Ultrasonography of cirrhosis - Revision history

Mikael Häggström: /* Diagnosis */ uppercase

2019-03-20T13:36:22Z

Diagnosis: uppercase

Mikael Häggström: reverted

2019-03-20T13:33:42Z

reverted

Mikael Häggström: /* Diagnosis */ Not that useful

2019-03-20T13:33:01Z

Diagnosis: Not that useful

Mikael Häggström: Forked some

2018-12-11T15:27:07Z

Forked some

Mikael Häggström: /* Diagnosis */ Linked

2018-12-11T15:14:44Z

Diagnosis: Linked

Mikael Häggström: /* Diagnosis */ Unspecific

2018-12-11T12:36:09Z

Diagnosis: Unspecific

Mikael Häggström: "

2018-12-10T06:31:51Z

Mikael Häggström: +How soon

2018-12-06T17:14:21Z

+How soon

Mikael Häggström: /* Planning */ contrast

2018-12-06T17:09:15Z

Planning: contrast

Mikael Häggström: /* Diagnosis */ +Pulsatility

2018-11-29T21:36:43Z

Diagnosis: +Pulsatility

@@ Line 30: / Line 30: @@
 ::*Reversal or alternating directions of portal venous flow<ref name=Radiopaedia-Cirrhosis/>
 ::*Portal venous thrombosis
-::*cavernous transformation of the portal vein,<ref name=Radiopaedia-Cirrhosis/> appearing like multiple veins.
+::*Cavernous transformation of the portal vein,<ref name=Radiopaedia-Cirrhosis/> appearing like multiple veins.
 :*Hepatic artery Doppler:
 ::*Increased velocity in hepatic artery<ref name=Radiopaedia-Cirrhosis/>

@@ Line 18: / Line 18: @@
 [[File:Ascites ultrasound 2.JPG|thumb|Irregular liver surface and ascites.]]
 Cirrhosis is indicated by:
-*Surface nodularity.<ref name=Radiopaedia-Cirrhosis>{{cite web|url=https://radiopaedia.org/articles/cirrhosis|title=Cirrhosis|website=Radiopaedia|accessdate=2018-06-16|author=Dr Yuranga Weerakkody, A.Prof Frank Gaillard et al.}}</ref>
+*Surface nodularity: (sensitivity 88%, specificity 82-95%)<ref name=Radiopaedia-Cirrhosis>{{cite web|url=https://radiopaedia.org/articles/cirrhosis|title=Cirrhosis|website=Radiopaedia|accessdate=2018-06-16|author=Dr Yuranga Weerakkody, A.Prof Frank Gaillard et al.}}</ref>
 *General coarse and heterogeneous texture<ref name=Radiopaedia-Cirrhosis/>
 *Segmental hypertrophy or atrophy<ref name=Radiopaedia-Cirrhosis/>

@@ Line 18: / Line 18: @@
 [[File:Ascites ultrasound 2.JPG|thumb|Irregular liver surface and ascites.]]
 Cirrhosis is indicated by:
-*Surface nodularity: (sensitivity 88%, specificity 82-95%)<ref name=Radiopaedia-Cirrhosis>{{cite web|url=https://radiopaedia.org/articles/cirrhosis|title=Cirrhosis|website=Radiopaedia|accessdate=2018-06-16|author=Dr Yuranga Weerakkody, A.Prof Frank Gaillard et al.}}</ref>
+*Surface nodularity.<ref name=Radiopaedia-Cirrhosis>{{cite web|url=https://radiopaedia.org/articles/cirrhosis|title=Cirrhosis|website=Radiopaedia|accessdate=2018-06-16|author=Dr Yuranga Weerakkody, A.Prof Frank Gaillard et al.}}</ref>
 *General coarse and heterogeneous texture<ref name=Radiopaedia-Cirrhosis/>
 *Segmental hypertrophy or atrophy<ref name=Radiopaedia-Cirrhosis/>

