Screening for diffuse and focal liver disease: the case for hepatic sonography

Multimodality Detection of Metastatic Melanoma

A retrospective evaluation of radionuclide liver and spleen scintigraphy (LS), ultrasonography (US), and computed tomography (CT) was performed in 88 patients who had pathologically proven cutaneous melanoma. In patients who had all three examinations ( n=24), the matrix analysis showed that CT was significantly more sensitive (0.94) in detecting intra-abdominal metastasis when compared to US (0.62, P<0.05) and LS (0.38, P<0.01). Sixty-four patients had only US and LS studies. In this group of patients US was found to be more sensitive than LS, 0.88 and 0.54 respectively ( P<0.01). Furthermore, when CT was compared with US, CT was shown to detect metastases significantly earlier than US ( P=0.03). Overall, CT provided the most accurate means for detecting the intra-abdominal metastases of cutaneous melanoma.

Ultrasonography and Scintigraphy of the Liver in Focal and Diffuse Disease

In a clinical series the accuracy of standard colloid scintigraphy and gray-scale ultrasonography in investigations for liver disease was evaluated. The results of 246 investigations in which both methods were utilized were reviewed and classified according to diagnosis and follow-up. In focal disease the sensitivity was 0.90 for scintigraphy, and 0.83 for ultrasonography; ultrasonography had the higher specificity, 0.94 compared with 0.77 for scintigraphy. In diffuse disease the sensitivity was found to be low for both methods, about 0.60, while specificity was high, 0.86 for scintigraphy and 0.92 for ultrasonography. Decreased liver function in diffuse liver disease as reflected by bone marrow uptake at scintigraphy was not found to have any influence on the degree of sensitivity of ultrasonography.

Metadoxine accelerates fatty liver recovery in alcoholic patients: results of a randomized double-blind, placebo-control trial. Spanish Group for the Study of Alcoholic Fatty Liver

BACKGROUND/AIMS

Our aim was to investigate the effectiveness of metadoxine (pyridoxol L, 2 pyrrolidone-5-carboxylate) in the treatment of alcoholic fatty liver.

METHODS

A double-blind randomized multicenter trial involving 136 chronic active alcoholic patients diagnosed with fatty liver by clinical, biochemical and ultrasonographic criteria was performed. Patients were treated with 1500 mg/day of metadoxine (n = 69) or placebo (n = 67) for 3 months. Patients were clinically and biochemically evaluated every month. Ultrasonography was performed before and after treatment.

RESULTS

At the end of the study there was a significant improvement in the liver function tests in both groups. However, the changes were more rapid and greater in patients treated with metadoxine, in whom significant changes in serum levels of bilirubin, aminotransferases and gammaglutamyl transpeptidase were already observed after 1 month of treatment, and normalization of these parameters was observed at the end. After treatment, the percentage of patients with ultrasonographic signs of steatosis was significantly lower in the metadoxine group (28% vs 70%, p < 0.01) and the degree of steatosis was also lower in this group. Sixteen patients treated with metadoxine and 15 with placebo continued drinking. Alcohol intake was lower than initially, and similar in both groups. In the metadoxine group, the biochemical changes were similar in both the abstinent and the nonabstinent patients. In contrast, in the placebo group the improvement in the liver function tests was significantly higher in abstinents. Among patients who continued drinking, the prevalence (45% vs 92%, p < 0.05) and the degree of steatosis were also significantly lower in patients treated with metadoxine.

CONCLUSIONS

In patients with alcoholic fatty liver, metadoxine accelerates the normalization of liver function tests and the ultrasonographic changes, even in those who do not completely abstain from alcohol intake. Thus, metadoxine could be useful in the treatment of the early stages of alcoholic liver disease.

Ultrasonography of diffuse liver disease. A review

Radiographically, the liver may appear normal even if severely diseased. Ultrasonography can be an important adjunct in the evaluation of diffuse parenchymal hepatic disease. Diffuse liver disease appears ultrasonographically as a change in liver echogenicity from normal when compared with the renal cortex or spleen. Diffuse liver disease can be characterized as either hyperechoic due to fatty change, steroid hepatopathy, and cirrhosis or hypoechoic due to congestion, suppurative hepatitis, and lymphoma. Ultrasonographic diagnosis of diffuse liver disease should be substantiated by biopsy and histopathologic evaluation.

