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Review
. 2006 Jun 14;12(22):3461-5.
doi: 10.3748/wjg.v12.i22.3461.

Role of microbubble ultrasound contrast agents in the non-invasive assessment of chronic hepatitis C-related liver disease

Scott Grier, Adrian-K-P Lim, Nayna Patel, Jeremy-F-L Cobbold, Howard-C Thomas, Isobel-J Cox, Simon-D Taylor-Robinson
Review

Role of microbubble ultrasound contrast agents in the non-invasive assessment of chronic hepatitis C-related liver disease

Scott Grier et al. World J Gastroenterol. .

Abstract

Patients who are chronically infected with the hepatitis C virus often develop chronic liver disease and assessment of the severity of liver injury is required prior to considering viral eradication therapy. This article examines the various assessment methods currently available from gold standard liver biopsy to serological markers and imaging. Ultrasound is one of the most widely used imaging modalities in clinical practice and is already a first-line diagnostic tool for liver disease. Microbubble ultrasound contrast agents allow higher resolution images to be obtained and functional assessments of microvascular change to be carried out. The role of these agents in quantifying the state of hepatic injury is discussed as a viable method of determining the stage and grade of liver disease in patients with hepatitis C. Although currently confined to specialist centres, the availability of microbubble contrast-enhanced ultrasound will inevitably increase in the clinical setting.

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Figures

Figure 1
Figure 1
Time scale for progression of hepatitis C-related liver disease[3,4].
Figure 2
Figure 2
Ultrasound image of hepatic steatosis, showing increased echotexture of the liver parenchyma in comparison to the right kidney.
Figure 3
Figure 3
Ultrasound image of a typical cirrhotic liver with a shrunken right lobe, a nodular surface (white arrow), surrounding ascites and a heterogeneous echotexture.
Figure 4
Figure 4
Characteristic haemodynamic changes seen in severe chronic liver disease which lead to the early arrival of microbubbles in the liver. Time is measured from injection (1) to arrival in the liver (2).
Figure 5
Figure 5
Hepatic vascular transit times (HVTT) following a bolus injection of a microbubble contrast agent, measured in a volunteer without significant liver disease (upper graph) and a patient with cirrhosis (lower graph). There is a much shorter HVTT in the patient with cirrhosis. Adapted from Lim et al[23].
Figure 6
Figure 6
Graph showing hepatic vascular transit times (HVTT) in patients with mild hepatitis, moderate to severe hepatitis and established cirrhosis. There is progressive shortening of the HVTT with increasing severity of liver disease. Adapted from Lim et al[23].
See this image and copyright information in PMC

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