Cirrhosis is a process associated with end-stage chronic liver disease and is not really a disease in itself. It can result from a wide range of pathological processes including chronic hepatitis and alcoholic disease. Ultrasound images appearances of cirrhosis In cirrhosis bands of fibrous tissue are laid down in the liver parenchyma between the hepatic lobules. This distorts and destroys the normal architecture of the liver, separating it into nodules. The process may be micronodular, which gives a generally coarse echotexture, or macronodular in which discrete nodules of 1 cm and above can be distinguished on ultrasound (Fig. below).
Ultrasound images Micronodular cirrhosis in a patient with alcoholic liver disease
ultrasound images Macronodular cirrhosis in a
patient with primary biliary cirrhosis. Cirrhotic nodules are demonstrated throughout the peripheral hepatic substance
with a lobulated liver outline. Ascites is also present.
Ultrasound images Monophasic ‘damped’ flow in the hepatic veins in a patient
with micronodular cirrhosis. This sign is not specific for cirrhosis and may be present under many other circumstances, including the presence of ascites.
The hepatocellular damage which causes cirrhosis gives rise to hepatic fibrosis, a precursor of cirrhosis. The fibrosis itself may have very little effect on the ultrasound appearances of the liver, but when advanced it is more highly reflective than normal liver tissue, giving the appearance of a ‘bright’ liver often with a coarse texture.10 Unlike fatty change, which is potentially reversible, fibrosis is the result of irreversible damage to the liver cells. The picture is further complicated by the association of fibrosis with fatty change, which also increases the echogenicity. The acoustic attenuation properties of fibrosis, however, are similar to normal liver, so the ultrasound beam can penetrate to the posterior areas using normal TGC settings. Fat, on the other hand, increases both the echogenicity and the attenuation, preventing penetration to the far field. The cirrhotic liver tends to shrink as the disease progresses. However, it may be normal in size, or may undergo disproportionate changes within different lobes. In some patients the right lobe shrinks, giving rise to relative hypertrophy of the caudate and/or left lobes. This is likely to be due to the venous drainage of the different areas of the liver. The rigid nature of the diseased liver also causes haemodynamic changes which can be demonstrated on spectral Doppler. The normally triphasic hepatic venous waveform can become flattened and monophasic (Fig. above ). This is not necessarily specific to cirrhosis but is also associated with numerous types of chronic liver disease or any condition, either intra- or extrahepatic, which compresses the venous flow, such as polycystic liver disease or the presence of ascites. The portal venous flow may also be compromised due to portal hypertension (see below) and is associated with numerous changes on ultrasound showing reduced velocity, reversed flow, partial or total thrombosis. A compensatory increase in hepatic arterial flow to the liver may also be seen as a result of portal venous compromise in portal hypertension. Patients with cirrhosis are at increased risk of developing HCC, the detection of which is particularly difficult in an already nodular liver. Both CT and ultrasound have a low sensitivity for detecting small focal lesions in cirrhotic livers.  The use of Doppler, contrast CT and contrast MRI continues to improve the detection rate of small lesions and many high-risk patients (i.e. those with cirrhosis) undergo regular ultrasound screening with tumour markers (AFP) as a precaution.14 Small lesions continue to present a diagnostic challenge, and the use of ultrasound contrast agents, and the development of MRI using iron oxide, are likely to improve both detection and characterization of HCCs. Cirrhosis has numerous aetiologies: Alcoholic cirrhosis The spectrum of alcoholic liver disease may take three forms: steatosis (alcoholic fatty liver), alcoholic hepatitis (often preceding cirrhosis) and finally cirrhosis. The later, chronic stages carry a worse prognosis, frequently associated with portal hypertension and an increased incidence of HCC (Fig.above). Alcoholic liver disease may be halted or reversed in the early stages in patients who discontinue alcohol intake, with subsequent nodular regeneration of hepatic tissue (Fig. above). Nodular regeneration is not easy to distinguish from frank cirrhosis or other focal liver lesions, such as HCC, and the use of ultrasound contrast agents, or other imaging such as MRI may be required. Regenerating nodules may cause the liver to enlarge, whereas end-stage cirrhosis causes shrinkage of the liver. Primary biliary cirrhosis (PBC) This is a progressive cholestatic liver disease of unknown aetiology which occurs predominantly in middle-aged females. The term ‘cirrhosis’ may be rather misleading for the early stages of this condition, which actually take the form of an inflammatory destruction of the intrahepatic bile ducts. These early stages of cholangitis are not, strictly speaking, cirrhotic. However as the destruction progresses, fibrotic bands form in a process of macronodular cirrhosis (Fig. above). Treatment of PBC involves control of the associated symptoms of portal hypertension and pruritus, but its progression is inevitable. Liver transplantation now offers a successful therapeutic option for these patients. Although the liver frequently looks normal on ultrasound in the early stages of the disease, gallstones,splenomegaly and lymphadenopathy can be demonstrated in many patients. Secondary biliary cirrhosis This occurs as a result of long-standing biliary obstruction. Causes usually include benign strictures or chronic stone impaction in the common bile duct causing progressive, gradual obstruction over a period of time. This causes ascending cholangitis and jaundice. The bile ducts may appear only mildly dilated on ultra- sound. It is also a recognized sequel of biliary atresia in children. Other causes of cirrhosis Cirrhosis may be drug-induced, particularly in patients on long-term treatment or therapy. It is also associated with many other diseases, such as hepatitis diabetes, ulcerative colitis, rheumatoid arthritis or any long-term conditions, acquired or congenital, which can affect the liver. Congenital forms of cirrhosis exist due to metabolic disorders: Wilson’s disease (deposition of copper in the liver and kidneys), glycogen storage disease (inability to break down glycogen to glucose), haemochromatosis (deposition of iron in the liver and pancreas) and others.

