The study included 201 consecutive patients with liver cirrhosis admitted to two Liver Units of university/primary hospitals in Southern Italy, between the period from October 2004 to June 2007 who fulfilled the following criteria: patients' willingness to undergo previously established screening; endoscopic, US and laboratory examinations performed within four weeks of each other; prospective follow-up for a minimum period of 6 months.
Of initial patients, 26 were kept out because their US and laboratory examinations had been previously performed in different centres. Fourteen patients, who had undergone endoscopic esophageal variceal ligation therapy, and eight who had received beta-blockers before US imaging, were also excluded from the study because prior treatment might have caused a change in lesion features.
The remaining 153 patients formed the study population (85 males) whose age ranged from 31 to 85 years (median age 66 years). Chronic liver damage in these patients was caused by hepatitis B (n = 9), hepatitis C (n = 114), alcohol abuse (n = 20) or unknown etiology, likely NonAlcoholic Steato Hepatitis (NASH), (n = 8). Ninety two patients had compensated cirrhosis of the liver. For 121 patients, the diagnosis of cirrhosis was established by contextual clinical (spider nevi, organomegaly) laboratory (low total cholesterol and pseudocholinesterase levels, reduced white blood cell count, globulin/albumin ratio > 1), antecedent imaging data and for 32 patients by biopsy. The non-invasive assessment of liver cirrhosis was blindly performed de novo to all patients by radiologists on the basis of US/US-doppler examinations (coarse echo-texture, nodularity presence, increased caudate/right lobe ratio, hypertrophy of the left lobe, characterized by a rounded inferior marginal edge, and portal vein enlargement with decreased flow velocity, absence of a normal doppler waveform, hepatofugal flow). No evidence of hepatocellular carcinoma at the first hepatic decompensation was detected. Renal insufficiency was properly excluded.
Of initial patients, 26 were kept out because their US and laboratory examinations had been previously performed in different centres. Fourteen patients, who had undergone endoscopic esophageal variceal ligation therapy, and eight who had received beta-blockers before US imaging, were also excluded from the study because prior treatment might have caused a change in lesion features.
The remaining 153 patients formed the study population (85 males) whose age ranged from 31 to 85 years (median age 66 years). Chronic liver damage in these patients was caused by hepatitis B (n = 9), hepatitis C (n = 114), alcohol abuse (n = 20) or unknown etiology, likely NonAlcoholic Steato Hepatitis (NASH), (n = 8). Ninety two patients had compensated cirrhosis of the liver. For 121 patients, the diagnosis of cirrhosis was established by contextual clinical (spider nevi, organomegaly) laboratory (low total cholesterol and pseudocholinesterase levels, reduced white blood cell count, globulin/albumin ratio > 1), antecedent imaging data and for 32 patients by biopsy. The non-invasive assessment of liver cirrhosis was blindly performed de novo to all patients by radiologists on the basis of US/US-doppler examinations (coarse echo-texture, nodularity presence, increased caudate/right lobe ratio, hypertrophy of the left lobe, characterized by a rounded inferior marginal edge, and portal vein enlargement with decreased flow velocity, absence of a normal doppler waveform, hepatofugal flow). No evidence of hepatocellular carcinoma at the first hepatic decompensation was detected. Renal insufficiency was properly excluded.
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