Dorsal acoustic windows may ameliorate liver ultrasound in patients with chronic liver disease and meteorism/obesity/ascites.
OBJECTIVE
To identify dorsal acoustic windows (DAWs) for the study of the liver and to investigate whether they could improve the visualization of the liver in patients with chronic liver disease and ascites, meteorism, and/or obesity.


METHODS
The study was based on a single ultrasound examination and divided into three successive stages. Firstly, we performed a preliminary study involving 10 cirrhotic patients to identify new DAWs. Inter-observer reproducibility of measurements obtained through the DAWs was then assessed in another 29 cirrhotic patients. Finally, in 50 patients with chronic hepatitis/cirrhosis, we employed the DAWs when ascites, meteorism or obesity hampered the conventional ultrasound examination.


RESULTS
With patients sitting, we found three new DAWs, by the combined use of which it was possible to explore the liver, spleen, and their vascular structures, and which provided reproducible measurements. In the clinical setting, we found 11 of 50 patients in whom the addition of the new DAWs led to better results in terms of successful visualization/Doppler measurements for portal vein (ratio = 100 % vs 27 %, p = 0.001), hepatic artery (ratio = 90 % vs 27 %, p = 0.004), and hepatic veins (mean number = 2.4 ± 0.2 vs 1.0 ± 0.2, p = 0.01). Among these 11 patients, in one case the addition of DAWs led to visualization of hepatic focal lesions in the right lobe, not previously displayed through conventional ultrasound.


CONCLUSIONS
These DAWs may be an additional tool that improves the accuracy of ultrasound examinations in patients with meteorism, ascites, or obesity.
Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Albertoni 15, 40138, Bologna, Italy. m.domenicali@unibo.it.
Marco
M
Domenicali
Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Albertoni 15, 40138, Bologna, Italy.
Manuel
M
Tufoni
Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Albertoni 15, 40138, Bologna, Italy.
Vittoria
V
Bevilacqua
Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Albertoni 15, 40138, Bologna, Italy.
Barbara
B
Benazzi
Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Albertoni 15, 40138, Bologna, Italy.
Carmen Serena
CS
Ricci
Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Albertoni 15, 40138, Bologna, Italy.
Alessandra
A
Tovoli
Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Albertoni 15, 40138, Bologna, Italy.
Lucia
L
Napoli
Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Albertoni 15, 40138, Bologna, Italy.
Paolo
P
Caraceni
Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Albertoni 15, 40138, Bologna, Italy.
Mauro
M
Bernardi
Chronic hepatitis; Cirrhosis; Dorsal acoustic windows; Hepatic Doppler measurements; Liver ultrasound