Artikel Terkait

4/ 5


Suka dengan artikel di atas? Silakan berlangganan gratis via email

This below all content of radiology information

Neuroradiology Musculoskeletal radiology MRI Musculoskeletal MRI Abnormal Mri Brain X-RAY differential diagnosis Head Neck Anatomy mnemonic CT Teleradiology Radiology News chest Radiology musculoskeletal salary pediatrics ultrasound ultrasound images job Brain tumour abdomen interventional radiology Apk Android CT Abdomen with contrast DAMS Imaging radiology ramblings residency c nature pediatric radiology random ramblings xray C T Radiology Top basics body imaging guide procedure web 2.0 Chest X Ray Interpretation Teleradiology Providers head and neck radiology video Fun Ultrasound Hepatitis b cancer chest radiology salary 1 CXR GenitoUrinary ORTHOPEDICS Sonographic Measurements Stroke dams md/ms coaching mammography radiology business tuberculosis BRAIN Clinicoradiological series FETUS GI radiology Gastrointestinal x ray Radiology 4 Radiology Conferences Radiology Images Telemedicine UPPER LIMPS Ultrasound in Emergencies dynamic MRI lifestyle radiology links renal case spine 3 tesla MRI Dams clinicoradiological series Entrepreneur Gastrointestinal Tract Images Literature Liver abscess ultrasound MD/MS coaching Radiology 40 Radiology Imaging Radiology Journal Radiology PDF Radiology mcqs Ultrasound Technique blog bone tumour cardiac CT career cerebral venous thrombosis chest xray d fracture gadolinium gastrointestinal genitourinary radiology hepatobiliary imaging lipoma medical blogs mri lower abdomen pelvis psychiatry radiation concern social networking technology training urogenital imaging weblog 3D CT Arachnoid cyst CT Cardiac Chest X Ray Diploma Guid Equipment Cost FDA Fibrous dysplasia Interventional Ultrasound Guiding Biopsi MDCT MR Pancreas MRI Vertebrae MRI Vertebrae lumbal MRI contrast MRS RTA Radiology Teaching resource TB Hip TECHNIQUE Tech Thorax X Ray Upper Ext aiims ankle sprain bowel cancer brain abscess case study computers and radiology contrast ependymoma epidermoid facebook guest post internet journal of radiology iphone kienbock disease liver liver segments ct locum tenens mri abdomen multislice CT pericallosal lipoma plain film teaching files private practice radiology humour shoulder arthrogram shoulder dislocation small bowel social media trigeminal neuralgia tuberous sclerosis venous x ray Vertebrae 3d printing 7 tesla MRI ACL reconstruction ACL tear ACLS AIIMS nov 2008 ALPSA lesion ANGIOGRAPHY ATFL B12 deficiency BLS BOLD Breast imaging Breast imaging Mammography CHF CT Paranasal CT Scanner Price CT angiography CT coronary angiography CT technology CV junction CXR teaching files Carcinoid Contrast Agent Creutzfeldt-Jakob Disease Dams MD/ms Dams grand rounds Diffusion weighted imaging Dysmenorrhea E E World Award 2011 EYE Embolization Imaging Entrepreneurship FMG India FMGE FNH Focal liver lesions ultrasound Focal nodular hyperplasia GBM GI Gall bladder Glioblastoma multiforme Glomus jugulare HEAD HEART HRCT HSG Head injury ICA dissection IRIA 2011 IUGR IVC filter Iliotibial Band Friction Syndrome Job Info Kidney Cancer LV thrombus Leptomeningeal cyst MAMOGRAPHY MCI Screening MD MPPG MR mammography MR urography MRA MRCP MRI Cervical MRI update MRI/PET MRV Mesenteric ischemia Middle East respiratory syndrome coronavirus (MERS-CoV) Motor neuron disease NECK Normal Liver US Oncology trial PDF Radiology PM and R Physician PNS Partial anomalous pulmonary venous drainage Persistent trigeminal artery Pg entrance Physiatrist Physiatry Physician Assistant Plastic Surgery Price MRI Machines 2017 Pulmonology Pulvinar sign Radiology Price List Radiology Today Radiology Updates Radiology grandrounds Radiology images of GI Tract Renal Ultrasound Retinal Surgery Rheumatology Ryles tube SKULL Seizure Sellar Masses Sleep Medicine Sports Medicine Subdural hematoma Surgery TBM TRIANGULAR FIBROCARTILAGE COMPLEX Trauma Surgery URI Ultrasound HIV Umbilical vein Update Article Upper Extremity X Ray Urology Usmle VHL Vascular Surgery Veteran Affairs X Ray Head about accessory bone acute cerebillitis acute pancreatitis aiims may 2011 aipg ankle ankle fracture apple articular cartilage aspergilloma atherosclerosis avulsion injury awards bankart lesion basilar artery thrombosis bilateral phaeochromocytoma biopsy bipolar bohler's angle bone tumours brachial plexus brain tb brainstem stroke