Christophe Aube and colleagues have determined whether ultrasound, and particularly, new Doppler signs, increase the diagnostic accuracy of the most accurate, currently available markers for the diagnosis of cirrhosis or severe fibrosis.
They studied a total of 32 clinical (n = 4), biochemical (n = 11) and Doppler ultrasound (n = 17) variables that were recorded in 106 patients with compensated chronic liver disease.
In order to evaluate diagnostic accuracy, discriminant analysis was used, first globally, and then using all variables by variable analysis.
For diagnosis of cirrhosis using Doppler ultrasound, diagnostic accuracy was 92% globally, and 89% with 3 variables (spleen length, hepatic vein spectrum and maximum portal vein velocity).
Based upon clinical signs, diagnostic accuracy was 86% globally, and 85% with one variable (firm liver).
When basing findings upon biochemical parameters these values fell to 80% globally, and 81% with two variables (hyaluronate and platelet count).
Based upon all parameters, diagnostic accuracy was 91% globally, and 91% with four variables (firm liver, hyaluronate, platelet and hepatic vein spectrum).
On an intention to diagnose basis, Doppler ultrasound provided a lower independent contribution due to missing data.
In the diagnosis of severe fibrosis, diagnostic accuracy was 83% globally, and 77% with one variable.
The researchers, who have published their study in the August issue of the journal, conclude that cirrhosis can be correctly diagnosed in approximately 90% of patients with compensated chronic liver disease using a few Doppler ultrasound signs including a new sign, the hepatic vein spectrum.
They add that Doppler ultrasound could be used for the first line diagnosis and biochemical markers, such as hyaluronate, in patients with missing Doppler ultrasound data.