SUMMARY Liver ultrasound was prospectively evaluated in 104 subjects who underwent liver biopsy, including 24 patients without evidence of liver disease (controls), and 80 with a broad spectrum of liver pathology. Ultrasonography was very specific (100%) and moderately sensitive (70%) in the detection of liver pathology, and hepatic neoplasms, steatosis, and fibrosis were detected by ultrasound in 80%, 80%, and 67% of cases respectively. In addition, ultrasonography diagnosed other pathologies-mainly biliary tract disease and abdominal neoplasms-in 26% of the patients.Ultrasound is an 'effective regional-imaging device based on morphology'.' Gray-scale signal processing allows a detailed analysis of texture patterns of solid organs and thus the characterisation of both diffuse pathological processes and space-occupying lesions.The contours and the echotexture of internal organs are outlined and changes in adjacent viscera delineated. Real-time imaging decreases examination time, and allows a quick and complete survey of the region of interest.Liver ultrasound thus has the ability to detect diffuse as well as focal liver disease by analysis of the liver texture and may define associated abnormalities such as ascites or splenomegaly. Different patterns of metastatic liver disease have been described23 and an accuracy of 90 % has been claimed.4 Diffuse hepatocellular disease may produce changes in liver echo pattern and an accuracy of 81 % has been recorded in a retrospective study.5In order to evaluate the accuracy, sensitivity, and specificity of liver ultrasound, a prospective study was undertaken of patients undergoing liver biopsy for evaluation of liver disease and controls undergoing abdominal surgery for various reasons.
Methods
PATIENTSA careful ultrasonographic examination of the liver was performed in 110 consecutive patients before
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