Portal flow steal occasionally persists even after the liver transplantation, which may reduce the portal flow and thus threaten the patients' outcome. Therefore, pre- and peri-operative detection of portal steal phenomenon requiring radiological or surgical interruption is essential for the liver transplantation candidates as well as for the recipients.
Adult ; Hepatitis B, Chronic/complications ; Humans ; Liver Cirrhosis/etiology/*therapy ; *Liver Transplantation ; Male ; Mesenteric Veins/*ultrasonography

Hepatitis B, Chronic ; complications ; Humans ; Liver ; diagnostic imaging ; pathology ; Liver Cirrhosis ; diagnostic imaging ; etiology ; pathology ; Ultrasonography

OBJECTIVETo perform a meta-analysis of contrast-enhanced ultrasound (CEUS) as a diagnostic tool for small hepatocellular carcinoma (HCC) in patients with cirrhosis.

METHODSA computer-based retrieval system was first used to identify reports on the diagnostic efficacy of CEUS for small HCC in patients with cirrhosis that were published between 1995 and April 2012 in the following literature databases: Medline, PubMed, Foreign Medical Journal Service (FMJS), China National Knowledge Infrastructure (CNKI), VIP Journal Integration Platform (VJIP), Wanfang Chinese Periodical Database, and Chinese Biomedicine Database (CBM). Two investigators, working independently, then selected cases from the relevant based upon specific inclusion and exclusion criteria. The extracted data was subjected to quality assessment of diagnostic accuracy studies (QUADAS). The MetaDisc version 1.4 software was used to conduct meta-analyses.

RESULTSSix studies, involving 380 lesions detected by various contrast mediums, were selected for analysis. Diagnosis of small HCC in patients with cirrhosis by CEUS based on Sonovue and Levovist had pooled sensitivities of 0.73 (95% confidence interval (CI): 0.67-0.79) and 0.76 (95% CI: 0.60-0.89), pooled specificities of 0.89 (95% CI: 0.81-0.94) and 0.79 (95% CI: 0.61-0.91), pooled positive likelihood ratios of 6.53 (95% CI: 2.74-15.52) and 3.60 (95% CI: 1.89-6.85), pooled negative likelihood ratios of 0.26 (95% CI: 0.13-0.54) and 0.21 (95% CI: 0.02-2.63), and pooled diagnostic odds ratios of 27.50 (95% CI: 7.99-94.72) and 25.74 (95% CI: 5.30-125.04), respectively. The area under the curve of the summary receiving operating characteristic (SROC) of CEUS based on Sonovue was 0.9252 and the Q* index was 0.8595.

CONCLUSIONCEUS is a valuable diagnostic tool for small HCC in cirrhotic patients.

Carcinoma, Hepatocellular ; complications ; diagnostic imaging ; Contrast Media ; Humans ; Liver Cirrhosis ; complications ; diagnostic imaging ; Liver Neoplasms ; complications ; diagnostic imaging ; 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

In this paper, the Peleg Method is used to calculate the fractal dimension of 5 normal images and 5 schistosomial fibrosis images in order to extract the texture features of B-Scan liver images based on a fractal model. The result indicates that this fractal dimension could be an effective parameter to distinguish the pathologic changes of the disease.
Algorithms ; Fractals ; Humans ; Image Processing, Computer-Assisted ; methods ; Liver ; diagnostic imaging ; pathology ; Liver Cirrhosis ; diagnostic imaging ; Schistosomiasis ; complications ; Ultrasonography ; methods

An 11 year-old girl, whose condition was diagnosed as juvenile-type autosomal recessive polycystic kidney disease (ARPKD) at five years of age, presented with chest pain and dyspnea that had developed suddenly two months previously. Two-dimensional echocardiography, Doppler study and cardiac catheterization confirmed pulmonary hypertension. The underlying mechanism of the diagnosis was not defined. Two and a half months after the onset of symptoms, the patient died of pulmonary hypertensive crisis. Careful regular checks of cardiopulmonary status using two-dimensional echocardiography and Doppler should be considered for the early detection of pulmonary hypertension even in an asymptomatic patient with juvenile-type ARPKD.
Biopsy ; Case Report ; Child ; Echocardiography, Doppler ; Fatal Outcome ; Female ; Human ; Hypertension, Pulmonary/ultrasonography ; Hypertension, Pulmonary/complications* ; Liver Cirrhosis/pathology ; Liver Cirrhosis/complications ; Polycystic Kidney, Autosomal Recessive/ultrasonography ; Polycystic Kidney, Autosomal Recessive/complications*