Alcoholic liver disease: value of the left-to-right portal vein ratio in its sonographic diagnosis

A study group of 50 patients in whom the left portal vein diameter was equal to or greater than the right portal vein diameter (LPVD greater than or equal to RPVD) was prospectively compared on ultrasonography with a control group of 50 patients with LPVD less than RPVD. Clinical and laboratory data indicating chronic alcoholic liver disease (CALD) were observed with a significantly higher frequency in the study group than in the control group. It emerges from this study that LPVD greater than or equal to RPVD represents a useful ultrasonographic sign of CALD, corresponding to a relative enlargement of the left hepatic lobe compared with the right.

Cholangiocarcinoma associated with multiple bile-duct hamartomas of the liver

The case of a 61-year-old woman with a surgically resected solitary cholangiocarcinoma of the liver is reported, where many discrete multiple bile duct hamartoma (MBDH) were also seen. The latter is a congenital lesion of the liver that potentially may be confused with widespread metastatic disease. The relationship between cholangiocarcinoma and MBDH was studied histologically by the use of an immunoperoxidase technique for cytokeratin. MBDH was strongly positive for cytokeratin, while the neoplasm showed this to a lesser extent, but a clear continuity between the MBDH epithelial cells and those of the neoplasm was demonstrated by the use of this technic. The potential use for the various cytokeratins in the differentiation of primary from secondary liver tumors, is discussed. This differentiation is a significant problem to the pathologist. Although cholangiocarcinoma may, on occasion, be associated with various congenital lesions of the bile ducts, the association with MBDH is extremely rare, this being only the third reported case.

Technetium-99m-iminodiacetic acid organic anions: review of biokinetics and clinical application in hepatology

Technetium-99m-labeled iminodiacetic acid analogs are a new class of organic anions, taken up and secreted by hepatocyte into hepatic bile by a carrier-mediated organic anion pathway. They provide a new dimension in the assessment of pathophysiology and morphology of the hepatobiliary system. The amount of uptake and the rapidity of its elimination from the liver is dependent upon the structural configuration of the agent as well as the functional integrity of the hepatocyte and the patency of the biliary system. The clinical areas for application are wide and include most of the hepatobiliary diseases. Technetium-99m-iminodiacetic acid, an agent well suited for both planar and single photon tomographic scintigraphy, is ideal for early diagnosis prior to anatomical changes in the hepatobiliary system. The data collection directly from the liver provides quantitation of both regional and global liver diseases. The count-based method for measuring gallbladder emptying overcomes the theoretical disadvantages of geometric tests. Biokinetics and current clinical application of six of the 99mTc-iminodiacetic acid agents are reviewed, and the potential future clinical and research areas of application are indicated.

A new quantitative ultrasonic method for diagnosis of chronic parenchymal liver disease

The degree of echogenicity of the hepatic parenchyma was measured by an objective method comparing patient's sonograms with a tissue-mimicking phantom obtained with available real-time ultrasound machines. A single sonographic image of the liver and the phantom was taken using identical setting in each case. The ratio of the mean density of the phantom to that of the liver was obtained. The mean of the ratio in 30 normal subjects was 1.04 +/- 0.01, in 26 patients with early alcoholic liver disease 1.23 +/- 0.04, and in 74 cirrhotic subjects 1.54 +/- 0.03, with a significant difference among the three groups (p less than 0.05). A significant correlation was also obtained between the ratio and a modified Child's classification (r = 0.553, p less than 0.05) in cirrhotic subjects. Follow-up studies were available in a limited number of patients with early alcoholic liver disease showing progression or improvement paralleling alcohol use. Using this method, ultrasound may have considerable potential in the diagnosis and follow-up of alcoholic liver disease.

Ultrasound findings in childhood chronic liver parenchymal diseases. An analysis of 41 patients

Forty-one children with liver disease were studied by ultrasound scan at King Khalid University Hospital, Riyadh, Saudi Arabia. Diagnoses were confirmed either by liver biopsy or specific laboratory tests. Sonograms were studied for liver size, beam penetration, echogenicity, vascularity, and biliary tree abnormalities. Different liver diseases, such as chronic hepatitis, biliary cirrhosis, Wilson's disease, familial idiopathic cirrhosis, type III glycogen storage disease, and secondary haemochromatosis revealed non-specific disease patterns. Four cases of biliary cirrhosis and two cases of glycogen storage disease showed periportal fibrosis. Two cases of familial idiopathic cirrhosis and a case of Wilson's disease revealed thickening of the gall bladder wall, which has not been described in the literature.