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Abdominal Ultrasound in Liver Fibrosis

Abdominal Ultrasound in Liver Fibrosis. Laurentius A. Lesmana Department of Internal Medicine, University of Indonesia Digestive Disease Centre, Medistra Hospital, Jakarta. US evaluation of the liver.

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Abdominal Ultrasound in Liver Fibrosis

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  1. Abdominal Ultrasound in Liver Fibrosis Laurentius A. Lesmana Department of Internal Medicine, University of Indonesia Digestive Disease Centre, Medistra Hospital, Jakarta

  2. USevaluation of theliver • Adequate scanning technique demands that each patient be examined with the following assessments: • The size of the liver in the longitudinal plane • The attenuation of the liver parenchyma • Liver echotexture • Hepatic vascular structures • Intrahepatic biliary ducts structures

  3. Liver Biopsy – Gold Standard • Obtained by either a percutaneousor US-guided fine-needle aspiration (FNA). • METAVIR Scores: • Fibrosis stage: F1-F4 (cirrhosis) • Inflammatory activity: A1-A3 • Biopsy is NOT NECESSARYif the clinical, laboratory, and radiologic data strongly suggest the presence of cirrhosis.

  4. NORMAL LIVER vs. CIRRHOTIC LIVER

  5. Can US Distinguish Fibrosis Stages?

  6. Liver Fibrosis Staging Diagnostic performance of three US parameters to detect early liver cirrhosis. ( 324 patients were evaluated by both US and liver biopsy ) Shen L, et al. World J Gastroenterol. 2006;12:1292-5.

  7. Accuracy of routine US in staging of liver fibrosis in chronic hepatitis • A retrospective evaluation of ultrasound images in 156 patients with Chronic viral hepatitis. • Three US features were assessed : surface nodularity, liver edge and parenchymal echotexture. • Scores of 0 to 3 ( 0=normal, 1=mild, 2=moderate and 3=severe. . Choong CC, et al. J Clin Imaging Sci. 2012;2:58

  8. US images and scoring system Choong CC, et al. J Clin Imaging Sci. 2012;2:58.

  9. Liver Fibrosis Staging Diagnostic performance of US parameters to detect significant fibrosis (>F2). Choong CC, et al. J Clin Imaging Sci. 2012;2:58.

  10. Liver Fibrosis Staging Diagnostic performance of US parameters to detect severe fibrosis (>F3). Choong CC, et al. J Clin Imaging Sci. 2012;2:58.

  11. Liver Fibrosis Staging Diagnostic performance of US parameters to detect cirrhosis (F4). Choong CC, et al. J Clin Imaging Sci. 2012;2:58.

  12. Conclusion • Conventional US cannot differentiate accurately the different liver fibrosis stage. • Newer ultrasound technique elastography • There are 4 US elastography techniques: • transient elastography (TE), • real time elastography (RTE) • acoustic radiation force impulse imaging (ARFI) • shear wave elastography (SWE)

  13. Recommendations • Conventional ultrasound can not be used as an accurate predictor of early and significant fibrosis in chronic viral hepatitis except for early cirrhosis. • Conventional US is still useful in detecting cirrhosis.

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