Cirrhosis echocardiography or ultrasound
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]
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Overview
On ultrasonography, changes in liver contours and nodularity may be evident. The echo texture may appear coarsened along with an increase in echogenecity from focal fatty changes and irregular appearing areas. It can also be used to screen for hepatocellular carcinoma, portal hypertension and Budd-Chiari syndrome.
Echocardiography
- Echocardiograms may be helpful in measuring the ejection fraction, and ischemic and hypokinetic areas of the ventricles in establishing a diagnosis of congestive cardiac failure as a cause of liver cirrhosis.
- Contrast echocardiography.
- Useful diagnostic test for hepatopulmonary syndrome.
- Intravenous microbubbles (> 10 micrometers in diameter) from agitated normal saline that are normally obstructed by pulmonary capillaries (normally <8 to 15 micrometers) rapidly transit the lung and appear in the left atrium of the heart within 7 heart beats.
- Similarly, intravenous technetium-99m–labeled albumin may transit the lungs and appear in the kidney and brain.
Ultrasound
Ultrasound findings are as follows:
- Changes in liver contour
- Nodularity
- Increase in echogenecity from focal fatty infiltration
- Vascular changes:
- Flow across both portal and systemic circulation increases
- Resistive index increases in end stage liver disease
- Vessels appear elongated and tortuous, called "corkscrewing" of the vessels
- Doppler ultrasound may show spontaneous shunts
- Splenomegaly and collaterals from portal hypertension may be noted.
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Transient Elastography
A new type of device, the FibroScan (transient elastography), uses elastic waves to determine liver stiffness which theoretically can be converted into a liver score based on the METAVIR scale. The FibroScan produces an ultrasound image of the liver (from 20-80mm) along with a pressure reading (in kPa). The test is much faster than a biopsy (usually lasts 2.5-5 minutes) and is completely painless. It shows reasonable correlation with the severity of cirrhosis.[1] [2]
Radiologic findings:
- Radiologic studies include:[3]
- Abdominal ultrasound
- Computed tomography scan
- Magnetic resonance imaging
- Evidence of Portal HTN:
- varices
- Ascites
DIAGNOSIS —
- Abdominal imaging (typically ultrasound) helps:
- Evaluate the liver parenchyma
- Detects extrahepatic manifestations of cirrhosis
Laboratory tests:
- AST to platelet ratio index
- FibroTest/FibroSure
Imaging studies:
- Findings on abdominal imaging are viewed in light of other signs of cirrhosis, such as physical examination or laboratory test findings.
- In addition to evaluating the liver, abdominal imaging may reveal:
- Hepatocellular carcinoma
- Extrahepatic findings suggestive of cirrhosis:
- Ascites
- Varices
- Splenomegaly
- Hepatic or portal vein thrombosis
References
- ↑ Foucher J, Chanteloup E, Vergniol J; et al. (2006). "Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study". Gut. 55 (3): 403–8. doi:10.1136/gut.2005.069153. PMID 16020491.
- ↑ Xie L, Chen X, Guo Q, Dong Y, Guang Y, Zhang X (2012). "Real-time elastography for diagnosis of liver fibrosis in chronic hepatitis B". Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 31 (7): 1053–60. PMID 22733854. Unknown parameter
|month=ignored (help) - ↑ Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, Schulzer M, Mak E, Yoshida EM (2012). "Does this patient with liver disease have cirrhosis?". JAMA. 307 (8): 832–42. doi:10.1001/jama.2012.186. PMID 22357834.
- ↑ Becker CD, Scheidegger J, Marincek B (1986). "Hepatic vein occlusion: morphologic features on computed tomography and ultrasonography". Gastrointest Radiol. 11 (4): 305–11. PMID 3533689.
- ↑ Di Lelio A, Cestari C, Lomazzi A, Beretta L (1989). "Cirrhosis: diagnosis with sonographic study of the liver surface". Radiology. 172 (2): 389–92. doi:10.1148/radiology.172.2.2526349. PMID 2526349.
- ↑ Sanford NL, Walsh P, Matis C, Baddeley H, Powell LW (1985). "Is ultrasonography useful in the assessment of diffuse parenchymal liver disease?". Gastroenterology. 89 (1): 186–91. PMID 3891495.
- ↑ Giorgio A, Amoroso P, Lettieri G, Fico P, de Stefano G, Finelli L, Scala V, Tarantino L, Pierri P, Pesce G (1986). "Cirrhosis: value of caudate to right lobe ratio in diagnosis with US". Radiology. 161 (2): 443–5. doi:10.1148/radiology.161.2.3532188. PMID 3532188.
- ↑ Simonovský V (1999). "The diagnosis of cirrhosis by high resolution ultrasound of the liver surface". Br J Radiol. 72 (853): 29–34. doi:10.1259/bjr.72.853.10341686. PMID 10341686.
- ↑ Trinchet JC, Chaffaut C, Bourcier V, Degos F, Henrion J, Fontaine H, Roulot D, Mallat A, Hillaire S, Cales P, Ollivier I, Vinel JP, Mathurin P, Bronowicki JP, Vilgrain V, N'Kontchou G, Beaugrand M, Chevret S (2011). "Ultrasonographic surveillance of hepatocellular carcinoma in cirrhosis: a randomized trial comparing 3- and 6-month periodicities". Hepatology. 54 (6): 1987–97. doi:10.1002/hep.24545. PMID 22144108.
- ↑ "EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma". J. Hepatol. 56 (4): 908–43. 2012. doi:10.1016/j.jhep.2011.12.001. PMID 22424438.