Ultrasound in Chronic Liver Disease, a Review

Ultrasound in Chronic Liver Disease, a Review

J. F. Gerstenmaier and R. N. Gibson

Insights Imaging. 2014 Aug; 5(4): 441–455.

Published online 2014 May 24. doi:  10.1007/s13244-014-0336-2

Abstract

Background 

With the high prevalence of diffuse liver disease there is a strong clinical need for noninvasive detection and grading of fibrosis and steatosis as well as detection of complications.

Methods

B-mode ultrasound supplemented by portal system Doppler and contrast-enhanced ultrasound are the principal techniques in the assessment of liver parenchyma and portal venous hypertension and in hepatocellular carcinoma surveillance.

Results

Fibrosis can be detected and staged with reasonable accuracy using Transient Elastography and Acoustic Radiation Force Imaging. Newer elastography techniques are emerging that are undergoing validation and may further improve accuracy. Ultrasound grading of hepatic steatosis

currently is predominantly qualitative.

Conclusion

A summary of methods including B-mode, Doppler, contrast-enhanced ultrasound and various elastography techniques, and their current performance in assessing the liver, is provided.

Teaching Points

• Diffuse liver disease is becoming more prevalent and there is a strong clinical need for noninvasive detection.

• Portal hypertension can be best diagnosed by demonstrating portosystemic collateral venous flow.

• B-mode US is the principal US technique supplemented by portal system Doppler.

• B-mode US is relied upon in HCC surveillance, and CEUS is useful in the evaluation of possible HCC.

• Fibrosis can be detected and staged with reasonable accuracy using TE and ARFI.

• US detection of steatosis is currently reasonably accurate but grading of severity is of limited accuracy.

Future perspective

The increasing prevalence of chronic liver disease, including fatty liver disease, together with the need to minimise invasive liver biopsies will continue to provide substantial drive for ultrasound research and development.

Conventional B-mode ultrasound =

 + Quantification of echointensity in the diagnosis of fatty liver disease is an area of recent interest. Standardisation of technique and interobserver eproducibility will need to be addressed.

  + Quantitative and semi-quantitative assessment of echotexture in the diagnosis of fibrosis and fatty liver disease is being developed

Doppler ultrasound =

 The role of Doppler ultrasound in chronic liver disease is likely to remain principally in the diagnosis of portal venous hypertension

Contrast-enhanced ultrasound =

 Kupffer-phase contrast agents can be used in the grading of fibrosis as well as in the detection of focal lesions,and it is hoped that these agents will become more widely available.

Elastography

 More widespread use of the two most extensively validated and established techniques of TE and ARFI is expected, and further shear wave elastography techniques are likely to become more widely adopted and evaluated.

PoCUS for WRIST TRAUMA

Abstract

Objective

We evaluated the effectiveness of point-of-care wrist ultrasonography compared with 3T-magnetic resonance imaging (MRI) for diagnosing triangular fibrocartilage complex (TFCC) injuries in trauma patients with ulnar-sided pain and instability. Moreover, we assessed the inter-observer variability between an emergency physician and a musculoskeletal radiology fellow.

Material and methods

A prospective cross-sectional study was conducted in an emergency department; patients with ulnar-sided sprain and instability were recruited. An emergency physician and a musculoskeletal radiology fellow independently evaluated the TFC, meniscal homologue, volar and dorsal distal radioulnar ligaments, and extensor carpi ulnaris using point-of-care ultrasonography. Findings were classified as normal, partial rupture, or complete rupture. Wrist 3T-MRI was used as the reference standard. We compared the diagnostic values for point-of-care ultrasonography obtained by both reviewers using DeLong's test. Intra-class correlation coefficients (ICCs) were calculated for agreement between each reviewer and the reference standard, and directly between the two reviewers.

Results

Sixty-five patients were enrolled. Point-of-care wrist ultrasonography showed acceptable sensitivity (97.2–99.1%), specificity (96.8–97.3%), and accuracy (96.9–97.9%); these diagnostic performance values did not differ significantly between reviewers (p = 0.58–0.98). Agreement between each reviewer and the reference standard was excellent (emergency physician, ICC = 0.964; musculoskeletal radiology fellow, ICC = 0.976), as was the inter-observer agreement (ICC = 0.968).

Conclusion

Point-of-care wrist ultrasonography is as precise as MRI for detecting TFCC injuries, and can be used for immediate diagnosis and further preoperative imaging. Moreover, it may shorten the interval from emergency department admission to surgical intervention while reducing costs.