Ultrasonography in patients with chronic liver disease: its usefulness in the diagnosis of cirrhosis.
OBJECTIVE
To prospectively assess the usefulness of ultrasonography in predicting the presence of cirrhosis in patients with asymptomatic chronic liver disease in unknown stage.


METHODS
Eighteen doppler and ultrasonographic features were prospectively assessed immediately before performing laparoscopy and/or liver biopsy. Usefulness of predictive variables selected by multiple regression analysis and included in a scoring scale was determined by ROC curves.


METHODS
One hundred and thirteen consecutive patients with neither clinical nor biochemical signs of advanced liver disease submitted for study.


RESULTS
Liver enlargement, liver surface nodularity, liver parenchyma distortion, flattening of flow wave in hepatic veins, portal and splenic veins dilatation, decreased variability in splenic vein caliber with breathing. Collateral vessels, and splenomegaly were associated to cirrhosis. Multivariate analysis showed the joint assessment of hepatic echostructure, portal vein caliber and spleen area to be the best approach to ultrasonographic staging, with sensitivity of 80%, specificity of 92% and accuracy of 89% in the diagnosis of cirrhosis.


CONCLUSIONS
Ultrasonography enabled the presence or absence of cirrhosis to be correctly determined even in patients with asymptomatic disease. Combined assessment of hepatic echostructure, portal vein diameter and spleen size provides the highest accuracy.
Macías Rodríguez
M A
MA
Servicio de Aparato Digestivo. Hospital Universitario Puerta del Mar. Cádiz. Spain. mmacias@comcadiz.com
Rendón Unceta
P
P
Navas Relinque
C
C
Tejada Cabrera
M
M
Infantes Hernández
J M
JM
Martín Herrera
L
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000473:pathology; D010535:Laparoscopy; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012044:Regression Analysis; D014463:Ultrasonography