Background: Patients with cirrhosis and hepatitis C virus (HCV) infection who have achieved sustained virologic response (SVR) currently undergo indefinite imaging every 6-12 months to screen for hepatocellular carcinoma (HCC). Although current research shows there is liver remodeling with regression of fibrosis/cirrhosis after HCV treatment, it is unclear if improvements in the features of cirrhosis are seen on radiologic imaging. We hypothesize that some features on imaging should also improve including, potentially, resolution of nodularity, splenomegaly, collateral vessels, and disproportionate sizes of lobes.
Methods: A retrospective review examined the radiology reports of 26 patients with HCV cirrhosis who had achieved SVR. Imaging studies obtained prior to and after SVR were reviewed. Changes in liver appearance, nodularity, spleen size, collateral vessels and size of certain lobes were documented. A MELD (model end-stage liver disease) score was calculated prior to and after achieving SVR.
Results: Patients underwent various combinations of MRI and ultrasound both before and after achieving SVR. Sonography was used as a basis for comparison in more than half of the patients. The mean period of follow-up imaging after SVR ranged from 6 months to 1 year. Patients who achieved SVR were noted to have a mean decrease in spleen size on imaging of 0.8cm (0.3-1.3cm) after about an average of 16 months after SVR. There was no objective measurement of the change in size of various lobes in serial imaging. Other features indicative of cirrhosis such as nodularity remained the same over time.
Conclusions: Attainment of SVR in HCV cirrhotic patients is associated with decreased spleen size. Improvements in nodularity or other radiologic signs of cirrhosis and portal hypertension are not yet evident. Additional data collected on a larger sample of patients will be presented and analyzed in detail.