The diagnosis of cirrhosis by high resolution ultrasound of the liver surface.

The objective was to assess the clinical usefulness of high resolution ultrasound (US) analysis of the liver surface for the diagnosis of cirrhosis. In a prospective study, US evaluation of the ventral contour of the liver was performed using a 7.5 MHz linear transducer in 100 patients with suspected liver disease. Only reproducible diffuse ventral liver surface irregularities were considered as an objective US sign of cirrhosis. All patients underwent liver biopsy and/or laparoscopy in order to obtain a definitive diagnosis. Disease prevalence for cirrhosis was 49%. In nine cases the visualized US irregularities were both unconvincing and hardly reproducible. Consequently, they were considered as non-diagnostic and excluded from further analysis. On 91 diagnostic studies, the sensitivity of US for cirrhosis was 91.1%, the specificity 93.5% and the accuracy 92.3%. Positive and negative predictive values were 93.2% and 91.5%, respectively. Provided non-diagnostic cases were considered as technically satisfactory studies and included as true-positive and false-positive cases, this would slightly increase the sensitivity but decrease specificity and accuracy to 91.8%, 84.3%, and 88.0%, respectively. High resolution US analysis of the ventral liver contour is a clinically reliable non-invasive test for the diagnosis of cirrhosis.     

Value of sonographic screening for gallstones in patients with chest pain and normal coronary arteries

The prevalence of sonographically detectable gallstones in patients with chest pain and normal coronary arteries was compared with the prevalence of gallstones in patients referred to sonography for nonbiliary disease. Among 545 patients with chest pain and normal coronary arteriograms, 101 (18.5%) were referred for sonographic examination of the gallbladder. This test group was compared to a matched control group (n = 101) undergoing abdominal sonography for nonbiliary disease. Six patients (5.9%) in the test group and eight patients (7.9%) in the control group were found to have gallstones by accepted sonographic criteria. Studies based on oral cholecystogram screening of healthy populations have claimed a prevalence of cholelithiasis of 2.3%-6.2% for males and 2.3%-12% for females. The authors were unable to demonstrate a higher prevalence of sonographically identified gallstones in patients with chest pain and normal coronary arteries than in patients examined for nonbiliary disease. The frequency of gallstones in this test group is comparable to that reported for a screened population of healthy men and women.     

Virtual laparoscopy: Initial experience with three-dimensional ultrasonography to characterize hepatic surface features

Objective

To examine the potential utility of 3D-reconstructed sonograms to distinguish cirrhotic from non-cirrhotic livers by demonstrating hepatic surface characteristics.

Materials and methods

A preliminary phantom study was performed to examine the potential resolution of 3D images, recognizing surface irregularities as a difference in height. In a prospective clinical study of 31 consecutive patients with ascites (21 cirrhosis, 10 non-cirrhosis), liver volume data were acquired by transabdominal mechanical scanning. The hepatic surface features of cirrhotic and non-cirrhotic patients were compared by 2 independent reviewers. Intra- and inter-operator/reviewer agreements were also examined.

Results

The phantom study revealed that 0.4 mm was the minimum recognizable difference in height on the 3D sonograms. The hepatic surface image was successfully visualized in 74% patients (23/31). Success depended on the amount of ascites; visualization was 100% with ascites of 10 mm or more between the hepatic surface and abdominal wall. The images showed irregularity of the hepatic surface in all cirrhotic patients. The surface appearance was confirmed as being very similar in 3 patients who had both 3D sonogram and liver resection for transplantation. The ability to distinguish cirrhotic liver from non-cirrhotic liver improved with the use of combination of 2D- and 3D-imaging versus 2D-imaging alone (sensitivity, p = 0.02; accuracy, p = 0.02) or 3D-imaging alone (sensitivity, p = 0.03). Intra-/inter-operator and inter-reviewer agreement were excellent (κ = 1.0).

Conclusion

3D-based sonographic visualization of the hepatic surface showed high reliability and reproducibility, acting as a virtual laparoscopy method, and the technique has the potential to improve the diagnosis of cirrhosis.     

