Ultrasound including elastogrpaphy
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The liver is coarsened in echotexture with a subtly nodular surface. The walls of the hepatic veins are slightly wavy. These features suggest cirrhosis. Multiple small hypoechoic lesions are seen within the liver which have features consistent with simple hepatic cysts. The two largest measure 9 mm and lie in segments IVa and V/VI. No other focal hepatic lesion is seen. The main portal vein is mildly enlarged measuring 14mm in maximum transverse diameter. It demonstrates flow in a normal direction. No flow is seen within the ligamentum teres. Numerous small, mobile gallstones are seen within the gallbladder. The common bile duct although not seen in its entirety due to bowel gas, is not dilated measuring 4 mm and there is no evidence of intrahepatic duct dilation.
ARFI - Median velocities and IQRs: 1) 1.52; 0.232 2) 1.27; 0.163 3) 1.39; 0.42
1. The ultrasound features suggest cirrhosis with enlargement of the main portal vein suggestive of portal hypertension.
2. Multiple small hepatic lesions suggest multiple cysts.
3. There is discrepancy in the ARFI values, Two lying in the F2 range and the other in the F0/F1 range.
ARFI reference values:
- 1.35 - absent or mild fibrosis (F0 or F1)
- 1.35-1.55 - significant fibrosis (F2)
- 1.55- 1.80 - severe fibrosis (F3)
- >1.80 - cirrhosis (F4)
These thresholds are not absolute.
Values with an IQR of <0.3 x median velocity should be either discounted or interpreted with caution (depending on how close to this threshold they are). ie IQR/median velocity should be ideally >0.3
Based on meta analysis of pooled data which included a predominance of HCV patients - Friedrich-Rust et al J Viral hepatitis 2012, 19 e212-1219
Results should be interpreted in clinical context. Such things as inflammatory activity, venous congestion can elevate the ARFI value.