh score in diffuse liver disease: a cross sectional study.

Abstract:

BACKGROUND:A previous pilot study showed that early arrival time of a microbubble in a hepatic vein is a sensitive indicator of cirrhosis. AIM:To see if this index can also grade diffuse liver disease. PATIENTS:Thirty nine fasted patients with histologically characterised disease were studied prospectively. Nine patients had no evidence of liver fibrosis, 10 had fibrosis without cirrhosis, and 20 had cirrhosis (five Child's A, seven Child's B, and eight Child's C). METHODS:Bolus injections of a microbubble (Levovist; Schering, Berlin) were given intravenously, followed by a saline flush. Time intensity curves of hepatic vein and carotid artery spectral Doppler signals were analysed. Hepatic vein transit time (HVTT) was calculated as the time after injection at which a sustained signal increase >10% of baseline was seen. Carotid delay time (CDT) was calculated as the difference between carotid and hepatic vein enhancement. RESULTS:Diagnostic studies were achieved in 38/39 subjects. Both HVTT and CDT became consistently shorter with worsening disease, as follows (means (SD)): HVTT: no fibrosis 44 (25) s, fibrosis 26 (8) s, Child's A 21 (1) s, Child's B 16 (3) s, and Child's C 16 (2) s; CDT: no fibrosis 31 (29) s, fibrosis 14 (6) s, Child's A 8 (1) s, Child's B 4 (4) s, and Child's C 3 (3) s. These differences were highly significant (p<0.001, ANOVA comparison). A HVTT <24 s and a CDT <10 s were 100% sensitive for cirrhosis (20/20 and 18/18, respectively) but not completely specific: 2/8 subjects with fibrosis had CDT values <10 s and 3/9 had HVTT <24 s. CONCLUSION:This minimally invasive test shows promise not only in diagnosing cirrhosis but also in assessing disease severity.

journal_name

Gut

journal_title

Gut

authors

Blomley MJ,Lim AK,Harvey CJ,Patel N,Eckersley RJ,Basilico R,Heckemann R,Urbank A,Cosgrove DO,Taylor-Robinson SD

doi

10.1136/gut.52.8.1188

keywords:

subject

Has Abstract

pub_date

2003-08-01 00:00:00

pages

1188-93

issue

8

eissn

0017-5749

issn

1468-3288

journal_volume

52

pub_type

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