Non-Invasive Assessment of Fibrosis Using Color Doppler Ultrasound in Patients with Hepatitis C Virus in the Amazon Rainforest, Brazil

Jorge Leão Universidade do Estado do Amazonas, Fundação de Medicina Tropical Heitor Vieira Dourado, Gerência de Virologia, Manaus, Amazonas, Brazil

Search for other papers by Jorge Leão in
Current site
Google Scholar
PubMed
Close
,
Marianna Brock Universidade do Estado do Amazonas, Fundação de Medicina Tropical Heitor Vieira Dourado, Gerência de Virologia, Manaus, Amazonas, Brazil

Search for other papers by Marianna Brock in
Current site
Google Scholar
PubMed
Close
,
Márcia Castilho Universidade do Estado do Amazonas, Fundação de Medicina Tropical Heitor Vieira Dourado, Gerência de Virologia, Manaus, Amazonas, Brazil

Search for other papers by Márcia Castilho in
Current site
Google Scholar
PubMed
Close
,
André Scariot Universidade do Estado do Amazonas, Fundação de Medicina Tropical Heitor Vieira Dourado, Gerência de Virologia, Manaus, Amazonas, Brazil

Search for other papers by André Scariot in
Current site
Google Scholar
PubMed
Close
,
Ana Scariot Universidade do Estado do Amazonas, Fundação de Medicina Tropical Heitor Vieira Dourado, Gerência de Virologia, Manaus, Amazonas, Brazil

Search for other papers by Ana Scariot in
Current site
Google Scholar
PubMed
Close
, and
Wornei Braga Universidade do Estado do Amazonas, Fundação de Medicina Tropical Heitor Vieira Dourado, Gerência de Virologia, Manaus, Amazonas, Brazil

Search for other papers by Wornei Braga in
Current site
Google Scholar
PubMed
Close
Restricted access

The purpose of this study was to correlate morphologic and hemodynamic Doppler ultrasound findings as indicators of the degree of inflammation and fibrosis and to diagnose chronic vital hepatitis complications and progression. A prospective, descriptive study of a case series was conducted that analyzed Doppler ultrasound images of the liver and portal system and used the portal vein congestion index, hepatic and splenic artery impedance indices, and the liver vascular index. Of 50 patients positive for antibodies against hepatitis C virus, morphologic changes highlighted increased hepatic parenchyma echogenicity in 24%, and increased gall blander echogenicity and wall thickness in 4%. The most common hemodynamic changes observed were reduced flow velocity in the portal vein trunk in 26%, congestion index changes in 12%, liver vascular index changes in 16%, and splenic and hepatic artery impedance index changes in 14%. These indices were shown to be associated with alanine aminotransferase levels, which suggested that they are important liver damage indicators in the early phase of infection with hepatitis C virus.

Author Notes

*Addresss correspondence to Jorge Leão, Universidade do Estado do Amazonas, Fundação de Medicina Tropical Heitor Vieira Dourado, Gerência de Virologia, Av. Pedro Teixeira, No. 25, Bairro Dom Pedro, CEP 69040–000, Manaus, Amazonas, Brazil. E-mail: jorgeleao18@hotmail.com

Financial support: This study was supported by the Tropical Medicine Foundation Heitor Vireira Dourado and the Superintendency of the Manaus free zone.

Authors' addresses: Jorge Leão, Marianna Brock, Marcia Castilho, and Wornei Braga, Universidade do Estado do Amazonas, Fundação de Medicina Tropical Heitor Vieira Dourado, Gerência de Virologia, Manaus, Amazonas, Brazil, E-mails: jorgeleao18@hotmail.com, mariannabrock@hotmail.com, mcastilho@fmt.am.gov.br, and wornei.braga@hotmail.com. André Scariot and Ana Scariot, Rua Castanhal, Conjunto Deborah, Bairro Dom Pedro, Manaus, Amazonas, Brazil, E-mails: alscariot@gmail.com and carola.amaral.uea@gmail.com.

  • 1.

    World Health Organization, 2011. Hepatitis C. Available at: http://www.who.int/mediacentre/factsheets/fs164/en/.

  • 2.

    Brasil, 2008. Hepatites Virais: O Brasil Está Atento. Brasília: Ministério da Saúde.

