Difference between revisions of "Ultrasonography of cirrhosis"
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| − | Ultrasonography is the first-line modality of medical imaging in patients with suspected cirrhosis and/or portal hypertension.<ref name="ProcopetBerzigotti2017">{{cite journal|last1=Procopet|first1=Bogdan|last2=Berzigotti|first2=Annalisa|title=Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy|journal=Gastroenterology Report|volume=5|issue=2|year=2017|pages=79–89|issn=2052-0034|doi=10.1093/gastro/gox012}}</ref> US is also typically the initial, first-line modality choice for the diagnosis and follow-up of portal hypertension.<ref name="BandaliMirakhur2017">{{cite journal|last1=Bandali|first1=Murad Feroz|last2=Mirakhur|first2=Anirudh|last3=Lee|first3=Edward Wolfgang|last4=Ferris|first4=Mollie Clarke|last5=Sadler|first5=David James|last6=Gray|first6=Robin Ritchie|last7=Wong|first7=Jason Kam|title=Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy|journal=World Journal of Gastroenterology|volume=23|issue=10|year=2017|pages=1735|issn=1007-9327|doi=10.3748/wjg.v23.i10.1735}}</ref> | + | Ultrasonography is the first-line modality of medical imaging in patients with suspected cirrhosis and/or portal hypertension.<ref name="ProcopetBerzigotti2017">{{cite journal|last1=Procopet|first1=Bogdan|last2=Berzigotti|first2=Annalisa|title=Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy|journal=Gastroenterology Report|volume=5|issue=2|year=2017|pages=79–89|issn=2052-0034|doi=10.1093/gastro/gox012}}</ref> US is also typically the initial, first-line modality choice for the diagnosis and follow-up of portal hypertension.<ref name="BandaliMirakhur2017">{{cite journal|last1=Bandali|first1=Murad Feroz|last2=Mirakhur|first2=Anirudh|last3=Lee|first3=Edward Wolfgang|last4=Ferris|first4=Mollie Clarke|last5=Sadler|first5=David James|last6=Gray|first6=Robin Ritchie|last7=Wong|first7=Jason Kam|title=Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy|journal=World Journal of Gastroenterology|volume=23|issue=10|year=2017|pages=1735|issn=1007-9327|doi=10.3748/wjg.v23.i10.1735}}</ref> For cirrhosis, it should be done without IV contrast. |
==Diagnosis== | ==Diagnosis== | ||
Revision as of 20:09, 6 December 2018
Author:
Mikael Häggström [notes 1]
Planning
- Need of investigation
The diagnosis of cirrhosis can be made by physical examination and blood testing alone,[1] but ultrasonography is very helpful as an additional diagnostic tool at least in subtle disease.
- Choice of modality
Ultrasonography is the first-line modality of medical imaging in patients with suspected cirrhosis and/or portal hypertension.[2] US is also typically the initial, first-line modality choice for the diagnosis and follow-up of portal hypertension.[3] For cirrhosis, it should be done without IV contrast.
Diagnosis
Cirrhosis is indicated by:
- Surface nodularity: (sensitivity 88%, specificity 82-95%)[4]
- General coarse and heterogeneous texture[4]
- Segmental hypertrophy or atrophy[4]
- Dilated portal vein: >13 mm (sensitivity 42%, specificity 95-100%)[4]
- Slow portal venous flow on Doppler: <15 cm/sec[4]
- Reversal or alternating directions of portal venous flow[4]
- Portal venous thrombosis with or without cavernous transformation[4]
- Dilated superior mesenteric vein and splenic vein of > 10mm.[4] These should be measured during deep inspiration since it may vary with respiration.[4]
- Loss of respiratory variation in superior mesenteric vein and splenic vein on spectral Doppler[4]
- Re-canalisation and hepatofugal paraumbilical venous flow.[4]
- Dilated porto-systemic collaterals.[4]
- Portalisation of hepatic vein flow on Doppler[4]
- Corkscrew appearance of hepatic arteries[4]
- Increased velocity in hepatic artery[4]
- Splenomegaly[4]
- Ascites[4]
File:Doppler ultrasonography of the portal vein in cirrhosis.jpg
Doppler ultrasonography of the portal vein over 5 seconds, showing peaks of maximal velocity, as well as points of minimal velocity.
- Portal flow pulsatility: An increased portal vein pulsatility is an indicator of cirrhosis, but may also be caused by an increased right atrial pressure.[5] Portal vein pulsatility can be quantified by pulsatility indices (PI), where an index above a certain cutoff indicates pathology:
| Index | Calculation | Cutoff |
|---|---|---|
| Average-based | (Max - Min) / Average[5] | 0.5[5] |
| Max-relative | (Max - Min) / Max[6] | 0.5[6][7] - 0.54[7] |
Surveillance
In patients with a diagnosis of cirrhosis, surveillance ultrasonography of hepatocellular cancer (HCC) is indicated, generally every 6 months.[8]
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
References
- ↑ Udell, JA; Wang, CS; Tinmouth, J; FitzGerald, JM; Ayas, NT; Simel, DL; Schulzer, M; Mak, E; et al. (Feb 22, 2012). "Does this patient with liver disease have cirrhosis? ". JAMA: The Journal of the American Medical Association 307 (8): 832–42. doi:. PMID 22357834.
- ↑ Procopet, Bogdan; Berzigotti, Annalisa (2017). "Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy ". Gastroenterology Report 5 (2): 79–89. doi:. ISSN 2052-0034.
- ↑ Bandali, Murad Feroz; Mirakhur, Anirudh; Lee, Edward Wolfgang; Ferris, Mollie Clarke; Sadler, David James; Gray, Robin Ritchie; Wong, Jason Kam (2017). "Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy ". World Journal of Gastroenterology 23 (10): 1735. doi:. ISSN 1007-9327.
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 Dr Yuranga Weerakkody, A.Prof Frank Gaillard et al.. Cirrhosis. Radiopaedia. Retrieved on 2018-06-16.
- ↑ 5.0 5.1 5.2 Iranpour, Pooya; Lall, Chandana; Houshyar, Roozbeh; Helmy, Mohammad; Yang, Albert; Choi, Joon-Il; Ward, Garrett; Goodwin, Scott C (2016). "Altered Doppler flow patterns in cirrhosis patients: an overview ". Ultrasonography 35 (1): 3–12. doi:. ISSN 2288-5919.
- ↑ 6.0 6.1 Goncalvesova, E.; Varga, I.; Tavacova, M.; Lesny, P. (2013). "Changes of portal vein flow in heart failure patients with liver congestion ". European Heart Journal 34 (suppl 1): P627–P627. doi:. ISSN 0195-668X.
- ↑ 7.0 7.1 Page 367 in: Henryk Dancygier (2009). Clinical Hepatology: Principles and Practice of Hepatobiliary Diseases . 1. Springer Science & Business Media. ISBN 9783540938422.
- ↑ Fateen, Waleed; Ryder, Stephen (2017). "Screening for hepatocellular carcinoma: patient selection and perspectives ". Journal of Hepatocellular Carcinoma Volume 4: 71–79. doi:. ISSN 2253-5969.
