Ultrasound is a non-invasive, real-time, inexpensive, radiation-free and easily repeatable method, usually used for liver imaging. In recent years, new ultrasound examination techniques for liver diseases such as contrast-enhanced ultrasound and elastography have been rapidly developed, which can effectively identify intrahepatic space-occupying lesions, assess the degree of liver fibrosis and portal hypertension, and monitor the effects of treatment. Therefore, these technologies play an important diagnostic role in clinical liver diseases and have therapeutic interventional value. This guideline classifies the instrument set-up, patient preparation, and physician examination methods through multimodal ultrasound examinations (gray-scale ultrasound, color Doppler ultrasound, contrast-enhanced ultrasound, elastic ultrasound) for liver diseases. In addition, liver diseases multimodal ultrasound technology diagnostic criteria for diffuse hepatic lesions (inflammatory lesions, fibrosis, and sclerosis), multiple space-occupying lesions, and interventional procedures have been defined and standardized. Concurrently, we also recommend the ultrasound monitoring time interval and diagnostic report writing standard for liver diseases.
Elasticity Imaging Techniques ; Humans ; Hypertension, Portal ; Liver/diagnostic imaging* ; Liver Cirrhosis ; Liver Diseases/diagnostic imaging* ; Ultrasonography

Elasticity Imaging Techniques ; Humans ; Liver/pathology* ; Liver Cirrhosis/pathology* ; Liver Diseases/pathology* ; Ultrasonography

Portal hypertension (PHT) is a common complication of liver cirrhosis, which could be measured by the means of portal vein pressure (PVP). However, there is no report about an effective and reliable way to achieve noninvasive assessment of PVP so far. In this study, firstly, we collected ultrasound images and echo signals of different ultrasound contrast agent (UCA) concentrations and different pressure ranges in a low-pressure environment based on an
Contrast Media ; Humans ; Hypertension, Portal/diagnostic imaging* ; Liver Cirrhosis ; Portal Vein/diagnostic imaging* ; Ultrasonography

BACKGROUND/AIMS: Previous studies have reported that endotoxemia is associated with pathogenesis and complications in cirrhosis. Endotoxin stimulates the secretion of inflammatory cytokines, which contributes to the development of complications. In addition, endotoxin easily invades the gut barrier system because of the increased intestinal permeability due to portal hypertensive enteropathy. In this report, we explored changes in cytokine levels and intestinal permeability and measured the thickness and elasticity of the bowel wall using ultrasonography in cirrhotic patients.METHODS: We enrolled 40 patients with cirrhosis classified as Child-Pugh B or C and 20 healthy volunteers. Abdominal ultrasonography examinations were used to evaluate bowel wall parameters in the ascending colon and terminal ileum. Intestinal permeability was measured using dual sugar absorption tests with lactulose and mannitol. Levels of tumor necrosis factor (TNF)-α and IL-10 were determined from blood samples. We compared these outcomes between cirrhotic patients and healthy controls and between Child-Pugh B and C patients. In addition, we explored the correlation between cytokine levels, intestinal permeability ratio, and bowel wall parameters in cirrhotic patients.RESULTS: In cirrhotic patients, the ascending colon wall elasticity decreased (20.4 vs. 10.9 kPa, p = 0.048) and the terminal ileum wall thickness increased (4.2 vs. 1.9 mm, p < 0.001). The intestinal permeability ratio and levels of the cytokines TNF-α and IL-10 increased (0.219 vs. 0.017, p < 0.001; 22.47 vs. 13.48 pg/mL, p < 0.001; and 14.91 vs. 8.57 pg/mL, p = 0.019, respectively) in cirrhotic patients. However, there were no significant differences between Child-Pugh classes and no significant correlations between bowel wall parameters and intestinal permeability or cytokine levels.CONCLUSIONS: Ultrasonography revealed bowel wall thickening and decreases in elasticity; in addition, intestinal permeability and cytokine levels increased in cirrhotic patients compared with healthy controls.
Absorption ; Ascites ; Colon, Ascending ; Cytokines ; Elasticity ; Endotoxemia ; Fibrosis ; Healthy Volunteers ; Humans ; Ileum ; Interleukin-10 ; Intestines ; Lactulose ; Liver Cirrhosis ; Mannitol ; Permeability ; Tumor Necrosis Factor-alpha ; Ultrasonography

