To study doppler and triphasic CT findings in patients of NASH induced cirrhosis diagnosed on transient elastography

Abstract

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly NAFLD, includes a spectrum from simple steatosis to non-alcoholic steatohepatitis (NASH), fibrosis, and cirrhosis. Given the invasiveness of liver biopsy, noninvasive tools such as transient elastography (TE), Doppler ultrasound, and triphasic CT have emerged as alternatives for staging liver fibrosis. This study aimed to assess Doppler and CT findings in NASH-induced cirrhosis patients diagnosed on TE.

Materials and Methods: This observational study included 51 patients (age >18 years) with NASH-related cirrhosis and liver stiffness >13 kPa on Fibroscan®. Exclusion criteria included viral hepatitis, alcohol use, and renal insufficiency. All participants underwent Doppler ultrasound and triphasic CT scans. Parameters such as hepatic artery resistive index (HARI), portal vein velocity, hepatic vein phasicity, caudate-right lobe ratio (CRL), and liver-to-spleen attenuation ratio were recorded. Statistical analyses were performed using SPSS v23.

Results: Most patients (68.6%) were in the F4 fibrosis stage. A strong positive correlation was observed between Fibroscan and portal vein diameter, while HARI and portal vein velocity were negatively correlated. HARI <0.77 showed 97.1% sensitivity and 90% accuracy in predicting F4 fibrosis. Triphasic hepatic vein waveform decreased with advanced fibrosis. Liver-to-spleen attenuation <0.8 correlated with higher liver stiffness, while CRL >0.65 was seen in advanced fibrosis.

Conclusion: Doppler and CT parameters, especially HARI and portal vein velocity, significantly correlate with Fibroscan scores, enhancing noninvasive diagnosis of advanced NASH-related fibrosis.