الفهرس 
INTRODUCTION AND AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Chronic Hepatitis C is one of the most intractable clinical problems in Egypt with drastic consequences from huge loss of resources, disabilities and work power losses, due to its high percentage of infection, progressive course and terminal complications.
Diagnosis and grading of hepatic fibrosis/cirrhosis one of the chief clues in selection of the appropriate plan of treatment and follow up of disease regression or progression.
Liver biopsy was one of the earliest and gold standard approaches to evaluate liver fibrosis/cirrhosis; however, it has it’s built in complications and pitfalls being an invasive and multi-channel procedure.
The newly emerged ultrasound technology as TE and SWE now challenge the established role of liver biopsy and limited its role and frequency in the clinical practice.
Transient elastography has multiple limitations and pitfalls, being non real-time modality, also regarding the high percentage of non-interpreted results.
Form the limitations and pitfalls of liver biopsy and those of TE, the need to SWE become and urge.
This study aimed to determine the accuracy of SWE in grading of liver fibrosis/cirrhosis in chronic hepatitis C patients. Being 2D real-time ultrasound modality implemented on ultrasound machines improves the accuracy of the modality.
The study population were a series of 161 chronic HCV patients 112 males and 49 females their ages ranged between 23-63 years with mean age of 43 years, presented to the outpatient and sovaldi project
clinics in National liver institute and Shebien Elkom Teaching Hospital and 30 healthy control 25 males and 5 females their age ranged from 24-61 years with mean age 42years.
Full history, clinical examination and laboratory investigations done for all patients to include and exclude the subjects for the study and decrease factors which might lead to erroneous measurements in liver stiffness such as congestive heart failure, previous TACE or microwave or chemoembolization of liver tumors.
Biopsy taken by semiautomatic gun, examined and reported by specialist according to the METAVIR scoring system. TE was done and Reported by a specialist, few were excluded from both due to ascites, bleeding tendency and obesity, hence the added value of SWE to overcome some of these limitations.
SWE was done for those patients and for healthy control subjects using Philips iU22 x Matrix ultrasound system in the radiology department, national liver institute, measurements of liver fibrosis/cirrhosis obtained quantitatively in KPs, ten measurements at least obtained in right lobe of the liver especially segment V and VIII with the patients holding breath in inspiratory phase, the average is recorded for further interpretation and processing .
The patients were categorized according to their quantitative measurements into 5 types, no fibrosis (F0) healthy control and (22) CHC patient, F1 (33) CHC patient, F2 (18) CHC patient, F3 (38) CHC patient and F4 (50) CHC patient.
Multiple correlations and ROC curves were held between the patients and control group from one side and between patients themselves from the other side to judge the accuracy of our modality in comparison to liver biopsy as a gold standard and TE as competing modality.
Results declared that SWE show significant discrimination between no or mild fibrosis (F0-F1) and significant fibrosis (≥F2) with AUROCs 0.994 and P value <.0001. The cut-off value is <5.73 KPs with sensitivity 100% and specificity 93.22% with PPV 95.7% and NVP 100% which is important clue in the clinical practice hence significant fibrosis should initiate antiviral protocol therapy.
The study show significant discrimination between F2 and F3 (severe fibrosis), AUROCs was 0.995 and P value <.0001 with sensitivity 97.3% and specificity 100%
In this study SWE differentiate significantly between severe fibrosis F3 and cirrhosis F4, AUROCs was 0.952 and P value <.0001 the cut-off value was < 20.2 KPs with sensitivity 99.0% and specificity 93%. This study show very strong correlation between SWE and liver biopsy in assessment of liver fibrosis/cirrhosis, and there was very strong agreement between them (Kendall’s tau-b was 0.892 with p-value >0.001-Spearman rho (ρ) value was 0.941 and p-value >0.001-Weighted Kappa (k) test value was 0.835). There was also very strong correlation between SWE and TE in assessment of liver fibrosis/cirrhosis, and there was very strong agreement between them (Kendall’s tau-b was 0.902 with p-value >0.001-Spearman rho (ρ) value was 0.947and p-value >0.001-Weighted Kappa (k) test value was 0.873). In conclusion SWE overcome errors of biopsy and limitations of TE, this study show high accuracy of SWE in grading of liver fibrosis/cirrhosis in chronic hepatitis C patients.
SWE can replace liver biopsy in assessment of liver fibrosis/cirrhosis being noninvasive and regarding its high accuracy. SWE can replace TE in assessment of liver fibrosis/cirrhosis being real-time technique and regarding its high accuracy. Real-time SWE show improved separation and discrimination of fibrosis/cirrhosis stages as a result of the use of shear waves with greater bandwidths and its quantitative numerical results. SWE is recommended for screening of liver fibrosis/cirrhosis being noninvasive, outpatient technique with no morbidity or mortality in contrast to liver biopsy. SWE is recommended for follow up of liver fibrosis/cirrhosis as it can predict the incidence of HCC, oesophageal varices by measuring liver stiffness in various segments of the liver.