Pelvic inflammatory disease: sonographic-pathologic correlation

A retrospective analysis of the sonographic findings in 65 women with pelvic inflammatory disease was correlated with pathologic findings at surgery and laparoscopy. Abnormal sonograms could be classified into one of the following three groups: Type I pattern (endometritis); Type II pattern (focal mass); Type III pattern (total pelvic distortion). A simulated uterine appearance, the "pseudouterus sign," was observed in three patients with previous hysterectomy. Various pathologic entities of the pelvic inflammatory disease spectrum could not be reliably distinguished sonographically.     

Diagnosis of chronic liver disease from liver scintiscans by artificial neural networks

Artificial neural networks were used in the diagnosis of chronic liver disease based on liver scintiscanning. One hundred and thirty-seven patients with chronic liver disease (12 with chronic persistent hepatitis, 39 with chronic aggressive hepatitis, and 86 with cirrhosis) and 25 healthy controls were studied. Sixty-five subjects (10 healthy controls, 20 patients with chronic hepatitis, and 35 patients with cirrhosis of the liver) were used in the establishment of a neural network. Liver scintiscans were taken starting 20 min after the intravenous injection of 111 MBq of Tc-99m-phytate. The neural network was used to evaluate five items judged from information on liver scintiscans: the ratio of the sizes of the left and right lobes, splenomegaly, radioactivity in the bone marrow, deformity of the liver and distribution of radioactivity in the liver. The neural network was designed to distinguish between three liver conditions (healthy liver, chronic hepatitis and cirrhosis) on the basis of these five items. The diagnostic accuracy with the neural network was 86% for patients with chronic hepatitis and 93% for patients with cirrhosis. With conventional scoring, the accuracy was 77% for patients with chronic hepatitis and 87% for patients with cirrhosis. Our findings suggest that artificial neural networks may be useful for the diagnosis of chronic liver diseases from liver scintiscans.     

Magnetic resonance imaging in chronic liver disease evaluated in relation to hepatic fibrosis--clinical and experimental results

In 21 patients with chronic liver disease, the ratio of liver to muscle signal intensity on T1-weighted images was negatively correlated with the progression of hepatic fibrosis defined according to findings by laparoscopy and liver biopsy, and differentiated six patients with early chronic hepatitis from eight with liver cirrhosis. On T2-weighted images, the number of low intensity nodules comparable in size to regenerating nodules surrounded by connective tissues showed a positive correlation with stage. When hepatic fibrosis with no necrosis or fat infiltration was induced in rats, T2 values were positively correlated with hepatic hydroxyproline content, though there was no such correlation for T1 values. These results suggest that MR imaging may be useful for determining the progression of hepatic fibrosis in chronic liver disease. T2 values may directly reflect hepatic fibrosis.     

Pattern of hepatic pathology diagnosed with echography in Yaounde (Cameroon)

The purpose of our study was to assess the pattern of liver diseases diagnosed by ultrasonography (US) in Yaounde (Cameroon). From a total of 1,007 consecutive US studies performed over a period of 14 months in subjects over the age of 15 years, we found 322 patients with a sonographic diagnosis of liver disease. 8 diagnoses comprised 83% of the patients. Apart from non specific homogeneous hepatomegaly these diagnoses consisted of: cirrhosis, primary liver malignancies, liver abscess, congestive hepatomegaly, secondary liver malignancies, diffuse steatosis and nodular calcifications. 30 liver abscess drainages were performed with sonographic guidance. We conclude that in our environment where Computed Tomography is scarce and expensive, US is a useful tool in the study of some of the most frequent liver diseases.     

Acute cholecystitis: sonographic-pathologic analysis

The study was performed to assess the pathogenic basis of sonographically demonstrable changes in the gallbladder wall in acute cholecystitis in an attempt to predict the degree of inflammation and to define a set of sonographic criteria for the diagnosis of acute cholecystitis. Sonograms in a control group of 30 patients (group A) without biliary tract symptoms, ascites, or cholelithiasis and 24 patients (group B) with proven diagnosis of acute cholecystitis were reviewed. The histologic sections of the gallbladder wall in the cholecystitis patients were correlated with sonographic findings. None of the gallbladders showed perforation at the time of pathologic evaluation. Data failed to show a correlation between the pathologic severity of the inflammatory process in the gallbladder wall and the degree of sonographic wall thickening and wall anechoicity. Of patients with acute cholecystitis, 70% met all of the following sonographic criteria: (1) gallbladder wallthickening of 5 mm or greater, (2) gallbladder wall anechoicity, (3) gallbladder distension, as determined by an external anteroposterior width of 4 cm or greater, and (4) cholelithiasis.     

