الفهرس 
Hepatitis C VirusOnly 14 pages are availabe for public view
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Abstract
Ultrasonography should be the first radiographic study performed in the evaluation of patients with chronic liver disease and those suspected to have cirrhosis, because it is the least expensive and does not pose a radiation exposure risk or involve intravenous contrast with the potential for nephrotoxicity as does computed tomography (CT).
Doppler Abdominal Ultrasonography is a non-invasive, widely available modality that provides valuable information regarding the gross appearance of the liver and blood flow in the portal vein, hepatic veins, hepatic artery and splenic vessels such patients.
The use of Doppler Ultrasonography in diagnosis and staging of chronic viral liver disease has been based on the hypothesis that alteration of liver haemodynamics due to chronic inflammatory changes may indirectly reflect histological alterations.
The diagnostic accuracy of Doppler US for liver fibrosis and early cirrhosis in patients with chronic virus hepatitis and compensated liver function has not been fully investigated.
To fulfill the aim of the work, this study was designed to evaluate the value of Doppler sonography in assessing the staging of fibrosis in chronic hepatitis C viral infection (as detected by histopathological examination) in Egypt.
This study was conducted in Tropical Medicine Department, Ain Shams University, in the period from August 2012 to September 2013. We performed our study on healthy 30 individuals and selected 60 patients of chronic liver disease with proven chronic hepatitis C virus infection by history taking, clinical manifestations and positive laboratory investigations for chronic HCV infection to fulfill the predesigned inclusion criteria.
All patients were subjected to the following; careful history, thorough clinical examination and laboratory investigations [liver enzymes (AST and ALT), serum albumin, INR, total and direct bilirubin, complete blood picture, viral markers (HCV-Ab, HBs-Ag and quantitative PCR for HCV-RNA), lipid profile (fasting serum cholesterol and serum triglycerides) and glucose profile (fasting blood sugar and 2-hours post-prandial blood glucose]. Abdominal ultrasound and histopathological examination of ultrasound guided liver biopsy were done for all cases.
As well as, Doppler ultrasound assessment was done. The following parameters were measured; portal vein diameter (PVD), portal vein cross sectional area (PVCSA), portal vein velocity (PVV), portal congestive index (PVCI), hepatic artery resistance index (HARI), splenic artery resistive index (SARI), Fibrosis index (FI), modified liver vascular index (MLVI) and portal hypertension index (PHI).
Concerning the clinical presentations of the studied group; abdominal pain and easy fatigability were the main complaints in the study group 61.7% and 58.3%, respectively. Hepatomegaly was detected in 21 patients (35%) and splenomegaly was detected in 18 patients (30%).
The current study revealed that the abdominal US parameters (liver size, echogenicity, liver surface and splenic size) were statistically significantly different in the Study group when compared to the control group.
Concerning the Doppler parameters, there was a highly significant statistical difference between study group and control group as regards to all studied Doppler ultrasonographic parameters. Main portal vein trunk diameter (MPVD), portal vein cross sectional area (PVCSA), portal congestive index (PVCI), Fibrosis index (FI), hepatic and splenic arteries resistivity indices (HARI & SARI), and portal hypertension index (PHI)) were higher in cases than control while mean portal vein velocity (MPVV), modified liver vascular index (MLVI) were higher in control than case group.
By comparing mean valuesof Modified liver vascular index (LVI), Portal Congestive index, Portal hypertension index and Fibrosis Index in different metavir stages from F1 to F4. MLVI had significantly decreased from F1 to F4, While, each of PCI, PHI and FI were significantly increased from F1 to F4.
The present work designed a logistic stepwise Multi regression analysis tostudy the role of abdominal and Doppler ultrasonographic parameters in the prediction of the degree of fibrosis among the study group.
By abdominal US, there were only 2 parameters namely the liver echogenicity and liver surface that were found to predict significantly the degree of fibrosis. While by Doppler US, all the measured parameters (PVD, PVCSA, MPVV, HARI, SARI, FI, PVCI, MLVI and PHI) must be used only in combination for the prediction of the degree of fibrosis because these parameters showed overall significance with no high significance for any of them alone.
By using the proposed model for prediction of fibrosis in post-HCV in chronic liver disease patients, it was found that; serum albumin in laboratory parameters, liver echogenicity in ultrasonographic parameters and portal congestive index in Doppler parameters could be used to predict the degree of fibrosis.
It has been concluded that, Doppler ultrasonography is helpful in assessment of the degree of fibrosis in patients with chronic hepatitis C. The following indices namely, portal hypertension index, portal congestive index, modified liver vascular index and fibrosis index are recommended in follow up of those patients.