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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

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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.

Sommario

Scopo dello studio

L’ecografia convenzionale è risultata affidabile nel rilevare la presenza di steatosi epatica, tra cui la forma non alcolica (NAFLD), ma non è né sensibile né specifica nel rivelare indizi suggestivi di fibrosi, tranne che in fase avanzata dove sono presenti segni conclamati di cirrosi. Il NALFD fibrosis score è un parametro non invasivo che predice bene la presenza di fibrosi significativa, ma non ci sono dati in letteratura riguardanti una possibile correlazione con i parametri ecografici. Lo scopo di questo studio è stato quindi quello di confrontare HARI dei pazienti con NAFLD a differente grado di severità di steatosi epatica vs l’HARI dei controlli, e di confrontare HARI dei pazienti affetti da NAFLD a differente NAFLD fibrosis score vs l’HARI dei controlli.

Metodi

Studio osservazionale spontaneo, no-profit condotto nel nostro Dipartimento tra il dicembre 2013 e il luglio 2014. Venivano inclusi i pazienti con NAFLD a differente severità di malattia e controlli sani. Venivano registrati e confrontati tra gruppi i seguenti parametri: ecogenicità, dimensioni del fegato e della milza, velocità massima della vena porta, indice di resistenza (RI), velocità di picco sistolico (PSV), velocità tele-diastolica finale (EDV) di arteria splenica, e PSV, EDV e RI dell’arteria epatica (HARI) ed il NAFLD fibrosis score.

Risultati

HARI risultava significativamente più basso nei pazienti affetti da NAFLD rispetto ai controlli (p < 0.0001). Una differenza significativa veniva trovata anche tra i gruppi a differente severità di steatosi (p < 0.0001). Veniva riscontrata anche una differenza tra HARI dei pazienti con NAFLD a differente NAFLD fibrosis score vs HARI dei controlli (p < 0.0001) con una correlazione positiva tra HARI e NAFLD fibrosis score.

Conclusione e discussione

L’ecografia Doppler può essere utile per individuare pazienti con NAFLD a rischio di evoluzione fibrotica. HARI tende a superare i valori dei controlli per i pazienti con NAFLD fibrosis score superiore a 0.675. La rilevazione di HARI superiore a 0.9 nei pazienti con NAFLD, indipendentemente dal grado di severità di steatosi, potrebbe indicare l’esecuzione della biopsia al fine di prevedere il rischio di progressione a steatoepatite e fibrosi. Bassi valori di HARI potrebbero essere invece espressione di rischio più basso che non necessiterebbero di alcuna biopsia.

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Authors and Affiliations

  1. Internal Medicine Unit, Guastalla Hospital, AUSL Reggio Emilia (RE), Reggio Emilia, Italy

    Claudio Tana & Mauro Silingardi

  2. Internal Medicine Unit, ASL 5 Spezzino, La Spezia, Italy

    Marco Tana

  3. Unit of Ultrasound in Internal Medicine, “G. d’Annunzio” University, Chieti, Italy

    Stefano Rossi & Cosima Schiavone

Authors
  1. Claudio Tana
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  2. Marco Tana
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  3. Stefano Rossi
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  4. Mauro Silingardi
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  5. Cosima Schiavone
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Corresponding author

Correspondence to Claudio Tana.

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Conflict of interest

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.

Additional information

This article won prize for the best oral communication at the 25th National Congress of the Italian Society of Ultrasound in Medicine and Biology (SIUMB).

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Tana, C., Tana, M., Rossi, S. et al. 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. J Ultrasound 19, 183–189 (2016). https://doi.org/10.1007/s40477-016-0203-8

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  • DOI: https://doi.org/10.1007/s40477-016-0203-8

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