Original Article
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 27, 2014; 6(7): 496-503
Published online Jul 27, 2014. doi: 10.4254/wjh.v6.i7.496
CEUS and Fibroscan in non-alcoholic fatty liver disease and non-alcoholic steatohepatitis
Sila Cocciolillo, Giustino Parruti, Leonardo Marzio
Sila Cocciolillo, Leonardo Marzio, Digestive Physiopathology Unit, Gabriele d’Annunzio University, Pescara Civic Hospital, 65124 Pescara, Italy
Giustino Parruti, Infectious and Tropical Diseases Unit, Pescara Civic Hospital, 65124 Pescara, Italy
Author contributions: Cocciolillo S contributed to the recruitment of patients, acquisition of data, design the study, analysis and interpretation of the data and writing of the draft manuscript; Parruti G supervised and analyzed data from fibroscan; Marzio L contributed to the conceptual design, provided administrative support and overall supervision of the study, analyzed the data and critically revised the manuscript.
Correspondence to: Sila Cocciolillo, MD, Digestive Physiopathology Unit, Gabriele d’Annunzio University, Pescara Civic Hospital, Via Fonte Romana 8, 65124 Pescara, Italy. s_sila2000@yahoo.it
Telephone: +39-329-2066508 Fax: +39-85-4295547
Received: April 18, 2014
Revised: June 12, 2014
Accepted: June 27, 2014
Published online: July 27, 2014
Abstract

AIM: To determine intra-hepatic blood flow and liver stiffness in patients with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) using contrast-enhanced ultrasound and fibroscan.

METHODS: This prospective study included 15 patients with NAFLD, 17 patients with NASH and 16 healthy controls. In each patient, real-time ultrasound was used to locate the portal vein (PV) and the right liver lobe, and 5 mL of SonoVue® was then injected intravenous in a peripheral vein of the left arm over a 4-s span. Digital recording was performed for 3 min thereafter. The recording was subsequently retrieved to identify an area of interest in the PV area and in the right liver parenchyma (LP) to assess the blood flow by processing the data using dedicated software (Qontrast®, Bracco, Italy). The following parameters were evaluated: percentage of maximal contrast activity (Peak%), time to peak (TTP, s), regional blood volume (RBV, cm3), regional blood flow (RBF, cm3/s) and mean transit time (MTT, s). At 24-48 h post-injection, liver stiffness was evaluated using Fibroscan and measured in kPa. The statistical evaluation was performed using Student’s t test.

RESULTS: In the PV, the Peak%, RBV and RBF were significantly reduced in the NAFLD and NASH patients compared with the controls (Peak%: NAFLD 26.3 ± 6.6, NASH 28.1 ± 7.3 vs controls 55.8 ± 9.9, P < 0.001; RBV: NAFLD 4202.3 ± 3519.7, NASH 3929.8 ± 1941.3 vs controls 7473 ± 3281, P < 0.01; RBF: NAFLD 32.5 ± 10.8, NASH 32.7 ± 12.1 vs controls 73.1 ± 13.9, P < 0.001). The TTP in the PV was longer in both patient groups but reached statistical significance only in the NASH patients compared with the controls (NASH 79.5 ± 37.8 vs controls 43.2 ± 30, P < 0.01). In the LP, the Peak%, RBV and RBF were significantly reduced in the NAFLD and NASH patients compared with the controls (Peak%: NAFLD 43.2 ± 7.3, NASH 41.7 ± 7.7 vs controls 56.6 ± 6.3, P < 0.001; RBV: NAFLD 4851.5 ± 2009, NASH 5069.4 ± 2292.5 vs controls 6922.9 ± 2461.5, P < 0.05; RBF: NAFLD 55.7 ± 10.1, NASH 54.5 ± 12.1 vs controls 75.9 ± 10.5, P < 0.001). The TTP was longer in both patient groups but did not reach statistical significance. The MTT in both the PV and LP in the NAFLD and NASH patients was not different from that in the controls. Liver stiffness was significantly increased relative to the controls only in the NASH patients (NASH: 6.4 ± 2.2 vs controls 4.6 ± 1.5, P < 0.05).

CONCLUSION: Blood flow derangement within the liver present not only in NASH but also in NAFLD suggests that a vascular flow alteration precedes liver fibrosis development.

Keywords: Non-alcoholic fatty liver disease, Non-alcoholic steatohepatitis, Contrast-enhanced ultrasound, Fibroscan, Hepatic blood flow, Liver stiffness

Core tip: The use of contrast-enhanced ultrasound (CEUS) assisted by dedicated software (Qontrast®) in combination with Fibroscan examination could provide a non-invasive tool to evaluate the level of fatty-liver disease. In this study, we found that there were reductions in portal and intra-parenchymal blood flow in patients affected by non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH), whereas liver stiffness was increased only in NASH patients. Qontrast®-assisted CEUS could be used to quantify early changes in intra-parenchymal liver flow before the onset of fibrosis.