branchial cyst breast cancer screening buford complex business today calcaneal fracture calcium scoring canned reports carcinoma esophagus carcinoma stomach cardiac ct/pet cardiac pacemaker cardiogen 82 cardiothoracic imaging catrotid artery dissection cavernoma cervical lymphnode levels chest radiographic score chest radiographs choledocolithiasis classification cloud computing cochlear implant colloid cyst communication in radiology compare case concha bullosa congenital brain anomalies congenital heart disease coronary CT coronary artery disease corpus callosum agenesis craniopharyngioma cryptococcal meningitis ct abdomen and pelvis cystic renal disease dams usmle dams visual treat deep brain stimulator dengue dengue hemorrhagic fever developmental dysplasia devices diagnostic imaging dialysis diffusion MR imaging diffusion tensor imaging diffusion tractography digital radiography distal facial neuroma dsa duplication gall bladder echinococcus echocardiography ectopic kidney elearning elevated diaphragm epilepsy esop facial neuroma fibular osteosarcoma functional mri gastrointenstinal tuberculosis germinoma gifts glioma google google plus gun shot injury haemangioblastoma health 2.0 healthcare consultancy hemangiblastoma hemophilia hippocampus hirayama disease hydatid cyst hypercoagulable hypoxic ischemic encephalopathy indian conferences inferior rectus anomaly infrared interior tomography interstitial lung disease intramedullary metastates intramedullary tuberculomas ipad ipad 2 jacoud's arthropathy kernohan's notch knee kohler's disease krukenberg tumour laceration leber's optic atrophy liver transplant lung contusion lymphatics macros marchifava bingami disease mastoiditis maxillary sinus mucocele medial malleolus ossicle medial tibial stress syndrome medical writting medicare medicolegal aspects of teleradiology migraine mortality motor area mri knee mri lumbal msk penang course mucinous cystadenoma multicentric Glioblastoma multiforme mycotic pseudoaneurysm of superficial temporal artery nephrogenic systemic fibrosis nephrology neurosurgery meets nonradiologist oesophagus olecranon spur online medical games open access opercular syndrome opinion orbit os odontoideum os radiale externum osirix osteochondritis osteochondroma osteoid osteoma outsourcing radiology ovarian tumour parameniscal cyst paranasal sinuses parotid vascular mass patellar sleeve avulsion fracture patent ductus arteriosus patent foramen ovale patient information pelvic MRI pericardial fat phaeochromocytoma pharmaceutical writting pineal tumour placenta accreta placenta increta placental insufficiency pneumococcal pneumonia polycystic kidney disease portal Hypertension posterior circulation stroke power point presentation primary complex protected health information pseudobulbar palsy pseudomyxoma peritonei publications pulmonary edema pulmonary embolism pulmonary tuberculosis rabbit ear sign rad radiographic deterioration pattern radiography radiolo radiologist blogs radiology city radiology debate radiology images of spleen radiology intervensional radiology learning radiology search engine radiology spotter radiology spotters radiolopolis raditudes rathke cleft cyst renal imaging renal sinus tumour right sided aortic arch robot round cell tumour sacral agenesis scaphoid fracture schatzki ring scientific content screening search engine secondaries secondary ossification centres silicosis social radiology soft tissue chondroma solitary pulmonary nodule spectroscopy spinal arachnoid cyst spinal cord tumours spinal osteochondroma spine tumour spinoglenoid cyst sternal tuberculosis stress fracture sacrum stroke mri sub-acute combined degeneration subclavian pseudoaneurysm subependymal giant cell astrocytoma sumer sethi swyer-james syndrome syringomyelia tb teaching video teleradiolo teleradiology business models teleradproviders teleultrasound temporal bone fracture tendoachilles testicular tumour tethered cord. MRI tibial stress fracture total knee arthroplasty total shoulder replacment trachea. tracheal diverticulum tracheal stenosis tracheomalacia traumatic lung cyst triceps tear triquetral fracture tubercular abscess tuberculoma tuberculosis elbow ultrasound image of The segments of the liver umblical artery doppler uroradiology vascular malformation vasovist venous angioma ventriculitis video ct scan video mri viral encephalitis vitamin deficiency