Ultrasound features of acute drug-induced liver injury in patients with chronic hepatitis B

Background There are many patients with hepatitis B in China, however, there are few studies on acute drug-induced liver injury (drug-induced liver injury, DILI) in patients with chronic hepatitis B (chronic hepatitis B, CHB).

Objective To explore the ultrasonographic features of DILI in CHB and evaluate the diagnostic value of ultrasound in hepatitis B complicated with drug-induced liver injury.

Methods A total of 106 patients with chronic hepatitis B complicated with acute drug-induced liver injury (CHB-DILI) and 106 patients with CHB were collected from January 2017 to December 2019 in the Fifth Medical Center of Chinese PLA General Hospital. Abdominal ultrasonography was used to compare the echo of liver parenchyma, the thickness of portal vein wall, the occurrence of fatty liver, the thickness of gallbladder wall and the size of spleen between the two groups, and the ultrasonic features were evaluated in different pathological inflammation and fibrosis stages.

Results The median age of patients with CHB-DILI was 38 years (range 28-48 years), and that of patients with CHB was 36 years (range 27 - 42 years). Most of the patients in both groups were male (59.43% vs 63.21%, P=0.573). Compared with patients with chronic hepatitis B, the incidence of hypoechoic liver parenchyma (35.85% vs 3.77%, P＜0.001), portal vein wall thickening (32.08% vs 9.43%, P＜0.001), fatty liver (39.62% vs 15.09%, P＜0.001) and gallbladder wall thickening (5.07 ± 2.21 mm vs 3.89 ± 1.17 mm, P＜0.001) were significantly higher in patients with chronic hepatitis B complicated with acute drug-induced liver injury. The incidences of hypoechoic liver parenchyma and portal vein wall thickening in patients with CHB-DILI were higher than those in patients with CHB in different pathological stages of inflammation and fibrosis (P＜0.05).

Conclusion Combined with the medication history, the ultrasound imaging features such as overall decreased echogenicity of the liver and accentuated brightness of the portal vein radicle walls in patients with chronic hepatitis B are helpful for the diagnosis of acute drug-induced liver injury.