Diagnostic and therapeutic use of chest sonography: value in critically ill patients.

OBJECTIVE. Portable chest radiography, used for critically ill patients, often fails to depict thoracic disease clearly. Chest sonography allows good characterization of pleural diseases, mediastinal lesions, and pulmonary consolidations, and provides accurate and safe guidance for interventional procedures. Accordingly, we evaluated its usefulness in the diagnosis and management of critically ill patients. SUBJECTS AND METHODS. Sonography was used prospectively to evaluate 41 critically ill patients, when portable chest radiographs were difficult to interpret and failed to explain the clinical findings. An initial diagnosis was made on the basis of clinical and radiologic information. The final diagnosis was confirmed by thoracentesis (n = 15), image-guided aspiration biopsy (n = 7), surgery (n = 3), and clinical follow-up (n = 16). All 41 sonographic examinations were performed by a sonographer who had no knowledge of the initial diagnosis. The sonographic findings were recorded and analyzed. The usefulness of sonography in diagnosis and management was then evaluated according to the following criteria: diagnostic value--(1) made diagnosis, (2) changed diagnosis, (3) additional information, (4) no benefit; and management aid--(1) affected decision, (2) affected decision and guided thoracentesis, (3) affected diagnosis and guided aspiration, (4) no benefit. RESULTS. Chest sonography was helpful in diagnosis in 27 (66%) of 41 patients and in treatment in 37 (90%) of 41 patients. A significant influence on treatment planning occurred in 17 (41%) of 41 patients. A diagnostic aspiration biopsy under sonographic detected sonographically. Thoracentesis were attempted in 25 of 29 patients with pleural effusion and were successful in 24 patients (96%); a minimal pneumothorax developed in one patient (4%). CONCLUSION. Chest sonography is a useful diagnostic tool for critically ill patients with chest diseases. This technique can be particularly helpful when CT is not available or when critically ill patients cannot be moved.     

MR T2*加权成像和磁敏感加权成像在慢性肝病中的应用现状

肝纤维化是各种慢性肝病的共同特征。在肝纤维化-肝硬化-肝癌进程中,目前认为肝纤维化只有处于特定阶段时经抗纤维化治疗才可以逆转。早期诊断肝纤维化并对其严重程度进行评价,有利于抓住抗纤维化时机及时治疗,有望促进病程逆转。慢性肝病病人肝内存在异常铁沉积,MR T2*加权成像和磁敏感加权成像能检测铁沉积,可评估肝纤维化严重程度及诊断肝硬化和肝癌。就T2*加权成像和磁敏感加权成像在慢性肝病中的研究进展进行综述。     

Clinical significance of hyperechogenic focal lesions of the cirrhotic liver

A review was made of the ultrasonographic (US) examinations performed over the period 1981-1986; 27 cirrhotic patients with hyperechoic liver lesions were identified, whose diagnoses had been made by means of either US-guided percutaneous biopsy, or laparoscopy, or autopsy. In 24 patients hepatocellular carcinomas nodules (HCC) were found, associated with cirrhosis, while in 3 cases only cirrhosis was seen. In the above mentioned 3 cases, a 2-year US follow-up showed no variation in the size of the nodules. These data confirm the importance of US in the screening of risk HCC patients, and point out that--however small--hyperechoic lesions in a cirrhotic liver suggest the cancerization of the substanding cirrhosis.     

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

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.     

