The accuracy of ultrasound in the detection of cirrhosis of the liver

The association of high amplitude echoes returned from the liver and cirrhosis is well recognized. There have been no reports in the literature as to the overall incidence of this finding in the clinical situation. We report our experience in a series of 67 patients with proven cirrhosis who had liver biopsy and an ultrasound examination within three months of one another. In 43 patients cirrhosis was suggested by recognition of a bright liver echo pattern. In 23 patients the liver echo pattern was normal, although additional relevant information was shown in half of this group. The detailed pathology has been analysed in an attempt to account for the false negative examinations, revealing a strong trend for cases of micronodular cirrhosis to give positive ultrasound examinations and macronodular cirrhosis negative examinations.     

Value of ultrasound-guided cytopuncture in the diagnosis of hepatocellular carcinoma

Ultrasonically guided fine needle aspiration biopsy cytologies (external diameter inferior to 1 mm) were carried out in 28 patients with proved hepatocellular carcinoma. In all cases, the diagnosis of malignant involvement of the liver was firmly established by cytological examination. A correct diagnosis of hepatocellular carcinoma was made in 26 of 28 patients (sensitivity = 93%). The specificity of the procedure was 100%. No complications were observed. The present study shows that fine needle aspiration biopsy under ultrasound guidance is a safe and accurate diagnostic procedure in hepatocellular carcinoma even associated with cirrhosis.     

Ultrasound in the detection of chronic liver disease (the "bright liver").

The association of high amplitude echoes returned from the liver and advanced cirrhosis is well recognized. We have become increasingly aware of a bright liver echo pattern in relatively mild cases of cirrhosis and in other chronic liver diseases. The pattern is very characteristic but non-specific in pathological terms. We have undertaken a small pilot study based on the observation of this characteristic ultrasound appearance to assess its clinical significance. Recognition of this pattern has always corresponded with liver disease of one of five types: cirrhosis, fatty infiltration, portal tract fibrosis, severe hepatitis or longstanding congestive cardiac failure. Although the use of ultrasound appears to be sensitive in the detection of generalized liver disease, it is relatively non-specific.     

Quantitative estimation of attenuation in ultrasound video images: correlation with histology in diffuse liver disease

RATIONALE AND OBJECTIVES: To determine the relationship between the attenuation of backscatter intensity in B-scan images of the liver and diffuse liver disease in order to assess the usefulness of this method in providing quantitative objective characterization of diffuse liver diseases in general and in fatty liver in particular. METHODS: Twenty-four healthy volunteers and 28 patients with elevated liver enzyme levels who underwent liver biopsy were included in this study. An automatic far-field slope (FFS) algorithm that estimates the decrease in amplitude of the backscattered echo as a function of beam depth was implemented on the noncompensated image that was acquired on a commercial phased-array ultrasound system fitted to a custom-built interface card. The images were processed at a work-station. All scans were acquired repeatedly, read, and graded blindly by experienced ultrasound radiologists. Histology obtained via needle biopsy was reviewed without knowledge of the ultrasound findings. RESULTS: Analysis of the FFS data for fatty infiltration in all patient groups yielded a sensitivity of 67%, a specificity of 77%, a positive predictive value (PPV) of 77%, negative predictive value (NPV) of 67%, and an accuracy of 71%. The mean score of the ultrasound reviewers showed a sensitivity of 82%, a specificity of 66%, a PPV% of 68%, an NPV of 81%, and an accuracy of 72%. Normal FFS values (false-negative) were found in five patients with proved fatty infiltration. All of these patients had coexistent moderate to severe hepatic inflammation. However, FFS data in patients with uncomplicated (pure) fatty infiltration revealed a sensitivity of 100%, a specificity of 80%, a PPV of 89%, an NPV of 100%, and an accuracy of 92%. The best ultrasound score yielded a sensitivity of 100%, a specificity of 60%, a PPV of 80%, an NPV of 100%, and an accuracy of 85% in the same patients. CONCLUSIONS: The data demonstrate an excellent sensitivity (100%) of the FFS values in patients with uncomplicated fatty infiltration. This was also the only group of patients in whom the FFS score was superior to the radiologists' best score. The FFS method can be used as a tool to follow up the response to a clinical or research treatment and to obtain standardization of pattern interpretation independently of the individual reader.     

