HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: 2272020193v1 227/1/89    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Colli, A. Articles by Conte, D. Search for Related Content PubMed PubMed Citation Articles by Colli, A. Articles by Conte, D.

Severe Liver Fibrosis or Cirrhosis: Accuracy of US for Detection—Analysis of 300 Cases¹

¹ From the Department of Internal Medicine, Ospedale A. Manzoni, Lecco, Italy (A.C., M.A., E.Z.); and Postgraduate School of Gastroenterology, IRCCS Ospedale Maggiore, Padiglione Granelli 3° piano, Via F. Sforza 35, 20122 Milan, Italy (M.F., B.M., D.C.). Received April 2, 2002; revision requested June 5; revision received June 13; accepted July 25. Supported by Associazione Amici della Gastroenterologia del Granelli (AAGG), CARIPLO Foundation, and Research Competition Award 2000 from IRCCS Ospedale Maggiore, Milan, Italy. Address correspondence to D.C. (e-mail: dario.conte@unimi.it).

PURPOSE: To determine the accuracy of various ultrasonographic (US) signs for assessment of the degree of liver fibrosis, with histologic results as reference standard.

MATERIALS AND METHODS: Three hundred consecutive asymptomatic patients with at least 6 months of increased levels of aspartate aminotransferase and/or alanine aminotransferase underwent liver US and biopsy. The estimated pretest probability of severe fibrosis or cirrhosis was 35%. Three US parameters were investigated: liver surface nodularity, caudate lobe hypertrophy, and pattern of hepatic venous blood flow. US results were compared with histologic results obtained after liver biopsy, which constituted the reference standard for diagnosis of severe fibrosis or cirrhosis. The degree of fibrosis was graded according to METAVIR criteria, with stages 3 and 4 considered together. Data were analyzed with and ² statistics. Sensitivity, specificity, positive and negative likelihood ratios, and posttest probability were calculated for each US sign.

RESULTS: In 107 (36%) patients with severe fibrosis (n = 34) or cirrhosis (n = 73), liver surface nodularity had the highest diagnostic accuracy, with specificity of 95% and positive and negative likelihood ratios 11.6 and 0.51, respectively. When liver surface nodularity was considered alone, posttest probability of severe fibrosis or cirrhosis increased from 35% to 86%. When caudate lobe hypertrophy and hepatic venous blood flow were also taken into account, posttest probability increased by only 2% (ie, to 88%).

CONCLUSION: US determination of liver surface nodularity is an accurate method for identifying the subset of asymptomatic patients with severe liver fibrosis or cirrhosis, which indicates a worse prognosis.

© RSNA, 2003

Index terms: Liver, cirrhosis, 761.794 • Liver, fibrosis, 761.794 • Liver, US, 761.12981, 761.12984

This article has been cited by other articles:

				G. Guaraldi, S. Cocchi, A. Motta, S. Ciaffi, M. Codeluppi, S. Bonora, F. Di Benedetto, M. Masetti, M. Floridia, S. Baroncelli, et al. A pilot study on the efficacy, pharmacokinetics and safety of atazanavir in patients with end-stage liver disease J. Antimicrob. Chemother., December 1, 2008; 62(6): 1356 - 1364. [Abstract] [Full Text] [PDF]

				J. A. Poff, F. V. Coakley, A. Qayyum, B. M. Yeh, L. W. Browne, R. B. Merriman, L. D. Ferrell, and V. A. Feldstein Frequency and Histopathologic Basis of Hepatic Surface Nodularity in Patients with Fulminant Hepatic Failure Radiology, November 1, 2008; 249(2): 518 - 523. [Abstract] [Full Text] [PDF]

				R.-B. Hsu, C.-I Chang, F.-Y. Lin, N.-K. Chou, N.-H. Chi, S.-S. Wang, and S.-H. Chu Heart transplantation in patients with liver cirrhosis. Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 307 - 312. [Abstract] [Full Text] [PDF]

				R.-B. Hsu, F.-Y. Lin, N.-K. Chou, W.-J. Ko, N.-H. Chi, and S.-S. Wang Heart transplantation in patients with extreme right ventricular failure Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 457 - 461. [Abstract] [Full Text] [PDF]

				D. A. Aguirre, C. A. Behling, E. Alpert, T. I. Hassanein, and C. B. Sirlin Liver Fibrosis: Noninvasive Diagnosis with Double Contrast Material-enhanced MR Imaging. Radiology, May 1, 2006; 239(2): 425 - 437. [Abstract] [Full Text] [PDF]

				M Pinzani Non-invasive evaluation of hepatic fibrosis: don't count your chickens before they're hatched Gut, March 1, 2006; 55(3): 310 - 312. [Full Text] [PDF]

				A. K. P. Lim, N. Patel, R. J. Eckersley, Y.-T. Kuo, R. D. Goldin, H. C. Thomas, D. O. Cosgrove, S. D. Taylor-Robinson, and M. J. K. Blomley Can Doppler Sonography Grade the Severity of Hepatitis C-Related Liver Disease? Am. J. Roentgenol., June 1, 2005; 184(6): 1848 - 1853. [Abstract] [Full Text] [PDF]

				C.-H. Lin, F.-Y. Lin, S.-S. Wang, H.-Y. Yu, and R.-B. Hsu Cardiac Surgery in Patients With Liver Cirrhosis Ann. Thorac. Surg., May 1, 2005; 79(5): 1551 - 1554. [Abstract] [Full Text] [PDF]

				G J Kraus, P Schedlbauer, S Lax, D Zebedin, and F Flueckiger The reverse target sign in liver disease: a potential ultrasound feature in cirrhotic liver nodules characterization Br. J. Radiol., April 1, 2005; 78(928): 355 - 357. [Abstract] [Full Text] [PDF]

				H. Kitamura and C. Kobayashi Impairment of Change in Diameter of the Hepatic Portion of the Inferior Vena Cava: A Sonographic Sign of Liver Fibrosis or Cirrhosis J. Ultrasound Med., March 1, 2005; 24(3): 355 - 359. [Abstract] [Full Text] [PDF]

				J F Pedersen, A Z Dakhil, D B Jensen, B Sondergaard, and P Bytzer Abnormal hepatic vein Doppler waveform in patients without liver disease Br. J. Radiol., March 1, 2005; 78(927): 242 - 244. [Abstract] [Full Text] [PDF]

				P. V. Pandharipande, G. A. Krinsky, H. Rusinek, and V. S. Lee Perfusion Imaging of the Liver: Current Challenges and Future Goals Radiology, March 1, 2005; 234(3): 661 - 673. [Abstract] [Full Text] [PDF]

				M. Regazzi, R. Maserati, P. Villani, M. Cusato, P. Zucchi, E. Briganti, R. Roda, L. Sacchelli, F. Gatti, P. Delle Foglie, et al. Clinical Pharmacokinetics of Nelfinavir and Its Metabolite M8 in Human Immunodeficiency Virus (HIV)-Positive and HIV-Hepatitis C Virus-Coinfected Subjects Antimicrob. Agents Chemother., February 1, 2005; 49(2): 643 - 649. [Abstract] [Full Text] [PDF]

				M. Vigano, S. Visentin, A. Aghemo, M. G. Rumi, G. Ronchi, A. Colli, A. Colucci, S. Paggi, M. Fraquelli, and D. Conte US Features of Liver Surface Nodularity as a Predictor of Severe Fibrosis in Chronic Hepatitis C * Dr Colli and colleagues respond: Radiology, February 1, 2005; 234(2): 641 - 641. [Full Text] [PDF]