Sonography of diffuse benign liver disease: accuracy of pattern recognition and grading

Sonograms of 110 patients were compared to recently performed liver biopsies for evaluation of the accuracy of sonography in predicting the type (pattern) of pathology and its grade of severity (mild, moderate, or severe) in a wide variety of diffuse liver processes. There are two distinct, abnormal sonographic patterns: the fatty-fibrotic pattern seen primarily with cirrhosis, chronic hepatitis, and/or fatty infiltration, and the centrilobular pattern seen primarily with acute hepatitis. Sonography was 88% accurate in assigning the correct pattern to the corresponding pathology (sensitivity 89%, specificity 86%, p less than 0.001). The degree of accuracy was dependent on the grade of pathologic severity, with mild disease offering the greatest difficulty; moderate and severe diseases were accurately detected and placed in the correct pattern in all cases. Sonographic grading of the severity of disease was far less precise (63% overall). This study showed that sonography can distinguish between two abnormal sonographic patterns of diffuse benign liver disease as well as between normal and abnormal patterns.     

Sonographic diagnosis of perforation in patients with acute appendicitis

The sonographic diagnosis of appendicitis can be challenging in patients with perforation. In order to detect the accuracy of specific sonographic features of appendiceal perforation, graded compression sonograms in 100 patients with surgically confirmed acute appendicitis were reviewed retrospectively. Twenty-two of these patients had perforation. A statistically significant association was found between three sonographic findings and perforation: loculated pericecal fluid, prominent pericecal fat, and circumferential loss of the submucosal layer of the appendix. No single finding had a specificity greater than 59%. By using a combination of one or more findings, the overall sensitivity of sonography for the diagnosis of perforation was 86%. The specificity, however, was only 60%. Our results suggest that in patients without a sonographically visible appendix, recognition of loculated pericecal fluid and prominent pericecal fat may be a useful indirect clue to the diagnosis of perforating appendicitis.     

Chronic liver disease: value of volumetry of liver and spleen with computed tomography

Volumetric comparisons of portions of liver and spleen were performed in patients with chronic liver diseases to determine their diagnostic value. Volumetric ratios of liver and spleen were determined by CT examination in 34 normal subjects and 125 consecutive patients with histologically proved liver cirrhosis, chronic active hepatitis, chronic persistent hepatitis, acute hepatitis, or fatty liver. Ratios of caudate lobe, spleen, and lateral segment of the left lobe of the liver to the remainder of the liver, right lobe and medial segment of the left lobe (RL+LM), were calculated. The product of caudate lobe/RL+LM and spleen/RL+LM was of value in differentiating liver cirrhosis from other liver disease, with a sensitivity of 60%, specificity of 98%, and accuracy of 86%. The same ratios differentiated liver cirrhosis and chronic active hepatitis from other liver diseases with a sensitivity of 79%, specificity of 100%, and accuracy of 90%. Volumetric ratio measurements are useful in the diagnosis of cirrhosis and chronic active hepatitis.     

Ultrasonography and computed tomography in diffuse liver disease with cholestasis

Ultrasonography (US) and computed tomography (CT) were performed on respectively 67 and 42 (altogether 72) patients, for the assessment of intrahepatic cholestasis. The diagnostic ability to differentiate between malignant (17 patients) and benign (55 patients) liver disease was analyzed. Coarse echogenicity of the liver led to inconclusive results in differentiating between cirrhosis (2 out of 29 patients) and malignant infiltration (4 out of 15 patients) by US. Other benign liver diseases in 23 patients, including acute hepatitis, chronic active hepatitis, fatty liver, and liver congestion, were correctly interpreted as benign. CT correctly disclosed malignant liver disease in all cases. A false positive diagnosis of malignancy was encountered in 4 (out of 17) patients with decompensated hepatic cirrhosis because of non-homogeneous expansive areas on CT in 3 cases. The true cause was in 2 patients non-uniform fatty infiltration, and in one patient with acute hepatitis A, small hypodense lesions. Among cholestatic patients, decompensated cirrhosis and malignant liver infiltration could not always be differentiated on US or CT.     

