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Ultrasound
Diagnosis
Liver
Diffuse Parenchymal Disease
Hepatic Cirrhosis
Hepatic Cirrhosis
Aya Kamaya, MD, FSRU, FSAR
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Chronic liver disease characterized by diffuse parenchymal necrosis with extensive fibrosis and regenerative nodule formation
              • End stage of final pathway in chronic hepatic damage

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • CT Findings

                • MR Findings

                  • Elastographic Findings

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Kamaya A et al: HCC screening: is ultrasound still needed at transplant centers?-point: yes, ultrasound remains first line. AJR Am J Roentgenol. 216(3):579-80, 2021
                                          2. Barr RG et al: Update to the Society of Radiologists in Ultrasound liver elastography consensus statement. Radiology. 296(2):263-74, 2020
                                          3. Expert Panel on Gastrointestinal Imaging et al: ACR Appropriateness Criteria. Chronic liver disease. J Am Coll Radiol. 17(5S):S70-80, 2020
                                          4. Fetzer DT et al: Ultrasound evaluation in patients at risk for hepatocellular carcinoma. Radiol Clin North Am. 57(3):563-83, 2019
                                          5. Elsayes KM et al: Spectrum of pitfalls, pseudolesions, and potential misdiagnoses in cirrhosis. AJR Am J Roentgenol. 211(1):87-96, 2018
                                          6. Park HS et al: Doppler ultrasound in liver cirrhosis: correlation of hepatic artery and portal vein measurements with model for end-stage liver disease score. J Ultrasound Med. 36(4):725-30, 2017
                                          7. Ge PS et al: Treatment of patients with cirrhosis. N Engl J Med. 375(8):767-77, 2016
                                          8. Beland MD et al: A pilot study estimating liver fibrosis with ultrasound shear-wave elastography: does the cause of liver disease or location of measurement affect performance? AJR Am J Roentgenol. 203(3):W267-73, 2014
                                          9. Ferraioli G et al: Shear wave elastography for evaluation of liver fibrosis. J Ultrasound Med. 33(2):197-203, 2014
                                          10. Buadu A et al: Small liver nodule detection with a high-frequency transducer in patients with chronic liver disease: report of 3 cases. J Ultrasound Med. 32(2):355-9, 2013
                                          11. Irshad A et al: Current role of ultrasound in chronic liver disease: surveillance, diagnosis and management of hepatic neoplasms. Curr Probl Diagn Radiol. 41(2):43-51, 2012
                                          12. Ridolfi F et al: Contrast-enhanced ultrasound evaluation of hepatic microvascular changes in liver diseases. World J Gastroenterol. 18(37):5225-30, 2012
                                          13. Shi Y et al: Quantitative diagnosis of early-stage liver cirrhosis with contrast-enhanced ultrasound--a clinical study. Adv Clin Exp Med. 21(3):385-90, 2012
                                          14. Friedrich-Rust M et al: Liver fibrosis in viral hepatitis: noninvasive assessment with acoustic radiation force impulse imaging versus transient elastography. Radiology. 252(2):595-604, 2009
                                          15. Goyal N et al: Non-invasive evaluation of liver cirrhosis using ultrasound. Clin Radiol. 64(11):1056-66, 2009
                                          16. Vessal S et al: Hepatic vein morphology: a new sonographic diagnostic parameter in the investigation of cirrhosis? J Ultrasound Med. 28(9):1219-27, 2009
                                          17. Haktanir A et al: Value of Doppler sonography in assessing the progression of chronic viral hepatitis and in the diagnosis and grading of cirrhosis. J Ultrasound Med. 24(3):311-21, 2005
                                          18. Nicolau C et al: Gray-scale ultrasound in hepatic cirrhosis and chronic hepatitis: diagnosis, screening, and intervention. Semin Ultrasound CT MR. 23(1):3-18, 2002
                                          19. Tchelepi H et al: Sonography of diffuse liver disease. J Ultrasound Med. 21(9):1023-32; quiz 1033-4, 2002
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Definitions

