Rachel Gandi, (2014) Diagnostic accuracy of Acoustic Radiation Force Impulse (ARFI) Elastography of liver and spleen to identify Noncirrhotic portal fibrosis (NCPF) from cirrhosis with portal hypertension and comparison with liver biopsy. Masters thesis, Christian Medical College, Vellore.
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Abstract
OBJECTIVES: To assess the diagnostic accuracy of ARFI elastography of liver and spleen to identify patients with NCPF from cirrhosis with portal hypertension as compared to liver biopsy, to differentiate significant liver fibrosis from non-significant liver fibrosis in patients with portal hypertension and to predict clinically significant portal hypertension (CSPH) compared to HVPG and the presence of high risk EV. METHODS: Prospective study approved by IRB. Patients with pre-biopsy preliminary diagnosis of cryptogenic cirrhosis were included and underwent ARFI elastography of the liver and the spleen. The liver stiffness (LS), spleen stiffness (SS), spleen stiffness to liver stiffness ratio (SS/LS) shear wave velocity measurements were correlated with the grades of liver fibrosis on biopsy, clinical and biochemical parameters, HVPG and the presence of high risk varices (EV) on endoscopy. Patients with other causes of portal hypertension were also studied who did not undergo liver biopsy. Chi- square test, kappa and spearmen correlation were used to analyse the data. RESULTS: 48 cases with preliminary diagnosis of cryptogenic cirrhosis were studied. 39 cases had liver biopsy. 11 cases were proven to be NCPF on biopsy. 9 cases were clinically suspected to have NCPF who did not undergo liver biopsy were also studied. 58 cases of portal hypertension of any etiology were studied to assess the correlation of ARFI of the liver and the spleen for CSPH. LS had 36% sensitivity, 93% specificity, PPV of 90%, NPV of 78.8% and kappa of 0.28 and p value of 0.04 to identify NCPF from other liver cirrhosis which was statistically significant. The SS/ LS ratio had 70% sensitivity, 79.2% specificity, PPV of 58.3%, NPV of 86.4% with kappa of 0.46 and p value of 0.06 which was statistically not significant. Spearman correlation (rho) of the liver stiffness (LS) with the fibrosis grades on liver biopsy was 0.54 with p value of < 0.001 which was statistically significant. Both LS and SS were found to have low sensitivity with low kappa agreement and were statistically not significant to identify CSPH. CONCLUSIONS: ARFI elastography of the liver and the spleen in combination have good sensitivity to identify NCPF from cirrhosis with portal hypertension as compared to liver biopsy. The best elastography parameter was the SS/LS. There is good correlation with liver stiffness velocities and grades of liver fibrosis. ARFI has low sensitivity and low specificity to identify CSPH.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | ARFI: Acoustic radiation force impulse, CSPH: Clinically significant portal hypertension, EV: Esophageal varices, HVPG: Hepatic venous pressure gradient, NCPF: Noncirrhotic portal fibrosis, NCIPH: Noncirrhotic intrahepatic portal hypertension, LS: Liver stiffness, SS: Spleen stiffness, SS/LS: ratio of Spleen stiffness to liver stiffness, HBV: Hepatitis B infection, IRB: Institutional review board. |
| Subjects: | MEDICAL > Radio Diagnosis |
| Depositing User: | Subramani R |
| Date Deposited: | 23 Mar 2020 16:00 |
| Last Modified: | 23 Mar 2020 16:00 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/12425 |
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