BACKGROUND AND AIMS: FibroScan(R) is a new medical device that noninvasively measures liver stiffness. The aim of this study was to assess the accuracy of the liver stiffness measurement by FibroScan(R) for making the diagnosis of liver fibrosis in patients with chronic viral hepatitis. METHODS: We studied 103 patients with chronic viral hepatitis B or C and they underwent FibroScan(R) and liver biopsy between October 2005 and August 2006. Liver fibrosis was staged on a 0-4 scale according to the Korean Society of Pathologists Scoring System. The diagnostic accuracy was assessed by analysis of the receiver operator characteristics (ROC). RESULTS: The liver stiffness was 3.5-57.1 kPa (mean: 11.8, SD: 8.9). The mean value of liver stiffness in each fibrosis stage group (F1, F2, F3 and F4) was 5.8+/-1.8 kPa, 11.3+/-6.8 kPa, 11.8+/-6.0 kPa and 23.4+/-16.5 kPa, respectively. Liver stiffness measured by FibroScan(R) showed reliable correlation with the liver fibrosis stage as confirmed by liver biopsy (r=0.56, p<0.001). The AUROC (95% CI) of > or = F2, > or = F3 and F4 was 0.93 (0.86-0.99), 0.72 (0.62-0.82) and 0.80 (0.67-0.92), respectively. The sensitivity and specificity of 7.5 kPa, which was the cutoff value for > or = F2, was 84% and 90%, respectively. CONCLUSIONS: FibroScan(R) is a reliable method for the diagnosis of significant fibrosis (> or =F2) and cirrhosis in patients with chronic liver disease. The liver stiffness measurement by FibroScan(R) showed good diagnostic performance for significant fibrosis.
Adult ; Aged ; Disease Progression ; Female ; Hepatitis B, Chronic/complications/*ultrasonography ; Hepatitis C, Chronic/complications/*ultrasonography ; Humans ; Liver/*ultrasonography ; Liver Cirrhosis/etiology/*ultrasonography ; Male ; Middle Aged ; Predictive Value of Tests ; ROC Curve ; Sensitivity and Specificity

BACKGROUNDS/AIMS: It is not easy to differentiate between patients with cirrhosis and those with alcoholic liver disease. Liver biopsy is generally considered the gold standard for assessing hepatic fibrosis; however, this protocol frequently carries a risk of severe complications and false-negative results. Transient elastography (Fibroscan, Echosens, Paris, France), which is a noninvasive method of measuring liver stiffness, has become available for assessing liver fibrosis. Liver stiffness reportedly differs markedly with the cirrhosis etiology. The aim of this study was thus to determine the diagnostic accuracy of the Fibroscan in the detection of cirrhosis in patients with alcoholic liver disease. METHODS: We enrolled 45 patients with alcoholic liver disease. Fibroscan, abdominal ultrasonography, aspartate aminotransferase/platelet ratio index (APRI), and liver biopsy were performed on all patients. Fibrosis stage was assessed using the Batts-Ludwig scoring system. RESULTS: The stage of fibrosis (F1-F4) was distributed among the cohort as follows: 5 patients at F1, 4 patients at F2, 7 patients at F3, and 29 patients at F4. Liver stiffness differed significantly between each fibrosis stage (P<0.001). For the diagnosis of cirrhosis, the area under the receiver operating characteristic curve was 0.97 for transient elastography (95% confidence interval, CI, 0.93-1.01), 0.81 for ultrasonography (95% CI, 0.68-0.94), and 0.83 for APRI score (95% CI, 0.70-0.95). The optimal cut-off value of liver stiffness for detecting cirrhosis was 25.8 kPa, with a sensitivity of 90% and a specificity of 87%. CONCLUSIONS: Transient elastography is a useful method for diagnosing cirrhosis in patients with alcoholic liver disease.
Adult ; Aspartate Aminotransferases/blood ; Elasticity Imaging Techniques/*methods ; Female ; Fibrosis ; Hepatitis, Alcoholic/complications/*ultrasonography ; Humans ; Liver/pathology/ultrasonography ; Liver Cirrhosis/complications/*ultrasonography ; Male ; Middle Aged ; Platelet Count ; ROC Curve

