Liver Ultrasound Findings in Cirrhosis and Nodules

Ultrasound indicators of cirrhosis

  • Liver parenchyma is coarse with decreased brightness of portal triads; attenuation is not as pronounced as in fatty infiltration; may show soft shadowing posteriorly due to fibrosis.
  • Chronic hepatitis often does not cause liver enlargement; fibrosis may produce surface changes.

Ratios and measurement

  • The ratio of caudate lobe width to right lobe width (C/RL) is used as an indicator of cirrhosis.
  • Threshold: CRL=0.65\frac{C}{RL} = 0.65 indicates cirrhosis.
  • This measurement is useful if abnormal, but not highly sensitive when normal.

Parenchymal texture and surface features

  • Increased echogenicity and coarsening due to fibrosis; surface nodularity may be present.
  • Increased attenuation with decreased vascular markings.
  • Fat infiltration influences echogenicity and attenuation.
  • Hepatosplenomegaly may occur with ascites; possible atrophy of the right and left medial lobes.
  • Surface nodularity more evident with ascites; higher-frequency transducers can better show the surface; hepatic fissures may be accentuated.
  • Isoechoic regenerating nodules may be seen throughout the liver parenchyma.

Nodules and nodular disease

  • Regenerating nodules: regenerating hepatocytes surrounded by fibrosis septa; isoechoic to liver parenchyma, may be indistinguishable from normal texture.
  • Dysplastic nodules or adenomatous hyperplastic nodules are larger than regenerating nodules.

Portal hypertension and malignancy risk

  • Portal hypertension may be present with or without abnormal Doppler flow patterns.
  • Cirrhosis is associated with an increased incidence of hepatocellular carcinoma within the liver parenchyma.

Technique and limitations

  • Findings are subjective and depend on gain settings (TGC and overall gain).
  • The degree of fatty infiltration influences echogenicity and attenuation.

Imaging patterns (referenced figures)

  • Patterns include alcoholic cirrhosis with fat content, biliary cirrhosis (nodular), micronodular cirrhosis, and macronodular cirrhosis.