Usefulness of sonographic guidance during percutaneous biopsy of mesenteric masses

OBJECTIVE: The objective of our study was to determine the usefulness of sonographic guidance for biopsy of mesenteric masses. MATERIALS AND METHODS: Twenty-five sonographically guided percutaneous biopsies of mesenteric masses were performed in 23 patients. Biopsies were performed with an 18-, 20-, or 22-gauge self-aspirating needle or core biopsy device. Final pathology results and patient medical records were reviewed for biopsy accuracy and complications. A biopsy was considered successful if a specific benign or malignant diagnosis was rendered by the pathologist or if surgical-pathologic confirmation was obtained. RESULTS: Open surgical biopsy was performed after sonographically guided biopsy in 13 patients and led to 12 concordant diagnoses (nine true-positives and three true-negatives) and one discordant diagnosis (false-negative). Specific pathologic diagnosis was rendered for the 10 percutaneous biopsies that were not confirmed by surgical biopsy: five biopsies matched known primary malignancies, consistent with metastases; four biopsies revealed primary tumors, and one biopsy revealed chronic inflammation (nine true-positives and one true-negative). Two biopsies were nondiagnostic because of insufficient material (n = 1) and necrotic tumor (n = 1). In the biopsies with diagnostic tissue specimens, sonographically guided biopsy achieved a sensitivity of 95% (18/19) and specificity of 100% (4/4) for allowing neoplastic tissue to be distinguished from nonneoplastic tissue. Complications included a mesenteric hematoma and abdominal wall cellulitis. CONCLUSION: Percutaneous biopsy of mesenteric masses is a useful and safe procedure.     

基于表面增强拉曼光谱的肝病血清检测技术研究

目的：通过比较正常人与慢性乙肝、肝硬变和肝癌患者血清之间的拉曼光谱差异,探索基于表面增强拉曼散射（ SERS）的血清诊断新方法。方法首先制备纳米银溶胶作为活性基底,分别测量30例正常人和48例慢性乙肝、48例肝硬变、46例肝癌患者血清的增强拉曼信号,并进行正交偏最小二乘法判别分析（ OPLS－DA ）。结果正常人与3组肝病患者血清在位移625、725、806、947、1018、1219、1131、1329、1440、1580、1660 cm－1处均有拉曼峰,且峰强弱存在差异;正常人血清在位移1096和1395 cm－1处有强峰,肝病患者血清在位移887 cm－1有强峰。 ROC曲线下面积（AUC）分别为0．981、0．966、0．984。结论初步研究表明血清SERS图谱可作为肝病早期诊断的一种辅助手段。     

急诊超声检查腹部创伤245例

目的探讨急诊超声在腹部创伤后定位诊断内脏损伤的价值.方法回顾分析急诊超声诊断并经手术或CT证实的腹部创伤所致内脏损伤245例.结果①245例共346个脏器损伤,超声确诊299例,误诊47例,总符合率为86.4%;②超声诊断脾、肝、肾及胃肠、肠系膜血管、膀胱、后腹膜脏器损伤等符合率分别为：93.4%、91.9%、80.9%及51.3%;③超声与手术比较检出腹腔积液及腹膜后血肿符合率分别为：100%（213/213）和89.5%（51/57）.结论急诊超声对腹部创伤后定位诊断脏器损伤具有较高临床诊断价值.     

Liver cirrhosis: evaluation of haemodynamic changes using an ultrasound contrast agent

Liver cirrhosis is associated with haemodynamic changes. Using Levovist, we measured and compared Doppler signal arrival and peak enhancement times in the hepatic vein of patients with cirrhosis (n= 12) or chronic liver disease (n= 16) and in 12 healthy subjects. There were six patients with Child stage A, one patient with B, and five patients with C. The signal was recorded starting 20 s before contrast infusion until 2 h 20 min after its end. A software of the ultrasound (US) machine automatically sampled time-intensity values. Arrival times were significantly shorter (P < 0.001) in cirrhotic than non-cirrhotic (chronic liver disease + controls) and in patients with Child stage C compared with A. Differences in peak enhancement were weakly significant between cirrhotic and chronic patients (P < 0.04) and highly significant between the former and controls (P < 0.001), whereas differences between Child stages C and A were not significant (P > 0.05). Finally, cirrhotic patients had arrival times consistently shorter than 17 s. Automatic time-intensity curve analysis made measurements objective and conceptual error systematic, thus identifiable. Analysis of the passage of Levovist at the hepatic vein can thus become a non-invasive, well-tolerated and cost-effective diagnostic and monitoring tool in a larger number of patients with liver disease.