Diagnosis of cirrhosis based on regional changes in hepatic morphology: a radiological and pathological analysis.

Abstract

Transverse images of cirrhotic livers revealed specific morphological changes. The right lobe exhibited relatively greater shrinkage, while the caudate lobe underwent relative enlargement. Sonograms or CT scans of 25 proved cirrhotic livers, 25 normal livers, and 15 livers with diffuse disease other than cirrhosis were analyzed using a number of measurements and ratios to evaluate and quantify the frequency and possible diagnostic value of these alterations. Using the ratio of transverse caudate lobe width to transverse right lobe width, cirrhotic livers could be separated from noncirrhotic liver (both normal and abnormal) with a sensitivity of 84%, a specificity of 100%, and an accuracy of 94%. Another ratio revealed relative widening of the porta hepatis in 84% of cirrhotic livers, but this was not specific for cirrhosis. Pathological analysis of 11 cirrhotic cadaver livers revealed greater fibrosis in the right lobe than in the caudate lobe.

Diagnosis and Quantitation of Fibrosis

“…A reduction in the size of the right lobe of the liver with relative enlargement of the left and caudate lobes is a reliable indicator of cirrhosis. 5,125,126 The specificities in these studies are high, but have lower sensitivities because these changes are relatively late signs of cirrhosis. In other reports, up to 11 sonographic and Doppler measurements reported accuracies in the detection of cirrhosis of between 82% and 88%.…”

“…3,4 Standard cross-sectional imaging studies will only identify or exclude advanced fibrosis. 5 Novel technologies such as transient hepatic elastography and magnetic resonance imaging (MRI) elastography show promise as noninvasive methods of testing for hepatic fibrosis. 6 -8 In this article, we will review our current methods of diagnosing and quantifying hepatic fibrosis and discuss how the newer technologies may be integrated into clinical practice.…”

Confluent hepatic fibrosis in liver cirrhosis: possible relation with middle hepatic venous drainage

“…The lesions were most commonly seen in the patients with advanced and/or alcoholic cirrhosis, and in MHV drainage area in terms of hepatic venous drainage or at the boundary between medial and anterior segments in terms of portal venous supply. In general, the MHV receives blood mainly from the medial segment and ventral portion of the anterior segment [22], and the most common site of confluent fibrosis was confirmed to be within the MHV drainage area.…”

“…The developmental mechanism of confluent fibrosis has been speculated to be related to impaired portal microcirculation [4,22]. It is based on the fact that decreased or absent portal blood supply was detected on CT during arterial portography [23], and that the reduction of portal flow resulted in loss of the volume of hepatocytes with increased fibrosis and segmental atrophy of the liver [24].…”

Indications of Liver Biopsy in the Era of Noninvasive Assessment of Liver Fibrosis

“…Imaging such as abdominal ultrasonography and CT scan were established around 1980s as noninvasive methods for liver fibrosis. 20,21 In 1990s, LB was still required in patients of HCV infection taking interferon therapy. By then, liver transplantation was also established.…”