Evaluation of Chronic Liver Disease: Does Ultrasound Scoring Criteria Help?

Noninvasive approaches for assessment of liver histology include routine laboratory tests and radiological evaluation. The purpose of our study was to determine the utility of a simplified scoring system based on routinely evaluated ultrasound features for the evaluation of chronic liver disease and correlate it with the histological findings. For this cross-sectional analytical study the data was collected prospectively by nonprobability purposive sampling technique. The ultrasound variables/parameters and their assigned scoring system that was a modified version adopted from published literature were evaluated. Sensitivity, specificity, positive and negative predictive values of the liver morphological score and combined score of liver morphology and sizes was determined using stage and grade as reference standard. Our results show a high sensitivity and PPV of liver morphological sonographic evaluation for the staging and grading of CLD respectively thus supporting it as a screening diagnostic strategy. Of the three liver morphology variables, specificity of liver surface evaluation was highest for the stage of fibrosis and grade of inflammation. The simplified ultrasound scoring system evaluated in our study is clinically relevant and reproducible for differentiating patients with CLD with mild or no fibrosis from moderate to severe fibrosis. 1. Introduction The common causes of chronic liver disease are viral hepatitis, alcohol abuse, and metabolic disorders. These result in hepatocytes damage, the consequence of which may be liver fibrosis, cirrhosis, and/or hepatocellular carcinoma [1]. The disease is a substantial cause of morbidity and mortality in the developing countries. Accurate evaluation of the severity of disease is crucial for treatment planning, that is, commencement of antiviral treatment and prognostication [2]. Noninvasive approaches for assessment of liver histology include routine laboratory tests like serum markers, liver functions test, and radiological evaluation of liver. Liver histological diagnosis based on needle biopsy determines the inflammatory activity (grading), the extent of fibrosis (staging), and other comorbidities [3]. But the procedure of ultrasound guided liver biopsy is invasive with about 1% risk of significant complications like postinterventional hemorrhage, bile leak, infection, and injury to adjacent organs with less than 0.1% mortality [4]. Sampling errors may also be encountered since the liver parenchymal damage in chronic hepatitis is not homogeneous. In addition there is possibility of inter- and