Diagnostic accuracy of doppler waveform pattern of hepatic veins in detection of cirrhosis in patient with hepatitis C taking histopathology as gold standard
DOI:
https://doi.org/10.59736/IJP.23.04.1005Keywords:
Diagnostic Accuracy, Doppler Ultrasound, Hepatitis C, Hepatic Vein Waveform, Liver Cirrhosis, Non-Invasive DiagnosisAbstract
Background: Chronic hepatitis C infection frequently progresses to liver cirrhosis. Color Doppler ultrasound provides a non-invasive method to detect cirrhosis by identifying abnormal hepatic vein waveform patterns, offering an adjunct to invasive liver biopsy.
Methods: This descriptive cross-sectional validation study was conducted at Department of Radiology, Mardan Medical Complex from January to September of 2025. A total of 96 patients aged between 18 and 60 years with chronic hepatitis C infection were included using non-probability consecutive sampling. Patients with esophageal varices, portal vein thrombosis, or hepatocellular cancer were excluded. Color Doppler ultrasound was performed using a 3.5 MHz transducer to assess hepatic venous waveform patterns. Abnormal waveforms were defined as biphasic (reduced phasicity) or monophasic (flat) patterns, compared to normal triphasic waveforms. Liver biopsy was performed under ultrasound guidance for histopathological confirmation. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated using histopathology as the gold standard.
Results: The mean age was 50.16 ± 5.99 years with 53 (55.2%) males and 43 (44.8%) females. Mean duration of hepatitis C infection was 36.83 ± 15.04 months. Doppler ultrasound showed positive findings in 59 (61.5%) patients while histopathology confirmed cirrhosis in 54 (56.3%) cases. The diagnostic performance revealed sensitivity of 90.7% (95% CI: 79.7-96.9%), specificity of 76.2% (95% CI: 60.5-87.9%), positive predictive value of 83.0%, negative predictive value of 86.5%, and diagnostic accuracy of 84.3%. Significant associations were found in patients ≤50 years (p=0.03) and both genders (p<0.001), but not with HCV duration (p=0.12).
Conclusion: Color Doppler ultrasound demonstrated high sensitivity and moderate specificity for detecting liver cirrhosis in hepatitis C patients. It represents a valuable first-line screening tool that can reduce reliance on invasive liver biopsies by approximately 76%, particularly beneficial in resource-limited settings where integration with elastography or serum biomarkers may enhance accuracy.
References
Yang J, Qi JL, Wang XX, Li XH, Jin R, Liu BY, et al. The burden of hepatitis C virus in the world, China, India, and the United States from 1990 to 2019. Front Public Health. 2023; 11:1041201.
Asghar MS, Ahsan MN, Rasheed U, Hassan M, Jawed R, Abbas MB, et al. Severity of Non-B and Non-C Hepatitis Versus Hepatitis B and C Associated Chronic Liver Disease: A Retrospective, Observational, Comparative Study. Cureus. 2020; 12(12): e12294.
Bouayad A, Laamiri FZ, Elmoumou L, Rezzouk B, Hadef R. Prevalence of liver fibrosis and cirrhosis in 699 Moroccan patients with chronic hepatitis C. Pan Afr Med J. 2021;39(1):32-8.
Koumar L, Senthamizhselvan K, Barathi D, Verma A, Rao P, Selvaraj J, et al. Portal Vein Thrombosis in Patients with Cirrhosis of the Liver: Prevalence and Risk Factors. Cureus. 2023; 15(12): e50134.
Zhang M, Jin H, Cao J, Ren R, Jia M, Yang Y, et al. Application of Ultrasound Elastography in Assessing Portal Hypertension. Diagnostics. 2022; 12(10):2373-9.
Mehta SK, Sunny S, Nafe Z, Priyadarshi K, Singh PK. Trends of Chronic Liver Disease in a Tertiary Care Centre in the Eastern Part of India: A Retrospective Study. Cureus. 2023;15(3): e36662.
Rudra OS, Jindal A, Sarin SK. Use of Noninvasive Tests to Assess Clinically Significant Portal Hypertension and Response to Beta-Blockers. Gastro Hep Adv. 2025;4(10):100761.
Ahmad MW, Rashid N, Dogar IH, Umer M, Shehzadi HS, Ahmad R. Diagnostic Accuracy of Doppler Scan of Portal Vein to Determine Early Cirrhosis of Hepatitis-C Patients in Gujranwala Population. Pak J Med Health Sci. 2023; 17(2):212-4.
Yasmin T, Sultana S, Ima MN, Islam MQ, Roy SK, Rafat S. Correlation between Hepatic Vein Waveform Changes on Doppler Ultrasound and the Severity of Diseases in Cirrhotic Patients. J Med. 2021;22(2):100-6.
Sugawara Y, Yoshihisa A, Ishibashi S, Matsuda M, Yamadera Y, Ohara H, et al. Liver Congestion Assessed by Hepatic Vein Waveforms in Patients with Heart Failure. CJC Open. 2021;3(6):778-86.
Latheef S, Patil S, Sajjan S, Kolekar P. Correlation Between Hepatic Waveform Changes on Doppler Ultrasound and Disease Severity in Cirrhotic Patients. Cureus. 2025;17(5): e83658.
Nadeem S, Wasim S, Manzoor S, Ata H, Raja R, Arooj S. Diagnostic accuracy of hepatic vein resistive index in detection of hepatic fibrosis in patients of chronic liver disease. J Rawalpindi Med Coll. 2020;24(3):278-82.
Khan AA, Nasir H, Afzaal MH, Amin S. Doppler waveform abnormalities of hepatic veins with histological changes in chronic hepatitis C infection. J Rawalpindi Med Coll. 2016;20(3):217-20.
Azam S, Azam R, Zafar SI, Mohsin I, Sadiq H, Fatima S. Doppler Analysis of Hepatic Venous Waveforms: A Reliable Way to Diagnose and Guess the Size of Esophageal Varices in People with Cirrhosis of the Liver. Pak Armed Forces Med J 2024; 74(3): 602-6.
Malik U, Farhan S, Nadeem MA. Diagnostic accuracy of Doppler ultrasonography for diagnosing esophageal varices in cirrhotic patients. Esculapio J Serv Inst Med Sci. 2023;11(1):25–7.
Khan NH, Zunair, Khan AA, Ameer S. Diagnostic accuracy of Doppler ultrasound in detecting tumor thrombus in inferior vena cava (IVC) in renal cell carcinoma. J Fatima Jinnah Med Coll. 2016;10(3):82–6.
Charoenchue P, Na Chiangmai W, Amantakul A, Wanchaitanawong W, Chitapanarux T, Pojchamarnwiputh S. Prediction of esophageal varices in viral hepatitis C cirrhosis: performance of combined ultrasonography and clinical predictors. Int J Biomed Imaging. 2023; 2023:7938732.
Sena CM, Gonçalves L, Seiça R. Methods to evaluate vascular function: a crucial approach towards predictive, preventive, and personalised medicine. EPMA J. 2022;13(2):209-35.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Hina Fida, Zubair Janan, Sumaira Noureen, Laila Khan
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