BACKGROUND/AIMS: Antiviral therapy (AVT) reduces the risk of hepatocellular carcinoma (HCC) development in patients with chronic hepatitis B (CHB). This multicenter retrospective study investigated the effects of AVT and hepatitis B virus (HBV)-related factors on the risk of HCC development in a cohort with heterogeneous HBV status. METHODS: A total of 1,843 patients with CHB from two institutions were included in this study. Ultrasound and laboratory tests, including the α-fetoprotein test, were conducted regularly to detect HCC development. RESULTS: The mean age of our study population (1,063 men and 780 women) was 49.4 years. Cirrhosis was identified in 617 patients (33.5%). During follow-up (median, 42.5 months), 81 patients developed HCC (1.39% per person-year). A total of 645 patients (35.0%) received ongoing AVT at enrollment. Ongoing AVT was not significantly associated with the risk of HCC development (all p>0.05). HBV-related variables (HBV DNA level, hepatitis B e antigen status, and alanine aminotransferase level) were also not significantly associated with the risk of HCC development (all p>0.05). In contrast, cirrhosis was significantly associated with the risk of HCC development, regardless of adjustment (adjusted hazard ratio=4.098 to 7.020; all p<0.05). Cirrhosis significantly predicted the risk of HCC development in subgroups with and without ongoing AVT at enrollment, regardless of adjustment. CONCLUSIONS: Our study showed that cirrhosis, not AVT and HBV-related variables, was associated with HCC development in a cohort of patients with heterogeneous HBV status. Our results may help clinicians apply individualized surveillance strategies according to fibrotic status in patients with CHB.
Alanine Transaminase ; Carcinoma, Hepatocellular ; Cohort Studies ; DNA ; Fibrosis ; Follow-Up Studies ; Hepatitis B virus ; Hepatitis B ; Hepatitis B, Chronic ; Hepatitis ; Humans ; Liver Cirrhosis ; Liver ; Male ; Retrospective Studies ; Ultrasonography

OBJECTIVE: The most common cause of hemorrhage after paracentesis is direct needle puncture of the inferior epigastric artery (IEA). This study examined the relationship between the amount of the ascites and the location of the IEA in liver cirrhosis. METHODS: Abdominal computed tomography (CT) examinations of patients with liver cirrhosis were reviewed retrospectively and divided into two groups according to the amount of ascites. The distances between the midline and the IEAs of both sides were measured at the umbilicus, McBurney's point, anterior superior iliac spine, and mid-inguinal level. Branching of the IEAs, abdominal wall and mesenteric varices in the abdomen below the umbilicus level were recorded. RESULTS: A total of 120 abdominal CTs were reviewed. The distances from the midline to the IEA in the large ascites group were longer than those in the small ascites group at the level of the right McBurney's point (44.5±14.6 mm vs. 39.6±11.8 mm, P=0.043) and left McBurney's point (48.6±15.3 mm vs. 43.3±11.5 mm, P=0.035). The incidence of abdominal wall varices was higher in the large ascites group (21.7% vs. 5.0%, P=0.014). CONCLUSION: In patients with liver cirrhosis, the large amount of ascites might be associated with lateralizing the location of the IEA. Moreover, it may be necessary to confirm the blood vessels in the abdominal wall and mesentery near the puncture site by bedside ultrasound before the paracentesis.
Abdomen ; Abdominal Wall ; Ascites ; Blood Vessels ; Epigastric Arteries ; Hemoperitoneum ; Hemorrhage ; Humans ; Incidence ; Liver Cirrhosis ; Liver ; Mesentery ; Needles ; Paracentesis ; Punctures ; Retrospective Studies ; Spine ; Tomography, X-Ray Computed ; Ultrasonography ; Umbilicus ; Varicose Veins

