EVALUATION OF ULTRASONOGRAPHIC STAGING SYSTEMS FOR THE ASSESSMENT OF SCHISTOSOMA-MANSONI INDUCED HEPATIC INVOLVEMENT

For the sonographic assessment and grading of hepatosplenic morbidity induced by Schistosoma mansoni infection, several quantitative and qua litative classification systems have been used, In an attempt to evalu ate two staging systems, a study was performed as part of a schistosom iasis research and control programme in Richard Toll, Senegal. A total of 700 residents of the township N'diangue were parasitologically, cl inically and sonographically examined in July 1993. Two ultrasound obs ervers (M.D. and E.D.) applied the Cairo and the Managil classificatio n (E.D. only) for the grading of periportal thickening of the liver. I n spite of high prevalence and intensity of infection, severe hepatic morbidity was rare. According to the Cairo classification, there was a high percentage of subjects with grade I periportal thickening, with considerable inter-observer variability. In the Cairo classification, which is based on the diameter of peripheral portal vein branches, fir m cut-offs are used, independent of body height. We show the relations hip between body height and portal vein diameters and recommend the us e of body height-dependent reference values to avoid falsely high perc entages of periportal thickening, especially in children. To minimize inter-observer variability, a clarification of existing instructions f or taking measurements for grading is suggested. These suggestions hav e been considered during the follow-up expert meeting on the Cairo cla ssification in Niamey under the auspices of the World Health Organizat ion in October 1996. (C) 1997 Elsevier Science B.V.