  • 3.

    Gonçales FG, 2003. Hepatites virais. Cimermam S, Cimermam B, eds. Medicina Tropical. São Paulo: Atheneu, 407412.

  • 4.

    Nezam HA, 2004. The natural history of hepatitis C. Liver Disease 24: 38.

  • 5.

    Paraná R, Paiva T, Leite M, Oliveira FN, Kali N, Lobato C, Dantas T, Neto JT, 2007. Infection with hepatitis C virus among health care workers in the Brazilian Western Amazon Region (Rio Branco, State Of Acre). Am J Trop Med Hyg 76: 165169.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Torres KL, Malheiro A, Tateno A, de-Lima TA, Viana-Maia LP, Diniz-Pimentel JP, Encarnacão-de Morais MP, de-Milo-Usui CS, de-Oliveira-Braga F, Ferreira-Silva IA, Vasquez F, Eduardo-Levi J, 2009. Hepatitis C virus in blood donors, Brazil. Emerg Infect Dis 15: 676678.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    De Oliveira-Filho AB, Pimenta AD, Rojas MD, Chagas MC, Crespo DM, Crescente JA, De Lemos JA, 2010. Likely transmission of hepatitis C virus through sharing of cutting and perforating instruments in blood donors in the State of Pará, Northern Brazil. Cad Saude Publica 26: 837844.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Foccacia R, Baraldo DC, Souza FV, 2003. Hepatite C epidemiologia. Foccacia R, ed. Tratado de Hepatites Virais. São Paulo: Atheneu, 221230.

  • 9.

    Resende C, 2005. Doppler hepático. Santos AA, Nacif MS, eds. Radiologia e Diagnóstico por Imagem: Abdome. Rio de Janeiro: Sociedade Brasileira de Radiologia. Livraria e Editora Rubio Ltda., 3101.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Vezozzo DC, 2001. Radiologia convencional e ultra-sonografia. Gayotto LC, Alves VA, eds. Doenças do Fígado e Vias Biliares. São Paulo: Atheneu, 173193.

  • 11.

    Piscaglia F, Donati G, Serra C, Muratori R, Solmi L, Gaiani S, Gramantieri L, Bolondi L, 2001. Value of splanchnic Doppler ultrasound in the diagnosis of portal hypertension. Ultrasound Med Biol 27: 893899.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Moriyasu F, Nishida O, Ban N, Nakamura T, Sakai M, Miyake T, Uchino H, 1986. Congestion index of the portal vein. AJR 146: 735739.

  • 13.

    Smith JO, Sterling RK, 2009. Systematic review: non-invasive methods of fibrosis analysis in chronic hepatitis C. Aliment Pharmacol Ther 30: 557576.

  • 14.

    Tarzamni MK, Somi MH, Farhang S, Jalilvand M, 2008. Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients. World J Gastroenterol 14: 18981902.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Maia CR, 2000. Anatomia vascular do fígado. Nectoux JL, ed. Ultra-Sonografia Vascular. Rio de Janeiro: Revinter, 305323.

  • 16.

    Zwiebel WJ, 2003. Introdução à Ultra-Sonografia Vascular. Rio de Janeiro: Revinter.

  • 17.

    Goyal N, Jain N, Rachapalli V, Cochlin DL, Robinson M, 2009. Non-invasive evaluation of liver cirrhosis using ultrasound. Clin Radiol 64: 10561066.

  • 18.

    Iwao T, Toyonaga A, Oho K, Tayama C, Masumoto H, Sakai T, Sato M, Tanikawa K, 1997. Value of Doppler ultrasound parameters of portal vein and hepatic artery in the diagnosis of cirrhosis and portal hypertension. Am J Gastroenterol 92: 10121017.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Ohta M, Hashizume M, Kawanaka H, Akazawa K, Tomikawa M, Higashi H, Kishihara F, Tanoue K, Sugimachi K, 1995. Prognostic significance of hepatic vein waveform by Doppler ultrasonography in cirrhotic patients with portal hypertension. Am J Gastroenterol 90: 18531857.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Borges VF, Diniz AL, Cotrim HP, Rocha HL, Salomão FC, 2011. Dopplerfluxometria da veia hepática em pacientes com esteatose não alcoólica. Radiol Bras 44: 16.