Accuracy of ultrasonography in diagnosis of hepatocellular disease.

Retrospective evaluations were made of abdominal echograms in 61 patients who underwent liver biopsy within 3 weeks after ultrasound study. Without knowledge of clinical or biopsy data, determinations were made by two independent observers of: (1) liver size, (2) beam penetration, (3) echogenicity, (4) vascularity, (5) ancillary abnormality, and (6) diagnostic impression. Using these parameters, the presence of generalized parenchymal disease was identified in 81% of reviews of patients with cirrhosis. Thus, in patients with known cirrhosis, there was a 19% false negative rate. In normal patients, 76% were correctly called normal by the reviewers. However, in 24% generalized parenchymal disease was suggested (24% false positive). Patients with fatty liver could not be reliably distinguished from patients with cirrhosis, nor could patients with hepatitis be easily separated from those with normal livers. In all of these determinations, the combination of several features provided more diagnostic accuracy than any single echographic finding.     

Quantitative US attenuation in normal liver and in patients with diffuse liver disease: importance of fat

Two methods are used to estimate ultrasound attenuation in liver. These were based on amplitude change and frequency change as a result of depth dependent attenuation. Evaluation of the two methods against a family of calibrated phantoms yielded correlation coefficients of 0.98 and 0.99, respectively. Liver attenuation in 26 control subjects was 0.50 and 0.52 dB/MHz/cm, respectively. Liver attenuation was estimated in 50 patients who later underwent liver biopsy. Comparison with quantitative histologic results showed that the presence of fat alone accounted for the increased attenuation associated with cirrhosis. Similar high attenuation values were found in patients with fatty infiltration. Fibrosis alone did not result in elevated liver attenuation. Cirrhotics without fatty infiltration had attenuation similar to that of the controls. Mechanisms of action are discussed.     

B超定位肝穿刺活检的临床应用

目的对慢性肝炎患者进行B型超声检查,并在B超定位下肝穿刺活检作组织病理学诊断,以明确肝脏的炎症活动分级与肝纤维化程度分期。方法对84例慢性肝炎患者进行超声检查,采取B超定位,组织切割针获取标本,送病理组织学检查。结果84例超声诊断轻度肝损伤53例,中度肝损伤18例,可疑肝硬化8例,肝硬化5例。组织病理学诊断:轻度慢性肝炎39例,中度慢性肝炎26例,早期肝硬化12例,肝硬化7例。结论通过超声定位肝穿刺活检作组织病理学诊断,可了解慢性肝炎的病理分级分期,从而指导临床治疗。     

超声引导下穿刺活检对肝内实性占位病变的诊断价值

目的 探讨超声引导下细针穿刺活检(US-FNA)对肝内实性小占位病变定性诊断的价值.方法 对36例经常规超声或CT无法定性的直径＜3 cm的肝内实性小结节进行US-FNA,所获组织行病理学检查,对定性诊断为良性病变的患者均以超声或CT行定期随访.结果 US-FNA取材成功率为100％,共穿刺38次,其中一次取材成功者达34例(94.4％),诊断准确率达97.2％,假阴性率2.8％.诊断原发性肝细胞肝癌24例,肝转移癌3例,肝血管瘤3例,肝硬化结节2例,肝脓肿3例,肝类癌1例.其中1例首次病理结果为非恶性病变,1个月复后查发现患者肝内结节增大,再次行US-FNA确诊为原发性肝细胞癌.所有患者术后无严重并发症发生,1例发生针道转移.结论 US-FNA是一种准确、快速、微创及经济的肝内实性小占位病变定性诊断方法.     

