Liver fibrosis assessment: a correlation of fibro scan values with gray scale assessment of portal vein

Yayati Pimpalwar, Akhilesh Rao


Background: FibroScan is an expensive modality with excellent accuracy for diagnosis of cirrhosis by measuring liver stiffness. In less developed countries it is not a financially viable method for fibrosis measurement. The aim of this study is to compare and correlate FibroScan values with gray scale sonographic assessment of portal vein calibre diameter which can be done using a basic ultrasonography machine.

Methods: Prospective review of 124 patients with chronic liver disease done between Dec 2015 to May 2016 with the objective of correlating FibroScan values with gray scale assessment of portal vein.

Results: In our study 50 patients had liver stiffness scores of > or = 7.5 kPa and above. A total of 45 patients had a respiratory phase variation of portal vein calibre of < 20%. Out of these, 37 patients had a liver stiffness score of 7.5 kPa or above. These 37 patients were correctly classified by portal vein calibre variability as having moderate to severe fibrosis. The results of this study revealed a significant correlation (Pearson coefficient, r = -0.617, p= 0.01) between calibre variation of the portal vein and FibroScan scores. We also noted that in presence of mild fibrosis as predicted by lower FibroScan scores, PV calibre variation is not a reliable indicator of mild fibrosis.

Conclusions: We propose that, in less developed countries, gray scale assessment of portal vein diameter using any low cost ultrasound machine can be used as an optimal method for predicting moderate to severe liver fibrosis.


FibroScan, Liver fibrosis, Portal vein calibre variation, Transient elastography

Full Text:



Afdhal NH. Fibroscan (Transient Elastography) for the Measurement of Liver Fibrosis. Gastroenterol Hepatol. 2012;8(9):605-7.

Lupsor M, Badea R, Stefanescu H, Sparchez Z, Serban A, Maniu A et al. The Diagnostic Performance of Ultrasonic Transient Elastography for Noninvasive Assessment of Liver Fibrosis in 1138 Chronic Hepatitis C Patients. Ultrasound in Medicine Biol. 2011;37(8):S81.

Sandrin L, Fourquet B, Hasquenoph J, Yon S, Fournier C, Mal F et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound in Medicine Biology. 2003;29(12):1705-13.

Pinzani M. Non-invasive evaluation of hepatic fibrosis: don't count your chickens before they're hatched. Gut. 2006;55(3):310-2.

Ferraioli G, Parekh P, Levitov A, Filice C. Shear Wave Elastography for Evaluation of Liver Fibrosis. Journal of Ultrasound in Medicine. 2014;33(2):197-203.

Foucher J. Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut. 2006;55(3):403-8.

Shi K, Fan Y, Pan Z, Lin X, Liu W, Chen Y, et al. Transient elastography: a meta-analysis of diagnostic accuracy in evaluation of portal hypertension in chronic liver disease. Liver International. 2012;33(1):62-71.

Ganne-Carrié N, Ziol M, de Ledinghen V, Douvin C, Marcellin P, Castera L et al. Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases. Hepatol. 2006;44(6):1511-7.

Bureau C, Metivier S, Peron JM, Robic MA, Rouquet O, Dupuis E. et al. Prospective assessment of liver stiffness for the non-invasive prediction of portal hypertension (abstract). J Hepatol. 2007;46:S34.

Bolondi L, Mazziotti A, Arienti V. Ultrasonographic study of portal venous system in portal hypertension and after porto-systemic shunt operations. Surgery. 1984;95:261-9

Kazemi F, Kettaneh A, N’Kontchou G, Pinto E, Ganne-Carrie N, Trinchet JC. et al. Liver stiffness measurement selects patients with cirrhosis at risk of bearing large oesophageal varices. J Hepatol. 2006;45:230-5.

Talwalkar J, Kurtz D, Schoenleber S, West C, Montori V. Ultrasound-Based Transient Elastography for the Detection of Hepatic Fibrosis: Systematic Review and Meta-analysis. Clinical Gastroenterology and Hepatology. 2007;5(10):1214-20.

Castera, L, Bernard PH, Le Bail B, Foucher J, Merrouche W, Couzigou, P. et al. What is the best non-invasive method for early prediction of cirrhosis in chronic hepatitis C? Prospective comparison between Fibroscan and serum markers (Lok index, APRI, AST/ALT ratio, platelet count and Fibrotest) (abstract). Hepatol. 2007;46:156A.

Vizzutti F, Arena U, Romanelli RG, Rega L, Foschi, M., Colagrande S. et al. Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis. Hepatol. 2007;45:1290-7.

Carrion JA, Navasa M, Bosch J, Bruguera M, Gilabert R, and Forns X. Transient elastography for diagnosis of advanced fibrosis and portal hypertension in patients with hepatitis C recurrence after liver transplantation. Liver Transpl. 2006;12: 1791-8.