Biomarkers ; blood ; Humans ; Liver Cirrhosis ; diagnosis ; Ultrasonography, Doppler ; methods

Doppler ultrasonography of the hepatic vasculature is an integral part of evaluating precirrhotic and cirrhotic patients. While the reversal of the portal venous flow is a well-recognized phenomenon, other flow patterns, although not as easily understood, may play an important role in assessing the disease status. This article discusses the different characteristic flow patterns observed from the portal vein, hepatic artery, and hepatic vein in patients with liver cirrhosis or related complications and procedures. Knowledge of these different flow patterns provides additional information that may reinforce the diagnosis of cirrhosis, help in staging, and offer prognostic information for determining the direction of therapy. Doppler ultrasonography is invaluable when liver transplantation is being considered and aids in the diagnosis of cirrhosis and portal hypertension.
Diagnosis ; Fibrosis* ; Hepatic Artery ; Hepatic Veins ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Liver Transplantation ; Portal Vein ; Ultrasonography, Doppler ; Ultrasonography, Doppler, Color

In order to determine the value of CT in the diagnosis of choledocholithiasis, the authors retrospectivelystudied 33 cases of choledocholithiasis proven by surgery from January 1983 to June 1985. Among them, 15 caseswere examined by both CT and ultrasonography. The results were as follows: 1. There were 12 men and 21 women withmean age of 57 years. 2. CT correctly diagnosed choledocholithiasis in 29(88%) of total 33 cases. There were 4false negative diagnoses and there were no false positive. 3. In 15 cases which were examined by both CT andultrasonography, 13(86%) cases were correctly diagnosed by CTand 7(46%) by utrasonography. 4. The majority(88%) ofcholedocholithiasis were demonstrated as calcific density and 4 cases(12%) were nearly isodense to pancreas. 5.Most cases were shown as homogenous density and 5 cases(16%) as ringlike structure with low density center andhigh density periphery. 6. Additional findings, such as intrahepatic and/or GB stones, pericholangitic abscess, GBempyema, ascites, and liver cirrhosis were also identified by CT. 7. CT is effective for noninvasive and accuratedetection of choledocolithiasis. So invasive cholangiography, such as E.R.C.P or P.T.C can be reserved in manycases of choledocholithiasis.
Abscess ; Ascites ; Cholangiography ; Choledocholithiasis ; Diagnosis ; Female ; Humans ; Liver Cirrhosis ; Male ; Pancreas ; Ultrasonography

Radiological imaging plays a crucial role in the diagnosis of hepatocellular carcinoma (HCC) as the noninvasive diagnosis of HCC in high-risk patients by typical imaging findings alone is widely adopted in major practice guidelines for HCC. While imaging techniques have markedly improved in detecting small liver lesions, they often detect incidental benign liver lesions and non-hepatocellular malignancy that can be misdiagnosed as HCC. The most common mimicker of HCC in cirrhotic liver is nontumorous arterioportal shunts that are seen as focal hypervascular liver lesions on dynamic contrast-enhanced cross-sectional imaging. Rapidly enhancing hemangiomas can be easily misdiagnosed as HCC especially on MR imaging with liver-specific contrast agent. Focal inflammatory liver lesions mimic HCC by demonstrating arterial-phase hypervascularity and subsequent washout on dynamic contrast-enhanced imaging. It is important to recognize the suggestive imaging findings for intrahepatic cholangiocarcinoma (CC) as the management of CC is largely different from that of HCC. There are other benign mimickers of HCC such as angiomyolipomas and focal nodular hyperplasia-like nodules. Recognition of their typical imaging findings can reduce false-positive HCC diagnosis.
Carcinoma, Hepatocellular/*diagnosis/radiography ; Diagnosis, Differential ; Hemangioma/complications/radiography/ultrasonography ; Hepatitis B/complications ; Humans ; Inflammation/radiography/ultrasonography ; Liver/radiography/ultrasonography ; Liver Cirrhosis/complications/radiography ; Liver Neoplasms/*diagnosis/radiography ; Magnetic Resonance Imaging ; Non-alcoholic Fatty Liver Disease/radiography/ultrasonography

OBJECTIVE: Studies have presented conflicting results regarding the accuracy of ultrasonography (US) for diagnosing portal hypertension (PH). We sought to identify evidence in the literature regarding the accuracy of US for assessing PH in patients with liver cirrhosis. MATERIALS AND METHODS: We conducted a systematic review by searching databases, including MEDLINE, EMBASE, and the Cochrane Library, for relevant studies. RESULTS: A total of 14 studies met our inclusion criteria. The US indices were obtained in the portal vein (n = 9), hepatic artery (n = 6), hepatic vein (HV) (n = 4) and other vessels. Using hepatic venous pressure gradient (HVPG) as the reference, the sensitivity (Se) and specificity (Sp) of the portal venous indices were 69-88% and 67-75%, respectively. The correlation coefficients between HVPG and the portal venous indices were approximately 0.296-0.8. No studies assess the Se and Sp of the hepatic arterial indices. The correlation between HVPG and the hepatic arterial indices ranged from 0.01 to 0.83. The Se and Sp of the hepatic venous indices were 75.9-77.8% and 81.8-100%, respectively. In particular, the Se and Sp of HV arrival time for clinically significant PH were 92.7% and 86.7%, respectively. A statistically significant correlation between HVPG and the hepatic venous indices was observed (0.545-0.649). CONCLUSION: Some US indices, such as HV, exhibited an increased accuracy for diagnosing PH. These indices may be useful in clinical practice for the detection of significant PH.
Hepatic Veins/ultrasonography ; Humans ; Hypertension, Portal/*diagnosis/*ultrasonography ; Liver Cirrhosis/*ultrasonography ; Middle Aged ; Portal Pressure ; Portal Vein/ultrasonography ; Prospective Studies ; Sensitivity and Specificity ; Vascular Resistance