The prevalence of diffuse and focal lesions of the hepatic parenchyma in a nonselected, resident population. A prospective echographic study

A group of 2978 randomly chosen residents from a rural area of Veneto (Italian region), aged 18-69 years, was assumed as a study population. They underwent US examination of the liver, routine liver function tests, and--when necessary--other imaging techniques and liver biopsy. Liver US exam detected diffuse lesions in 26% of cases (mostly bright liver pattern), and focal lesions in 3%; US findings were normal in 66% of patients and questionable or inconclusive in 5%. As far as focal lesions were concerned, the final diagnosis was angioma (24 cases), cyst (31), neoplasm (5). When bright liver pattern was observed, liver function tests were altered in 78% of the patients; when US findings were normal, liver function tests were normal in 59% of cases. In conclusion our data: 1) show that focal and diffuse liver abnormalities are relatively frequent in unselected and asymptomatic people, 2) confirm US diagnostic utility, and 3) suggest that US be employed as a screening exam in study populations.     

低频与高频超声诊断肝脏疾病的比较研究

目的:探讨高频超声诊断肝脏疾病的临床价值。方法:选择我院行肝脏超声检查的患者,先行低频超声检查,再行高频超声检查。高频超声或常规低频超声发现肝脏占位性病变且病灶距皮下≤70mm者120例(实性病灶83例,囊性病灶37例);早期肝硬化53例,轻度脂肪肝95例,共268例纳入研究。病灶长径20mm的患者,中、重度脂肪肝,以及晚期肝硬化除外。对比分析高频超声和低频超声显示肝脏病灶的能力。结果:距皮下≤70mm的肝内实性病灶,高频超声发现83例,低频超声发现47例(χ2=45.97,P0.001);最大径5mm的实性占位性病灶,高频超声发现43例,低频超声发现或疑似9例(χ2=56.23,P0.001)。距皮下≤70 mm的肝内囊性病灶,高频超声发现37例,低频超声发现25例(χ2=14.32,P0.001),另外12例低频超声诊断为实性病变。早期肝硬化患者,高频超声发现硬化结节53例,低频超声发现或疑似硬化结节22例(χ2=43.81,P0.001)。轻度脂肪肝患者,高频超声诊断95例,低频超声72例(χ2=26.17,P0.001)。结论:高频超声可明显提高肝脏表浅部位微小病灶的检出率,可以早期诊断肝硬化、脂肪肝等弥漫性病变,是常规超声的有效补充。     

乳腺浸润性导管癌不同分子分型及病理组织学分级间常规超声征像的差异

 目的 探讨乳腺浸润性导管癌不同分子分型及病理组织学分级间常规超声征像的差异。方法 收集因乳腺肿物入保定市第一中心医院诊疗并最终手术确诊为乳腺浸润性导管癌的患者资料,回顾性分析术前常规超声典型征像及术后病理学资料,比较不同分子分型及病理组织学分级间的超声征像差异及相关性。结果 (1)五组分子分型病灶的超声征像均存在统计学差异(P<0.05),其中三阴型多表现为肿物回声均匀(47.2%,17/36),病灶后方回声增强(58.3%,21/36);少表现为回声衰减(5.6%,2/36),微钙化(27.8%,10/36)等。HER-2阳性(HR阳性)多表现为微钙化(77.8%,35/45)伴病灶后方回声衰减(48.9%,22/45)。Luminal A型多表现乏血供(62.2%,46/74)。(2)不同组织学分级病灶的超声征像存在统计学差异(P<0.05)。中高分化组病灶多表现为边缘毛刺征(70.0%,133/190),高回声晕(60.5%,115/190),病灶后方回声衰减(42.1%,80/190);低分化组病灶超声征像多表现为富血供(84.3%,43/51)。多变量logistic回归分析显示,血流分布及肿块后方回声特点是超声影像学辨别低分化组IDC病灶的独立危险因素(P<0.05)。结论 乳腺浸润性导管癌的超声检查在一定程度上有助于辨别分子分型及组织学分级程度,为乳腺癌患者个性化治疗方案的选择及预后提供影像学依据。     

Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liver disease

To establish the accuracy of ultrasonography in assessing diffuse parenchymal liver disease we performed a prospective comparative study with histology in 50 patients with a wide range of liver disease. Liver biopsy was performed within 24 h of the ultrasound examination and ultrasonography was performed by a single operator who was unaware of clinical details of the patients. Histology was reviewed blind and the degree of steatosis graded mild, moderate or severe while increased portal fibrous tissue was graded mild, moderate or established cirrhosis. Thirty-six patients had steatosis and 31 patients had increased fibrous tissue on histology. Ultrasonography correctly identified steatosis in 32/36 (89%) patients including all patients with the severe grade. Increased fibrous tissue was correctly identified in 24/31 (77%) with a sensitivity of 100% in patients with moderate fibrosis and established cirrhosis. Specificity was 93% for steatosis and 89% for increased fibrous tissue. These results show that ultrasonography can provide a non-invasive prediction of liver histology which in moderate and severe steatosis and advanced fibrosis can be both highly sensitive and specific.     

Prostatic carcinoma: detection and staging using suprapubic US

Eighteen patients with pathologically proved carcinoma of the prostate were examined with suprapubic ultrasound (US) to assess the capability of the modality in the detection and staging of the disease. Five of the patients were evaluated for recurrent disease. A detailed, retrospective, echo-textural analysis of the prostate and periprostatic structures was performed. The most frequently encountered US findings were recorded and used as criteria in the diagnosis and staging. Most diagnostic of the echo patterns were the presence of a large (greater than 6 mm) focal density within the peripheral zone that was as bright as or less bright than the density of the capsule, a mixed or diffuse pattern, and loss of integrity of the capsule, seminal vesicles, or bladder. Using these criteria, we were able to correctly diagnose 17 of 18 cases, with an accuracy rate of 94%. US was also used to assess the extent of local disease in carcinoma of the prostate. The US staging was compared with the staging by digital rectal examination and by clinicopathologic results. We correctly staged 15 of 18 cases (83%) with US, while the rectal examination helped to stage correctly only 10 of 18 cases (56%). All errors were due to understaging. We find suprapubic US to be very helpful in the diagnosis and staging of prostatic cancer. Since there is some overlap between the findings in benign and malignant disease, we cannot recommend US as an alternative to prostate biopsy. Further experience in detection and staging with prospective studies may be necessary before final conclusions can be made.     

Ultrasound in hepatoma-can specific diagnosis be made?

The ultrasound appearances of primary hepatocellular carcinoma in 32 patients are described. Attempts to correlate the appearances with serological, histological, and arteriographic findings revealed no consistent pattern. There appears to be no great difference in the range of ultrasound appearances in primary hepatocellular carcinoma when compared with that reported for metastatic disease. The findings suggest that in patients with cirrhosis, ultrasound is a sensitive method for the detection and accurate location of hepatocellular carcinoma, but that in these patients the echo pattern provides little help in the differentiation of primary from secondary carcinoma. Our study has revealed four different echo patterns in patients with hepatocellular carcinoma: echofree (47%), echogenic (23%), mixed (175) and diffuse infiltration 13%).     

不典型肝脓肿超声诊断的应用(附32例分析)

目的:探讨不典型肝脓肿的超声表现及超声诊断技术临床应用价值。方法:回顾性分析32例不典型肝脓肿的超声表现,其中3例超声造影检查。全部病例经临床随访及穿刺活检后经病理证实。结果:不典型肝脓肿随病理过程的变化超声表现各不相同,可表现为实性低回声、等回声及偏高回声,与周围肝组织分界不清,内回声强弱不等,分布极不均匀,可见形态不规则的小片状液区。部分病灶内可见正常肝内门脉血管穿行。注射对比剂后整个过程病灶内部未见增强,均呈低回声,病灶边界较造影前清晰。结论:不典型肝脓肿声像图复杂多变,超声检查仍为可靠方法,超声造影更具诊断意义。     

