We aimed to present three new ultrasound signs—gallbladder scalloping, mammillated caudate lobe, and inferior vena cava scalloping—and determine their accuracy in diagnosing liver cirrhosis.
Materials and Methods
A total of 201 consecutive patients with a history of chronic liver disease who had undergone ultrasound imaging and liver biopsy were identified. A senior ultrasound radiologist blindly reviewed the ultrasound examinations. Specificity, sensitivity, positive predictive value, and negative predictive value of diagnosing cirrhosis were calculated for all evaluated ultrasound signs and selected combinations of signs, using the liver biopsy results as the reference standard.
Of the 201 patients, 152 (76%) had either pathology-proven cirrhosis or significant fibrosis. Caudate lobe hypertrophy was the most specific (88%) and most positive predictor (90%) for cirrhosis, whereas mammillated caudate lobe was the most sensitive (78%). Inferior vena cava scalloping was the most specific (78%) of the three proposed ultrasound signs. When signs were combined, the presence of either gallbladder scalloping or liver surface nodularity was highly sensitive for cirrhosis (87%), whereas the presence of either gallbladder scalloping or inferior vena cava scalloping with caudate lobe hypertrophy was highly specific (93%).
Gallbladder scalloping, mammillated caudate lobe, and inferior vena cava scalloping are three novel signs that improve the accuracy of ultrasound in diagnosing cirrhosis.
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- Non-invasive evaluation of liver cirrhosis using ultrasound.Clin Radiol. 2009; 64: 1056-1066
- Current role of ultrasound in chronic liver disease: surveillance, diagnosis and management of hepatic neoplasms.Curr Probl Diagn Radiol. 2012; 41: 43-51
- Evaluation of liver fibrosis: a concise review.Am J Gastroenterol. 2004; 99: 1160-1174
- Diagnosis and quantitation of fibrosis.Gastroenterology. 2008; 134: 1670-1681
- Noninvasive monitoring of patients with chronic hepatitis C.Hepatology. 2002; 36: S57-S64
- Noninvasive assessment of liver fibrosis.Hepatology. 2011; 53: 325-335
- Invasive and non-invasive methods for the assessment of fibrosis and disease progression in chronic liver disease.Best Pract Res Clin Gastroenterol. 2011; 25: 291-303
- Practice guideline for the performance of an ultrasound examination of the abdomen and/or retroperitoneum.(Available at)http://www.aium.org/resources/guidelines.aspxDate: 2002Date accessed: August 14, 2012
- Grading and staging the histopathological lesions of chronic hepatitis: the Knodell histology activity index and beyond.Hepatology. 2000; 31: 241-246
- Diagnostic ultrasound.4th ed. Elsevier Mosby, St. Louis2011
- Clinical evaluation of diagnostic tests.AJR Am J Roentgenol. 2005; 184: 14-19
- Diagnosis of cirrhosis based on regional changes in hepatic morphology: a radiological and pathological analysis.Radiology. 1980; 135: 273-283
- Severe liver fibrosis or cirrhosis: accuracy of US for detection—analysis of 300 cases.Radiology. 2003; 227: 89-94
- Cirrhosis: value of caudate to right lobe ratio in diagnosis with US.Radiology. 1986; 161: 443-445
- What is the criterion for differentiating chronic hepatitis from compensated cirrhosis? A prospective study comparing ultrasonography and percutaneous liver biopsy.J Hepatol. 1997; 27: 979-985
- Sonographic evaluation of liver nodularity: inspection of deep versus superficial surfaces of the liver.J Clin Ultrasound. 2002; 30: 399-407
- Cirrhosis: diagnosis with sonographic study of the liver surface.Radiology. 1989; 172: 389-392
- 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. 2005; 24 (quiz 360-351): 355-359
- Which patients with hepatitis C develop liver complications?.Hepatology. 2000; 31: 513-520
- Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups.Lancet. 1997; 349: 825-832
Published online: March 27, 2018
Accepted: February 3, 2018
Received in revised form: January 30, 2018
Received: December 5, 2017
The authors declare no conflicts of interest.
© 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.