OBJECTIVE: To validate the diagnostic value of a new point shear-wave elastography method, S-shearwave elastography (S-SWE; Samsung Medison Co., Ltd.), in noninvasive assessment of liver fibrosis. MATERIALS AND METHODS: In this prospective multicenter study, liver stiffness (LS) measurements for 600 participants were obtained with both S-SWE and transient elastography (TE). The rates of unsuccessful LS measurements in S-SWE and TE were compared, and correlations between S-SWE and TE measurements were assessed. In 107 patients with histologic reference data, the optimal LS cut-off values for predicting severe fibrosis and cirrhosis on S-SWE were determined using receiver operating characteristic (ROC) curve analysis. The LS cut-off values in S-SWE were then validated in 463 patients without histologic reference data by using TE values as the reference standard, and the sensitivity and specificity of the cut-off values for predicting severe fibrosis and cirrhosis were calculated. RESULTS: The frequency of unsuccessful LS measurements on TE (4.5%, 27/600) was significantly higher than that (0.7%, 4/600) on S-SWE (p < 0.001). LS measurements on S-SWE showed a significant correlation with TE values (r = 0.880, p < 0.001). In 107 patients with histological reference data, the areas under the ROC curves on S-SWE were 0.845 and 0.850, with optimal cut-offs of 7.0 kilopascals (kPa) and 9.7 kPa, for the diagnosis of severe fibrosis and cirrhosis, respectively. Using these cut-off values, S-SWE showed sensitivities of 92.9% and 97.4% and specificities of 89.5% and 83.1% in TE-based evaluations of severe fibrosis and cirrhosis, respectively. CONCLUSION: LS measurements on S-SWE were well correlated with those on TE. In addition, S-SWE provided good diagnostic performance for staging of hepatic fibrosis, with a lower rate of unsuccessful LS measurements compared with TE.
Diagnosis ; Elasticity Imaging Techniques ; Fibrosis ; Humans ; Liver Cirrhosis ; Liver ; Methods ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Ultrasonography

Primary hepatic epithelioid hemangioendothelioma is a rare neoplasm of endothelial origin. The clinical manifestations are nonspecific, ranging from complete absence of symptoms to hepatic failure and death. Spontaneous rupture of a hepatic epithelioid hemangioendothelioma is an extremely rare presentation. We present a case of primary hepatic epithelioid hemangioendothelioma in a 65-year-old male patient with alcoholic liver cirrhosis. He was hospitalized due to epigastric pain and multiple liver masses on abdominal ultrasound. Dynamic liver CT imaging revealed multiple peripheral nodular enhanced mass lesions with delayed centripetal enhancement, and the adjacent collection of high-attenuation fluid along the liver capsule. Abdominal tapping revealed blood in the peritoneal cavity. Primary hepatic epithelioid hemangioendothelioma with spontaneous rupture was finally diagnosed based on a histopathologic examination revealing positive immunohistochemical staining for CD34.
Antigens, CD34/metabolism ; Bone Neoplasms/diagnosis/secondary ; Diagnosis, Differential ; Hemangioendothelioma, Epithelioid/*diagnosis/pathology/ultrasonography ; Humans ; Liver Cirrhosis, Alcoholic/complications/diagnosis ; Liver Neoplasms/*diagnosis/pathology/ultrasonography ; Male ; Pancreatic Neoplasms/diagnosis/secondary ; Rupture, Spontaneous ; Tomography, X-Ray Computed

Humans ; Liver Cirrhosis ; diagnosis ; diagnostic imaging ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed ; Ultrasonography, Doppler, Color ; methods

Cholangitis, Sclerosing ; diagnosis ; therapy ; Hepatitis, Autoimmune ; diagnosis ; therapy ; Humans ; Liver Cirrhosis, Biliary ; diagnosis ; therapy ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed ; Ultrasonography

BACKGROUND/AIMS: The diagnosis and treatment of benign hepatic lesions remain controversal. The widespread availability of ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI), and their frequent application in evaluating abdominal pain, has resulted in more frequent discovery of incidental benign hepatic lesions. To address these points, the clinical data of patients with benign hepatic lesions treated with surgical resections at our hospital were reviewed retrospectively. METHODS: We reviewed the clinical records of thirty nine patients with benign hepatic lesions who had undergone hepatic resection from January, 1985 to August, 2002 at Hanyang University Hospital. RESULTS: There were 39 patients, whose mean age was 47.0 years. The ages ranged from 24~74 years. There were 14 male patients and 25 female patients. The ratio of male and female was 1:1.8. Major symptoms were right upper quadrant pain, mass, epigastric pain, and non-specific GI symptoms. 22 cases of anatomical resections (10 right lobectomy, 5 left lobectomy, 7 left lateral segmentectomy) and 17 non anatomical resections were done. There were no postoperative deaths in this series. Fourteen patients (35.9%) developed operative complications. All of them were minor complications. During the mean follow up time, symptomatic relief was achieved in patients out of patients who we could contact with opd follow up or telephone interview. Three patients died of massive pleural effusion 4 years after operation, myocardial infarction 14 months after operation, alcoholic liver cirrhosis and diabetes mellitus 33 months after operation. CONCLUSION: Hepatic resection in patients who had benign hepatic lesions in the liver was safe and effective treatment modality if patients were selected with suitable indications.
Abdominal Pain ; Diabetes Mellitus ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Interviews as Topic ; Liver ; Liver Cirrhosis, Alcoholic ; Magnetic Resonance Imaging ; Male ; Myocardial Infarction ; Pleural Effusion ; Retrospective Studies ; Ultrasonography