                                                    • Chronic liver disease characterized by diffuse parenchymal necrosis with extensive fibrosis and regenerative nodule formation
                                                      • End stage of final pathway in chronic hepatic damage

                                                  IMAGING

                                                  • General Features

                                                    • Ultrasonographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Elastographic Findings

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Staging, Grading, & Classification

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Kamaya A et al: HCC screening: is ultrasound still needed at transplant centers?-point: yes, ultrasound remains first line. AJR Am J Roentgenol. 216(3):579-80, 2021
                                                                                  2. Barr RG et al: Update to the Society of Radiologists in Ultrasound liver elastography consensus statement. Radiology. 296(2):263-74, 2020
                                                                                  3. Expert Panel on Gastrointestinal Imaging et al: ACR Appropriateness Criteria. Chronic liver disease. J Am Coll Radiol. 17(5S):S70-80, 2020
                                                                                  4. Fetzer DT et al: Ultrasound evaluation in patients at risk for hepatocellular carcinoma. Radiol Clin North Am. 57(3):563-83, 2019
                                                                                  5. Elsayes KM et al: Spectrum of pitfalls, pseudolesions, and potential misdiagnoses in cirrhosis. AJR Am J Roentgenol. 211(1):87-96, 2018
                                                                                  6. Park HS et al: Doppler ultrasound in liver cirrhosis: correlation of hepatic artery and portal vein measurements with model for end-stage liver disease score. J Ultrasound Med. 36(4):725-30, 2017
                                                                                  7. Ge PS et al: Treatment of patients with cirrhosis. N Engl J Med. 375(8):767-77, 2016
                                                                                  8. Beland MD et al: A pilot study estimating liver fibrosis with ultrasound shear-wave elastography: does the cause of liver disease or location of measurement affect performance? AJR Am J Roentgenol. 203(3):W267-73, 2014
                                                                                  9. Ferraioli G et al: Shear wave elastography for evaluation of liver fibrosis. J Ultrasound Med. 33(2):197-203, 2014
                                                                                  10. Buadu A et al: Small liver nodule detection with a high-frequency transducer in patients with chronic liver disease: report of 3 cases. J Ultrasound Med. 32(2):355-9, 2013
                                                                                  11. Irshad A et al: Current role of ultrasound in chronic liver disease: surveillance, diagnosis and management of hepatic neoplasms. Curr Probl Diagn Radiol. 41(2):43-51, 2012
                                                                                  12. Ridolfi F et al: Contrast-enhanced ultrasound evaluation of hepatic microvascular changes in liver diseases. World J Gastroenterol. 18(37):5225-30, 2012
                                                                                  13. Shi Y et al: Quantitative diagnosis of early-stage liver cirrhosis with contrast-enhanced ultrasound--a clinical study. Adv Clin Exp Med. 21(3):385-90, 2012
                                                                                  14. Friedrich-Rust M et al: Liver fibrosis in viral hepatitis: noninvasive assessment with acoustic radiation force impulse imaging versus transient elastography. Radiology. 252(2):595-604, 2009
                                                                                  15. Goyal N et al: Non-invasive evaluation of liver cirrhosis using ultrasound. Clin Radiol. 64(11):1056-66, 2009
                                                                                  16. Vessal S et al: Hepatic vein morphology: a new sonographic diagnostic parameter in the investigation of cirrhosis? J Ultrasound Med. 28(9):1219-27, 2009
                                                                                  17. Haktanir A et al: Value of Doppler sonography in assessing the progression of chronic viral hepatitis and in the diagnosis and grading of cirrhosis. J Ultrasound Med. 24(3):311-21, 2005
                                                                                  18. Nicolau C et al: Gray-scale ultrasound in hepatic cirrhosis and chronic hepatitis: diagnosis, screening, and intervention. Semin Ultrasound CT MR. 23(1):3-18, 2002
                                                                                  19. Tchelepi H et al: Sonography of diffuse liver disease. J Ultrasound Med. 21(9):1023-32; quiz 1033-4, 2002