口服有回声型对比剂经腹彩超在诊断胃底静脉曲张中的价值

目的:评价口服有回声型对比剂经腹彩超在诊断胃底静脉曲张中的价值。方法:对85例肝硬化伴有门静脉高压患者采用口服有回声型对比剂充盈胃腔后经腹彩超检查,与胃镜检查结果进行比较。结果:超声检出胃底静脉曲张33例,经胃镜证实胃底静脉曲张49例,超声假阴性16例,均为轻度胃底静脉曲张。超声诊断正确率为81.2%(69/85);敏感性为67.3%(33/49);特异性为100%(36/36)。结论:口服有回声型对比剂经腹彩超对胃底静脉曲张的显像具有较高的临床应用价值。     

乙肝患者外周血单核细胞比例与肝脏病变程度的关系研究

目的探讨乙肝患者外周血单核细胞比例与肝脏病变程度的关系。方法收集2010-2011年解放军302医院明确诊断的轻中度慢性乙型肝炎患者197例(肝炎组)、乙肝肝硬化患者248例(肝硬化组),以同期269例健康体检者作为对照组。采用Sysmex XE-2100血液分析仪进行全血细胞分析,实时荧光PCR扩增仪进行血清HBV DNA定量,ELISA法测定血清肝纤维化指标透明质酸(HA)、层粘连蛋白(LN)、Ⅳ型胶原(IV.C)、Ⅲ型前胶原(PCⅢ)水平。共390例患者进行了肝组织活检,参照中华医学会《病毒性肝炎防治方案》(2000年)进行肝脏炎症程度(G0-G4)及纤维化程度(S0-S4)评价。结果全血细胞分析结果表明,肝炎组和肝硬化组外周血单核细胞比例(分别为8.93%±3.05%、9.85%±3.61%)明显高于对照组(8.16%±1.88%,P<0.01),且肝硬化组明显高于肝炎组(P<0.01);血清HBV DNA定量分析表明,239例HBV DNA≥100U/ml的患者单核细胞比例(8.61%±2.83%)显著高于206例HBV DNA<100U/ml的患者(8.12%±2.53%,P<0.05);ELISA检测结果表明,肝硬化组肝纤维化指标HA、LN、IV.C、PCⅢ水平均明显高于肝炎组,且同组内肝纤维化指标升高者的单核细胞比例高于肝纤维化指标正常者;390例患者的肝组织活检病理结果显示,随肝脏炎症及纤维化程度加重,单核细胞比例升高的患者逐渐增多,差异有统计学意义(P<0.01,P<0.01)。结论乙肝患者外周血单核细胞比例升高与肝脏病变程度关系密切,可在一定程度上反映肝脏的炎症及纤维化水平。     

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.     

乳腺叶状肿瘤声像图特征及误诊分析

目的 探讨不同类型乳腺叶状肿瘤(PTB)的超声声像图特征并分析其误诊原因.方法 选取61例不同类型PTB患者乳腺肿块的位置、大小、数目、形态、回声等形态学特征,对比超声检查确诊PTB以及误诊患者声像图特征,并与病理结果对照分析,总结误诊原因.结果 1)本组PTB 61例,良性43例(70.5％),交界性10例(16.4...     

超声造影引导在肝占位性病变穿刺活检中应用价值

目的探讨超声造影引导在肝占位性病变穿刺活检中的临床应用价值。方法回顾性分析2014年1月至2016年12月行穿刺活检的102例肝占位性病变患者临床资料,其中,A组患者(n=53)采取超声造影引导行穿刺活检;B组患者(n=49)采取超声引导行穿刺活检,所取组织满足病理诊断为取材成功。比较两组患者穿刺成功率、定性诊断率。结果两组患者均全部穿刺成功,穿刺成功率均为100.0%。A组53例患者取材均满足病理诊断,定性诊断率100.0%;B组定性诊断率为83.7%(41/49)。A组的定性诊断率明显优于B组,差异有统计学意义(P<0.05)。结论超声造影引导下行肝占位性病变穿刺活检,能清楚显示肿瘤活性区域、坏死区域及液化区域,更为准确的定位取材,降低假阴性的风险,具有较高的临床应用价值。