@@ Line 25: / Line 25: @@
 *Fatty change which is variable <ref name=Radiopaedia-Cirrhosis/>
 *Signs of portal hypertension<ref name=Radiopaedia-Cirrhosis/>
-:*Dilated portal vein: >13 mm (sensitivity 42%, specificity 95-100%)<ref name=Radiopaedia-Cirrhosis/>
+:*Portal vein measurement and Doppler:
-:*Slow portal venous flow on Doppler: <15 cm/sec<ref name=Radiopaedia-Cirrhosis/>
+::*Dilated portal vein: >13 mm (sensitivity 42%, specificity 95-100%)<ref name=Radiopaedia-Cirrhosis/>
-:*Reversal or alternating directions of portal venous flow<ref name=Radiopaedia-Cirrhosis/>
+::*Slow portal venous flow on Doppler: <15 cm/sec<ref name=Radiopaedia-Cirrhosis/>
-:*Portal venous thrombosis with or without cavernous transformation<ref name=Radiopaedia-Cirrhosis/>
+::*Reversal or alternating directions of portal venous flow<ref name=Radiopaedia-Cirrhosis/>
-:*Dilated superior mesenteric vein and splenic vein of > 10mm.<ref name=Radiopaedia-Cirrhosis/> These should be measured during deep inspiration since it may vary with respiration.<ref name=Radiopaedia-Cirrhosis/>
+::*Portal venous thrombosis
-:*Loss of respiratory variation in superior mesenteric vein and splenic vein on spectral Doppler<ref name=Radiopaedia-Cirrhosis/>
+::*cavernous transformation of the portal vein,<ref name=Radiopaedia-Cirrhosis/> appearing like multiple veins.
-:*Re-canalisation and hepatofugal paraumbilical venous flow.<ref name=Radiopaedia-Cirrhosis/>
+:*Hepatic artery Doppler:
-:*Portalisation of hepatic vein flow on Doppler<ref name=Radiopaedia-Cirrhosis/>
+::*Increased velocity in hepatic artery<ref name=Radiopaedia-Cirrhosis/>
-:*Corkscrew appearance of hepatic arteries<ref name=Radiopaedia-Cirrhosis/>
+::*Corkscrew appearance of hepatic arteries<ref name=Radiopaedia-Cirrhosis/>
-:*Increased velocity in hepatic artery<ref name=Radiopaedia-Cirrhosis/>
+:*Splenomegaly<ref name=Radiopaedia-Cirrhosis/> (see [[ultrasonography of the spleen]] for size cutoffs)
-:*Splenomegaly<ref name=Radiopaedia-Cirrhosis/> (see [[ultrasonography of the spleen]])
+:*Ascites,<ref name=Radiopaedia-Cirrhosis/> with fluid seen in the hepatorenal recess.
 [[File:Doppler ultrasonography of the portal vein in cirrhosis.jpg|thumb|Doppler ultrasonography of the portal vein over 5 seconds, showing peaks of '''max'''imal velocity, as well as points of '''min'''imal velocity.]]
-*Portal flow pulsatility: An increased portal vein pulsatility is an indicator of cirrhosis, but may also be caused by an increased right atrial pressure.<ref name="IranpourLall2016">{{cite journal|last1=Iranpour|first1=Pooya|last2=Lall|first2=Chandana|last3=Houshyar|first3=Roozbeh|last4=Helmy|first4=Mohammad|last5=Yang|first5=Albert|last6=Choi|first6=Joon-Il|last7=Ward|first7=Garrett|last8=Goodwin|first8=Scott C|title=Altered Doppler flow patterns in cirrhosis patients: an overview|journal=Ultrasonography|volume=35|issue=1|year=2016|pages=3–12|issn=2288-5919|doi=10.14366/usg.15020}}</ref> Portal vein pulsatility can be quantified by pulsatility indices (PI), where an index above a certain cutoff indicates pathology:
+:''For further signs of portal hypertension, which may be used upon specific portal hypertension referral, see '''[[Ultrasonography of portal hypertension]]'''
 {|class="wikitable"

@@ Line 35: / Line 35: @@
 :*Corkscrew appearance of hepatic arteries<ref name=Radiopaedia-Cirrhosis/>
 :*Increased velocity in hepatic artery<ref name=Radiopaedia-Cirrhosis/>
-:*[[Splenomegaly]]<ref name=Radiopaedia-Cirrhosis/>
+:*Splenomegaly<ref name=Radiopaedia-Cirrhosis/> (see [[ultrasonography of the spleen]])
 :*Ascites<ref name=Radiopaedia-Cirrhosis/>
 [[File:Doppler ultrasonography of the portal vein in cirrhosis.jpg|thumb|Doppler ultrasonography of the portal vein over 5 seconds, showing peaks of '''max'''imal velocity, as well as points of '''min'''imal velocity.]]

@@ Line 11: / Line 11: @@
 ===How soon===
-In Swedish practice, ultrasonography for suspected cirrhosis should be done within 2 months.<ref group=notes">{{NU Hospital Group}}</ref>
+In Swedish practice, ultrasonography for suspected cirrhosis should be done within 2 months.<ref group="notes">{{NU Hospital Group}}</ref>
 In patients with known cirrhosis, surveillance [[ultrasonography of hepatocellular cancer]] (HCC) is indicated, generally every 6 months.<ref name="FateenRyder2017">{{cite journal|last1=Fateen|first1=Waleed|last2=Ryder|first2=Stephen|title=Screening for hepatocellular carcinoma: patient selection and perspectives|journal=Journal of Hepatocellular Carcinoma|volume=Volume 4|year=2017|pages=71–79|issn=2253-5969|doi=10.2147/JHC.S105777}}</ref>

@@ Line 9: / Line 9: @@
 ;Choice of modality
 Ultrasonography is the first-line modality of medical imaging in patients with suspected cirrhosis and/or portal hypertension.<ref name="ProcopetBerzigotti2017">{{cite journal|last1=Procopet|first1=Bogdan|last2=Berzigotti|first2=Annalisa|title=Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy|journal=Gastroenterology Report|volume=5|issue=2|year=2017|pages=79–89|issn=2052-0034|doi=10.1093/gastro/gox012}}</ref> US is also typically the initial, first-line modality choice for the diagnosis and follow-up of portal hypertension.<ref name="BandaliMirakhur2017">{{cite journal|last1=Bandali|first1=Murad Feroz|last2=Mirakhur|first2=Anirudh|last3=Lee|first3=Edward Wolfgang|last4=Ferris|first4=Mollie Clarke|last5=Sadler|first5=David James|last6=Gray|first6=Robin Ritchie|last7=Wong|first7=Jason Kam|title=Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy|journal=World Journal of Gastroenterology|volume=23|issue=10|year=2017|pages=1735|issn=1007-9327|doi=10.3748/wjg.v23.i10.1735}}</ref> For cirrhosis, it should be done without IV contrast.
 ==Diagnosis==