Ultrasound in chronic liver disease

Abstract

BackgroundWith the high prevalence of diffuse liver disease there is a strong clinical need for noninvasive detection and grading of fibrosis and steatosis as well as detection of complications.MethodsB-mode ultrasound supplemented by portal system Doppler and contrast-enhanced ultrasound are the principal techniques in the assessment of liver parenchyma and portal venous hypertension and in hepatocellular carcinoma surveillance.ResultsFibrosis can be detected and staged with reasonable accuracy using Transient Elastography and Acoustic Radiation Force Imaging. Newer elastography techniques are emerging that are undergoing validation and may further improve accuracy. Ultrasound grading of hepatic steatosis currently is predominantly qualitative.ConclusionA summary of methods including B-mode, Doppler, contrast-enhanced ultrasound and various elastography techniques, and their current performance in assessing the liver, is provided.Teaching Points• Diffuse liver disease is becoming more prevalent and there is a strong clinical need for noninvasive detection.• Portal hypertension can be best diagnosed by demonstrating portosystemic collateral venous flow.• B-mode US is the principal US technique supplemented by portal system Doppler.• B-mode US is relied upon in HCC surveillance, and CEUS is useful in the evaluation of possible HCC.• Fibrosis can be detected and staged with reasonable accuracy using TE and ARFI.• US detection of steatosis is currently reasonably accurate but grading of severity is of limited accuracy.

Role of Colour Doppler in Evaluation of Hemodynamic Changes in Chronic Hepatitis C Infection

“…Many reports confirmed the clinical usefulness of this technique in the diagnosis of the portal hypertension and liver cirrhosis. 9 Cirrhosis is characterized by the presence of the extensive fibrosis and numerous regenerative nodules replacing the normal liver parenchyma. Elevated vascular resistance and increased portal blood inflow are two principle mechanisms that have been reported to be involved in the development of portal hypertension secondary to cirrhosis.…”

The role of conventional ultrasound in pediatric chronic liver diseases

“…Studies in adults demonstrate the high accuracy of US (over 90%) in confirming the diagnosis of cirrhosis in patients with complications. Early stages and micronodular cirrhosis may be overlooked in up to 30% of cases (9,21). Such data are missing in children.…”

Noninvasive assessment of liver steatosis using ultrasound methods

“…The qualitative grading is conveniently classified as mild, moderate or severe, or grade 0-3 with 0 being normal [29]. Grade 1 (mild) is represented by a mild diffuse increase in fine echoes in the hepatic parenchyma with normal visualisation of the diaphragm and intrahepatic vessel borders.…”

“…The SHRI is the mean liver brightness divided by the mean renal cortex brightness. An image including both liver and kidney is required, typically showing segment VI of the liver and the upper pole of the right kidney [29]. Regions of interest (ROI) are selected in the liver parenchyma, excluding vessels, and in the renal cortex at the same field depth.…”

“…Regions of interest (ROI) are selected in the liver parenchyma, excluding vessels, and in the renal cortex at the same field depth. The mean brightness of each ROI is determined using numerical values assigned to grey-scale pixels [29] (fig 8). Some ultrasound systems allow the placement of ROIs directly on the screen.…”