S.H. Saverymuttu

Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liver disease

To establish the accuracy of ultrasonography in assessing diffuse parenchymal liver disease we performed a prospective comparative study with histology in 50 patients with a wide range of liver disease. Liver biopsy was performed within 24 h of the ultrasound examination and ultrasonography was performed by a single operator who was unaware of clinical details of the patients. Histology was reviewed blind and the degree of steatosis graded mild, moderate or severe while increased portal fibrous tissue was graded mild, moderate or established cirrhosis. Thirty-six patients had steatosis and 31 patients had increased fibrous tissue on histology. Ultrasonography correctly identified steatosis in 32/36 (89%) patients including all patients with the severe grade. Increased fibrous tissue was correctly identified in 24/31 (77%) with a sensitivity of 100% in patients with moderate fibrosis and established cirrhosis. Specificity was 93% for steatosis and 89% for increased fibrous tissue. These results show that ultrasonography can provide a non-invasive prediction of liver histology which in moderate and severe steatosis and advanced fibrosis can be both highly sensitive and specific.

Ultrasonic patterns in inflammatory bowel disease

Ultrasound examination was performed in 90 patients with varying bowel pathology. Ultrasound reliably demonstrated thickening of the bowel. In addition, the pattern of abnormality seen in Crohns disease and ulcerative colitis was different, and corresponded to the pathological changes seen in these disease processes. The pattern of bowel abnormality seen in other bowel diseases with an inflammatory aetiology generally corresponded to either the Crohns or ulcerative colitic pattern. The appearances are described, together with findings in other non-neoplastic diseases of the bowel.

Paradoxical lack of ultrasound attenuation with gross fatty change in the liver

The cardinal features of hepatic steatosis on ultrasound examination are now accepted as increased echogenicity of the liver parenchyma with increased attenuation of the ultrasound beam. Three cases are presented of patients with gross diffuse fatty infiltration of the liver, who showed a paradoxical lack of posterior attenuation on ultrasound examination. These examples serve to illustrate the role of scattering in attenuation of the ultrasound beam seen in fatty livers.

Ultrasound in the diagnosis of granulomatous liver disease.

Ultrasound is a widely used method of assessing the liver for space occupying lesions and, more recently, parenchymal liver disease. We have reviewed the ultrasound scans and reports of 11 patients with biopsy proven granulomatous liver disease. Multiple echogenic lesions 3-5 mm in diameter, each surrounded by an hypoechoic halo, were seen in the liver of all the patients and in the spleens of three patients. A specific diagnosis of granulomatous hepatitis was suggested at the time of scanning in seven patients. An abnormal liver was noted in the other four patients but no specific diagnosis was suggested. We believe that granulomata in the liver can be detected using ultrasound and, if the above appearances are seen during an ultrasound scan, a diagnosis of granulomatous hepatitis should be considered.

Correlation of 111Indium WBC scintigraphy with ultrasound in the detection and assessment of inflammatory bowel disease

111Indium (111In) WBC scintigraphy is an accurate method of assessing the extent of inflammatory bowel disease. A prospective study was performed to determine the correlation of ultrasound scanning with 111In WBC scintigraphy in the assessment of inflammatory bowel disease. Eighty-three indium and ultrasound scans were performed in 57 patients. Forty-six patients had Crohns disease and 11 patients had ulcerative colitis. The site extent of abnormality and the appearance of the bowel were recorded and compared to the findings on indium scintigraphy. Ultrasound detected 84% of indium-positive sites. If the rectum was excluded, sensitivity of detection rose to 91%. Three percent of indium-negative sites were positive on ultrasound.

Thickened stomach — An ultrasound sign of portal hypertension

Congestive gastrophy occurs with portal hypertension and is associated with vascular changes including dilatation and tortuosity of the submucous veins. Transabdominal ultrasound measurements of the stomach were made to determine whether these changes resulted in increased thickness of the stomach in patients with established cirrhosis and portal hypertension. Mean thickness of the antrum and body was 22.15 mm (range 13-31 mm) and 22.2 mm (range 13-31 mm) respectively in patients with portal hypertension: in the control group measurements of the antrum and body were 13.8 mm (range 8-20 mm) and 14.05 mm (range 11-19 mm) respectively (P less than 0.01 for both antrum and body). A thickened stomach may indicate the presence of portal hypertension.

Case report: Gastric sarcoidosis — Detection by ultrasound

We describe two cases of sarcoidosis in which gastric involvement was indicated by the demonstration of thickening of the stomach during upper abdominal ultrasound examination.