Preliminary Study Of CEUS In The Evaluation Of Hepatic Microcirculation In Non-alcoholic Fatty Liver Disease

Objective: The aim of this study was finding a non-invasive examination of hepatic microcirculation changes in non-alcoholic fatty liver disease by analyzing the time-intensity curve(TIC)of hepatic parenchymal perfusion and hepatic vascular transit time using contrast-enhanced ultrasonography(CEUS).Materials and methods: Forty-three patients with NAFLD were diagnosed by FibroScan combined with ultrasound,and 10 of them were confirmed by liver biopsy.Forty-three patients with NAFLD were enrolled as a case group,and 10 patients with non-hepatic disease who underwent CEUS examination were enrolled as a contral group in the same period.The auxiliary software performs perfusion parameter calculation on the selected liver parenchymal area(ROI)and plots the time-intensity curve.The parameters related to intrahepatic blood flow are as follows: echo is the contrast wave intensity,rise time(RT)is the signal enhancement time,peak intensity(PI)is the maximum enhancement of liver parenchyma,half of the peak intensity time(TPI/2)is the time required to reach half of the peak intensity,time to peak(TTP)is the time required for the enhanced signal to reach the maximum intensity,the slope(Wis)is the slope of the contrast curve,mean transit time(MTT)is the transit time of the contrast agent in the parenchyma and the area under the local hepatic parenchymal curve(AUC).Artificial assisted calculations are hepatic artery strengthen time(HAT),portal vein strengthen time(PVT),right hepatic vein strengthen time(HVT).And the strengthen times were used to calculate the difference in strengthen time between the portal vein and the right hepatic vein(?T1),the hepatic artery and the right hepatic vein(?T2)and the portal vein and the hepatic artery(?T3).Simultaneous collection of serological indicators are aspartate aminotransferase(ALT),alanine aminotransferase(AST),alkaline phosphatase(ALP),r-glutamyltranspeptidase(GGT),total bilirubin(TBil),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),fasting blood glucose(Glu),fasting insulin(INS),uric acid(UA),high-sensitivity C-reactive protein(hs-CRP),25-hydroxy vitamin D(25-OH-VD)and human indicators are height,weight,waist circumference.Results:(1)The time required for the NAFLD case group to reach 1/2 peak intensity(TPI/2)was lower than that of non-liver disease control group.The difference between the two groups was statistically significant(P<0.05);while the difference in strengthen time between the portal vein and the hepatic artery(? T3)in NAFLD was higher than that of the non-liver disease control group,the difference between the two groups was statistically significant(P<0.05).(2)Compared with non-hepatic disease control group,there were statistically significant differences among the 10 indicators,consisting of ALT,AST,GGT,TBIL,hs-CRP,TC,LDL-C,HDL-C,UA and Glu,in the NAFLD case group(P<0.05),and 9 indicators,consisting of hs-CRP,ALT,AST,GGT,TBIL,TC,LDL-C,UA and Glu,were higher than those in the non-hepatic disease control group,and the HDL-C index was lower than that in the non-hepatic disease control group.(3)Although there were no statistical differences in AUC,Wis and PI values,they were lower than the non-hepatic disease control group by about 50% in the NAFLD case group.Conclusions: Some CEUS parameters in NAFLD patients,such as the time required by1/2 peak intensity and the time difference between the portal vein and the hepatic artery,are abnormal,suggesting that quantitative analysis of hepatic perfusion by CEUS may be a valuable non-invasive method to evaluate the early hepatic microcirculation changes in NAFLD.