  • 21.

    Pierce ME, Sewell R, 1990. Identification of hepatic cirrhosis by duplex Doppler ultrasound value of the hepatic artery resistive index. Australas Radiol 34: 331333.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Sacerdoti D, Merkel C, Bolognesi M, Amodio P, Angeli P, Gatta A, 1995. Hepatic arterial resistance in cirrhosis with and without portal vein thrombosis: relationships with portal hemodynamics. Gastroenterology 108: 11521158.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Araújo AR, 2004. Hepatites B e C em Manaus: Perfil Clínico-Epidemiológico e Distribuição Espacial de Casos Conhecidos Desde 1997 a 2001. Rio de Janeiro: Universidade Federal do Estado do Rio de Janeiro.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Mathiesen UL, Franzén LE, Aselius H, Resjö M, Jacobsson L, Foberg U, Frydén A, Bodemar G, 2002. Increased liver echogenicity at ultrasound examination reflects degree of steatosis but not of fibrosis in asymptomatic patients with mild/moderate abnormalities of liver transaminases. Dig Liver Dis 34: 516522.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    D'Onofrio M, Martone E, Brunelli S, Faccioli N, Zamboni G, Zagni I, Fattovich G, Pozzi Mucelli R, 2005. Accuracy of ultrasound in the detection of liver fibrosis in chronic viral hepatitis. Radiol Med (Torino) 110: 341348.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Thabut D, Moreau R, Lebrec D, 2011. Noninvasive assessment of portal hypertension in patients with cirrhosis. Hepatology 53: 683694.

  • 27.

    Zheng RQ, Wang QH, Lu MD, Xie SB, Ren J, Su ZZ, Cai YK, Yao JL, 2002. Liver fibrosis in chronic viral hepatitis: an ultrasonographic study. World J Gastroenterol 9: 24843489.

  • 28.

    de Oliveira IR, Widman A, Fukushima JT, Saad WA, Gama-Rodrigues JJ, Cerri GG, 2001. Doppler ultrasonography evaluation of paraumbilical vein and portal hypertension. J Radiol 82: 16271631.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Bolondi L, Gandolfi L, Arienti V, Caletti GC, Corcioni E, Gasbarrini G, Labò G, 1982. Ultrasonography in the diagnosis of portal hypertension: diminished response of portal vessels to respiration. Radiology 142: 167172.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Liu GJ, Lu MD, 2010. Diagnosis of liver cirrhosis with contrast-enhanced ultrasound. World J Radiol 2: 3236.

  • 31.

    Bolondi L, Gaiani S, Barbara L, 1991. Accuracy and reproducibilty of portal flow measurement by Doppler US. J Hepatol 13: 269273.

  • 32.

    Zironi G, Gaiani S, Fenyves D, Rigamonti A, Bolondi L, Barbara L, 1992. Value of measurement of mean portal flow velocity by Doppler flowmetry in the diagnosis of portal hypertension. J Hepatol 16: 298303.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Nakanishi S, Shiraki K, Yamamoto K, Koyama M, Kimura N, Nakano T, 2005. Hemodynamics in the portal vein evaluated by pulse wave Doppler ultrasonography in patients with chronic hepatitis C treated with interferon. World J Gastroenterol 11: 396399.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Haktanir A, Cihan BS, Celenk C, Cihan S, 2005. Value of Doppler sonography in assessing the progression of chronic viral hepatitis and in the diagnosis and grading of cirrhosis. J Ultrasound Med 24: 311321.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    O'Donohue J, Ng C, Catnach S, Farrant P, Williams R, 2004. Diagnostic value of Doppler assessment of the hepatic and portal vessels and ultrasound of the spleen in liver disease. Eur J Gastroenterol Hepatol 16: 149155.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Colli A, 1994. Abnormalities of Doppler waveform of the hepatic veins in patients with chronic liver disease: correlation with histologic findings. AJR 162: 833837.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Schneider AR, Teuber G, Kriener S, Caspary WF, 2005. Noninvasive assessment of liver steatosis, fibrosis and inflammation in chronic hepatitis C virus infection. Liver Int 25: 1150.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 142 113 7
Full Text Views 351 7 0
PDF Downloads 76 2 0
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save