Diagnostic possibilities of perfusion computed tomography in assessing fibrosis regression in patients with chronic viral hepatitis С: а prospective study

Introduction: Despite the decrease in the prevalence of hepatitis C, which became possible thanks to direct-acting antiviral drugs, the issue of using the optimal diagnostic method for both diagnosing fibrosis and assessing the regression of fibrotic changes in patients with chronic viral hepatitis C remains relevant.

Objective: The aim of the study is to determine the diagnostic possibilities of perfusion computed tomography of the liver in assessing the regression of intermediate stages of fibrosis in patients with chronic viral hepatitis C.

Materials and Methods: The study included 25 patients with cirrhosis and 25 patients who underwent examination for chronic hepatitis C in the infectious diseases department of the Siberian State Medical University; among them there were 13 patients (7 men, 6 women) aged 39–47 years with stages F1 and F2, who underwent antiviral therapy. After treatment, all underwent a repeat PCR study after 4 and 12 weeks. For dynamic observation, all patients underwent a repeated range of laboratory and instrumental research methods after a year. Statistics. Statistical analysis was perfomed using the Statistica 10.0 for Windows software package.

Results: The MTT (p=0.003) had a statistically significant difference between the hepatitis and cirrhosis groups. Statistically significant differences were obtained for the stiffness index (p=0.0001). Total and direct bilirubin, AST, ALT, GGT, total protein, glucose, prothrombin time, and alkaline phosphatase significantly differed; these indices were elevated in patients with cirrhosis. Patients in both groups had statistically different levels of total protein (p=0.0001), platelet indices (p=0.0001) and albumin (p=0.003); in the cirrhosis group, they decreased. After therapy, statistical analysis of clinical and laboratory data, the stiffness index, and perfusion indices before and after treatment was performed in 13 patients who achieved a sustained virological response. Blood flow (BF) statistically differed (p=0.04) when compared before and after treatment. In the comparative analysis, statistically different values were found for albumin (p=0.03), ALT (p=0.02), ALP (p=0.01), glucose (p=0.009), and total protein (p=0.01), stiffness index according to ultrasound elastography data (p=0,04).

Discussion: The use of perfusion computed tomography (PCT) is advisable in patients with chronic viral hepatitis C, since the results of this method provide information on the dynamics of perfusion parameters, indirectly reflecting the regression of fibrosis.

Conclusion: In the course of the study, we found that in patients with chronic viral hepatitis C, after the use of antiviral therapy, the BF value increases, which is a marker of improved blood flow and regression of fibrotic changes.

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