Ultrasonography of cirrhosis

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Planning

Choice of investigation
US is also typically the initial, first-line modality choice for the diagnosis and follow-up of portal hypertension.[1]

Diagnosis

Cirrhosis is indicated by:

  • Surface nodularity: (sensitivity 88%, specificity 82-95%)[2]
  • General coarse and heterogeneous texture[2]
  • Segmental hypertrophy or atrophy[2]
  • Relative expansion of the caudate lobe, creating a ratio of caudate width compared to right lobe width of >0.65 (sensitivity 43-84%, specificity 100%)[2]
  • Reduction of the transverse diameter (<30 mm) of the medial segment of the left lobe (segment IV).[2]
  • Fatty change which is variable [2]
  • Signs of portal hypertension[2]
  • Dilated portal vein: >13 mm (sensitivity 42%, specificity 95-100%)[2]
  • Slow portal venous flow on Doppler: <15 cm/sec[2]
  • Reversal or alternating directions of portal venous flow[2]
  • Portal venous thrombosis with or without cavernous transformation[2]
  • Dilated superior mesenteric vein and splenic vein of > 10mm.[2] These should be measured during deep inspiration since it may vary with respiration.[2]
  • Loss of respiratory variation in superior mesenteric vein and splenic vein on spectral Doppler[2]
  • Re-canalisation and hepatofugal paraumbilical venous flow.[2]
  • Dilated porto-systemic collaterals.[2]
  • Portalisation of hepatic vein flow on Doppler[2]
  • Corkscrew appearance of hepatic arteries[2]
  • Increased velocity in hepatic artery[2]
  • Splenomegaly[2]
  • Ascites[2]

References

  1. ↑ 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:10.3748/wjg.v23.i10.1735. ISSN 1007-9327. 
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 Dr Yuranga Weerakkody, A.Prof Frank Gaillard et al.. Cirrhosis. Radiopaedia. Retrieved on 2018-06-16.


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