Diagnosis of liver cirrhosis with US: receiver-operating characteristic analysis of multidimensional caudate lobe indexes.

Abstract

To assess the utility of changes in the volume of the caudate lobe in the sonographic diagnosis of liver cirrhosis, the authors studied 58 patients with histologically proved cirrhosis, 18 patients with fatty liver, 28 patients with liver metastases, seven patients with lymphomatous liver involvement, and 75 healthy individuals. The longitudinal (CL), transverse (CT), and anteroposterior (CAP) diameters of the caudate lobe and the transverse diameter of the right lobe (RL) were measured, and one-, two-, and three-dimensional caudate lobe indexes and ratios were calculated. The analysis of the diagnostic performance of these criteria, compared by means of receiver-operating characteristic curves, revealed that the ratio of the three-dimensional caudate index (CI3) to the right lobe diameter (CI3/RL = [CL X CT X CAP]/RL) was superior to all other calculated criteria. At a specificity of 95%, the sensitivity of CI3/RL was 94.7%, compared with 73.3% for CT/RL. No significant differences were found between the control group and patients with fatty liver, metastases, or lymphomatous involvement. The study suggests that CI3/RL is the most reliable quantitative criterion for the US diagnosis of liver cirrhosis.

Hepatic vein Doppler waveform changes in early stage (Child-Pugh A) chronic parenchymal liver disease

“…A diagnosis of cirrhosis made with ultrasonography is based on hepatic and extrahepatic signs; this has been extensively described in the literature. 2,3 In recent years, the Doppler flowmeter has been used commonly to evaluate the abdominal blood vessels. The value of the qualitative findings is accepted worldwide in spite of the discussions on the certainty of quantitative measures.…”

“…In the late stages (ChildPugh B and Child-Pugh C) of chronic parenchymal liver disease, definite ultrasonographic findings, such as echo coarseness or brightness, irregular outline, increased ultrasound attenuation, can be found. [1][2][3] In these stages, parenchymal fibrosis can alter the compliance of the wall of the hepatic veins, and this decreases and flattens phasic oscillations. 1 However, in the early stage of this disease (Child-Pugh class A), the value of ultrasonography and Doppler ultrasonography is controversial.…”

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%.…”

Radiological diagnosis of hepatocellular carcinoma in non-cirrhotic patients

“…[ [23][24][25] Heterogeneous echostructure and multinodular appearance are frequent observations in chronic liver disease. However, its assessment mainly in the initial stages has much variability.…”