Comparação entre a fibrose periportal diagnosticada pelo ultra-som e pela ressonância magnética e a histologia hepática na hipertensão porta esquistossomótica

Abstract

Few studies have compared ultrasound with histology in the evaluation of liver fibrosis in schistosomiasis mansoni, but none has been reported with magnetic resonance imaging. This study was set up to evaluate liver fibrosis using the 3 methods. Fourteen patients attending the Centro de Treinamento e Referência em Doenças Infecciosas (UFMG) andSanta Casa de Misericórdia de Belo Horizonte (MG), from June 2006 to August 2007, have been selected for the study. All patients had advanced hepatosplenic schistosomiasis and were admitted to hospital for surgical treatment of portal hypertension. A standard protocol was filled out with the socio-demographic, clinical and laboratory data of patientsand, thereafter, the information was transferred to a data bank using the software Epi Data 3.1. For statistical analysis the software Statistical Package for Social Sciences (SPSS) was used. Patients were submitted to upper digestive endoscopy, ultrasound (US), magnetic resonance imaging (MRI), surgical wedge liver biopsy, parasitological stool examination and blood tests. Histology of liver fragments and histomorphometry were performed in the Gonçalo Moniz Foundation (FIOCRUZ Salvador, Bahia). For ultraso und, WHOs protocol was applied. For MRI, the ultrasound protocol was adapted by our team to grade liver fibrosis. Hepatic fibrosis was graded as absent, light, moderate and intense by the 3 methods. Histology confirmed the presence of Symmers fibrosis in all cases as did MRI. Ultrasound failed to diagnose periportal fibrosis in one patient. In regard to the intensity ofliver fibrosis there was poor concordance among the 3 methods, except for ultrasound and magnetic resonance which showed moderate concordance in the evaluation of liver fibrosis. In an attempt to improve the concordance, we grouped the grades absent and light, and called them, light, and the grades moderate and intense, and called them, intense. In this scenario, there was moderate concordance between the imaging techniques and histology. Histomorphometry did not separate patients with light from intense liver fibrosis, when it was compared with histology. No correlation was observed between spleen size and the intensity of liver fibrosis, or between a history of esophageal bleedingand fibrosis. Summing up, histology and MRI diagnosed liver fibrosis in all patients, but ultrasound failed to confirm periportal fibrosis in one. A poor concordance in the evaluation of fibrosis was found when the 3 methods were compared. Cases of advanced hepatosplenic schistosomiasis, with light liver fibrosis, diagnosed by histology, were found in the present study. Therefore, the intensity of liver fibrosis is not a reliable marker of disease severity in hepatosplenic schistosomiasis.