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Observational Study
, 19 (3), 183-9
eCollection

Hepatic Artery Resistive Index (HARI) and Non-Alcoholic Fatty Liver Disease (NAFLD) Fibrosis Score in NAFLD Patients: Cut-Off Suggestive of Non-Alcoholic Steatohepatitis (NASH) Evolution

Affiliations
Observational Study

Hepatic Artery Resistive Index (HARI) and Non-Alcoholic Fatty Liver Disease (NAFLD) Fibrosis Score in NAFLD Patients: Cut-Off Suggestive of Non-Alcoholic Steatohepatitis (NASH) Evolution

Claudio Tana et al. J Ultrasound.

Abstract

Purpose of the study: Conventional ultrasound (US) is reliable to reveal the presence of non-alcoholic fatty liver disease (NAFLD), but it is neither sensitive nor specific to reveal fibrosis clues, except in advanced stages where signs of cirrhosis are evident. NALFD fibrosis score is a non-invasive parameter that predicts well the presence of significant fibrosis, but correlations with US parameters are lacking. The aim of this study was, therefore, to compare resistive index of hepatic artery (HARI) of NAFLD patients with different severity degrees of diffuse fatty liver disease vs HARI of controls, and to compare HARI of NAFLD patients with different NAFLD fibrosis scores vs HARI of controls.

Methods: This was a spontaneous, no-profit observational study conducted in our US department between December 2013 and July 2014. Patients with NAFLD with different severity of disease and healthy controls were included. Echogenicity and size of liver and spleen, maximum portal vein velocity, RI, peak systolic velocity (PSV), and end diastolic velocity (EDV) of splenic artery, PSV, EDV, and RI of hepatic artery, and NAFLD fibrosis score were acquired and compared between groups.

Results: HARI was significantly lower in NAFLD patients than controls (p < 0.0001). A significant difference was also found between the groups of NAFLD severity (p < 0.0001). There was also a difference between HARI of NAFLD patients with different NAFLD fibrosis scores vs HARI of controls (p < 0.0001) with a positive correlation between HARI and NAFLD fibrosis score.

Conclusion and discussion: Conventional Doppler US can be helpful to detect NAFLD patients with the risk of fibrous tissue accumulation. HARI tends to exceed the range of controls for patients with NAFLD fibrosis score greater than 0.675. The detection of HARI greater than 0.9 in NAFLD patients, regardless of the US degree of severity of steatosis, might suggest the execution of biopsy to predict the risk of progression to steatohepatitis and fibrous tissue accumulation. Low values of HARI may be expression of lower risk, which does not necessitate any biopsy.

Keywords: Color Doppler; Hepatic artery resistive index; NAFLD fibrosis score; Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis; Ultrasound.

Conflict of interest statement

Dr. Claudio Tana received a Grant from the Italian Society of Ultrasound in Medicine and Biology (SIUMB) for the best oral communication presented at the 25th SIUMB Congress. Informed consent All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. All patients provided written informed consent to enrolment in the study and to the inclusion in this article of information that could potentially lead to their identification. Human and animal studies The study was conducted in accordance with all institutional and national guidelines for the care of humans, and did not include laboratory animals.

Figures

Fig. 1
Fig. 1
a Portal triad with hepatic artery visualization by Color Doppler US (arrows). b Hepatic artery resistive index (HARI), PSV, and EDV assessment for this subject (arrow)
Fig. 2
Fig. 2
Hepatic artery resistive index (HARI) in NAFLD patients with different severity of diffuse fatty liver disease vs controls. mS mild steatosis, MM moderate steatosis; SS severe steatosis. *p < 0.05, **p < 0.01; ***p < 0.001. Asterisk is used to mean comparison between NAFLD patients with different severity of fatty liver disease vs controls. SL vs SM, p < 0.001; SM vs SS, p < 0.001; SL vs SS, p < 0.001
Fig. 3
Fig. 3
Hepatic artery resistive index (HARI) in NAFLD patients with different NAFLD fibrosis scores [low, L (n = 12) <−1.455, mean value = 0.69 ± 0.08; intermediate, I (n = 25) ≥−1.455 to ≤−0.675, mean value = 0.73 ± 0.08; high, H (n = 12) > 0.675, mean value = 0.98 ± 0.02] vs controls (n = 13, mean value = 0.88 ± 0.03). *p < 0.05; **p < 0.01; ***p < 0.001. Asterisk is used to mean comparison between NAFLD patients with different NAFLD fibrosis scores vs controls. B vs I, NS; I vs A, p < 0.001; B vs A, p < 0.001

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