Soon Koo Baik

Diagnostic methods for cirrhosis and portal hypertension: Imaging: Ultrasound and doppler ultrasonography

Ultrasonography (US) and Doppler US have been widely used to diagnose cirrhosis and portal hypertension (PH) for several decades. As an alternative to invasive methods to diagnose cirrhosis, many attempts have used US to assess hepatic fibrosis and its clinical complications. Because of its low cost, ease of use, and high patient compliance, it has become the most common and valuable diagnostic modality for detecting not only parenchymal disease but also anomalies in liver hemodynamics by Doppler imaging. Therefore, previous studies have evaluated several US indices using to identify cirrhosis, including nodular liver surface, blunted liver edge, coarse parenchymal echogenicity, atrophic change of right lobe, splenomegaly, and enlarged diameter of the splenic vein (SV). In addition, Doppler US indices, which have been commonly used for evaluating PH, include the measurement of portal and splenic venous blood velocity and flow as well as the resistance indices at the hepatic, splenic, renal, and superior mesenteric arteries. However, the objectivity of measurements of US and Doppler indices to diagnose cirrhosis and PH is compromised by interobserver variation and interequipment variability. Finally, US and Doppler US are of major value in diagnosing portal vein thrombosis and therefore in ruling out pre-hepatic portal hypertension. We review herein the role of various US tests used in the diagnosis of cirrhosis and PH, including grayscale and Doppler US.