BACKGROUND/AIMS: Upper gastrointestinal endoscopy is usually recommended for the evaluation of esophageal varices in patients with liver cirrhosis. However, the prevalence of varices is extremely variable. We performed this study to determine the predictive values for esophageal varices and to select eligible patients for screening endoscopy. METHODS: Fifty-two patients were enrolled in this study. Laboratory tests including liver biochemistry and complete blood count along with ultrasonography with Doppler measurements and endoscopy were performed. RESULTS: Esophageal varices were present in 25 patients (48%). Variables associated with the presence of esophageal varices on univariate analysis were serum albumin, total bilirubin, prothrombin time and platelet count (p<0.05). Significant variables in ultrasonography with Doppler measurement were diameter of spleen (13.04+/-2.1 cm vs. 10.39+/-1.6 cm, p<0.001), peak velocity of portal vein (30.2+/-7.5 cm/sec vs. 36.1+/-8.0 cm/sec, p<0.01) and portal vein diameter (1.26+/-0.28 cm vs. 1.13+/-0.18 cm, p<0.05). On multivariate analysis, independent variables were platelet count (odds ratio (OR) 0.922; 95% confidence interval (CI), 0.86-0.99), diameter of spleen (OR 5.4; 95% CI, 1.63-17.88) and platelet count/spleen diameter ratio (OR 1.007; 95% CI, 1.01-1.02). The optimal critical value for the diameter of spleen was 11 cm. The sensitivity and specificity with this value were 84% and 63%, respectively. CONCLUSIONS: Doppler measurement was not helpful in distinguishing the presence of varices. However, clinical tests including biochemistry and ultrasonography would be useful in selecting eligible patients for screening endoscopy. Endoscopic screening for esophageal varices is recommended in cirrhotic patients with splenomegaly.
Adult ; Aged ; Blood Chemical Analysis ; Blood Flow Velocity ; Chronic Disease ; Esophageal and Gastric Varices/complications/*diagnosis/ultrasonography ; Female ; Humans ; Liver Cirrhosis/complications ; Liver Diseases/*complications ; Male ; Middle Aged ; ROC Curve ; Severity of Illness Index ; *Ultrasonography, Doppler

OBJECTIVETo investigate the natural history and clinical outcomes in a cohort of transfusion-related hepatitis C in northern areas of China. Methods The authors studied 283 patients (137 males, 146 females, mean age 45.79+/-9.92 age) who became infected with HCV while donating plasma 12.25 years ago. These cases were subjected to ultrasonography and liver biochemical tests and serologic anti-HCV assays. Statistical analyses were performed using the SPSS software.

RESULTSUltrasonographic findings suggestive of liver cirrhosis were 8.3% of cases. No decompensated cirrhosis or HCC was detected. The value of ALT was higher in severe chronic hepatitis (mean 62.07+/-50.87 IU/L) and cirrhosis (mean 115.50+/-108.41 IU/L) patients than in the other groups (mean 32.30+/-29.10 IU/L). The abnormal rate of ALT was 53.3% in severe group, 100% in cirrhosis group.

CONCLUSIONThe natural history of transfusion-related hepatitis C in the areas seemed to be relatively mild when compared with previous data. Our cases showed relatively low rate of positive findings in ultrasonography. None of this cohort had the decompensated cirrhosis or HCC. The factor of sex but not the age at time of infection was found being related to the outcomes. In the absence of liver biopsy, ultrasonography was a suitable and sensitive method for the diagnosis of the progressive hepatitis and cirrhosis.

Adult ; Aged ; China ; epidemiology ; Female ; Hepatitis C, Chronic ; diagnostic imaging ; epidemiology ; transmission ; Humans ; Liver ; diagnostic imaging ; Liver Cirrhosis ; complications ; diagnostic imaging ; Male ; Middle Aged ; Transfusion Reaction ; Ultrasonography