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

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children. The global prevalence of pediatric NAFLD from general populations is 7.6%. In obese children, the prevalence is higher in Asia. NAFLD has a strong heritable component based on ethnic difference in the prevalence and clustering within families. Genetic polymorphisms of patatin-like phospholipase domain–containing protein 3 (PNPLA3), transmembrane 6 superfamily member 2, and glucokinase regulatory protein (GCKR) are associated with the risk of NAFLD in children. Variants of PNPLA3 and GCKR are more common in Asians. Alterations of the gut microbiome might contribute to the pathogenesis of NAFLD. High fructose intake increases the risk of NAFLD. Liver fibrosis is a poor prognostic factor for disease progression to cirrhosis. Magnetic resonance spectroscopy and magnetic resonance proton density fat fraction are more accurate for steatosis quantification than ultrasound. Noninvasive imaging methods to assess liver fibrosis, such as transient elastography, shear-wave elastography, and magnetic resonance elastography are useful in predicting advanced fibrosis, but they need further validation. Longitudinal follow-up studies into adulthood are needed to better understand the natural history of pediatric NAFLD.
Asia ; Asian Continental Ancestry Group ; Child ; Diagnosis ; Disease Progression ; Elasticity Imaging Techniques ; Epidemiology ; Fibrosis ; Follow-Up Studies ; Fructose ; Gastrointestinal Microbiome ; Genetics ; Glucokinase ; Humans ; Liver Cirrhosis ; Liver Diseases ; Magnetic Resonance Spectroscopy ; Microbiota ; Natural History ; Non-alcoholic Fatty Liver Disease ; Phospholipases ; Polymorphism, Genetic ; Prevalence ; Protons ; Ultrasonography

PURPOSE: The purpose of this study was to retrospectively compare the technical success and reliability of the measurements made using two 2-dimensional (2D) shear wave elastography (SWE) systems using the comb-push technique from the same manufacturer and to assess the intersystem reproducibility of the resultant liver stiffness (LS) measurements. METHODS: Ninety-four patients with suspected chronic liver diseases were included in this retrospective study. LS measurements were obtained using two 2D-SWE systems (LOGIQ E9 and LOGIQ S8) from the same manufacturer, with transient elastography (TE) serving as the reference standard, on the same day. The technical success rates and reliability of the measurements of the two 2D-SWE systems were compared. LS values measured using the two 2D-SWE systems and TE were correlated using Spearman correlation coefficients and 95% Bland-Altman limits of agreement. Thereafter, Bland-Altman limits of agreement and intraclass correlation coefficients (ICCs) were used to analyze the intersystem reproducibility of LS measurements. RESULTS: The two 2D-SWE systems showed similar technical success rates (98.9% for both) and reliability of LS measurements (92.3% for the LOGIQ E9, 91.2% for the LOGIQ S8; P=0.185). Despite the excellent correlation (ICC=0.92), the mean LS measurements obtained by the two 2D-SWE systems were significantly different (LOGIQ E9, 6.57±2.33 kPa; LOGIQ S8, 6.90±6.64 kPa; P=0.018). CONCLUSION: Significant intersystem variability was observed in the LS measurements made using the two 2D-SWE systems. Therefore, even 2D-SWE systems from the same manufacturer should not be used interchangeably in longitudinal follow-up.
Elasticity Imaging Techniques ; Follow-Up Studies ; Humans ; Liver Cirrhosis ; Liver Diseases ; Liver ; Reproducibility of Results ; Retrospective Studies ; Ultrasonography

Contrast-enhanced ultrasound (CEUS) represents a significant breakthrough in ultrasonography (US), and it is being increasingly used for the evaluation of focal liver lesions (FLLs). CEUS is unique in that it allows non-invasive assessment of liver perfusion in real time throughout the vascular phase, which has led to dramatic improvements in the diagnostic accuracy of US in the detection and characterization of FLLs, the choice of therapeutic procedures, and the evaluation of response. Currently, CEUS is included as a part of the suggested diagnostic work-up of FLLs, including in cirrhotic patients with hepatocellular carcinoma, resulting in better patient management and cost-effective delivery of therapy.
Carcinoma, Hepatocellular ; Humans ; Liver ; Liver Cirrhosis ; Perfusion ; Ultrasonography