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Application of ultrasound for the diagnosis of cirrhosis/portal hypertension

  • Special Feature: Review Article
  • Imaging-based diagnosis and management of cirrhosis/portal hypertension
  • Published:
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Abstract

With advances in technologic approaches in patients with cirrhosis, including the improvement of management, a simple, one-step approach for advanced fibrotic state of the liver is clinically useful. Although refining the diagnosis of cirrhosis to reflect disease heterogeneity is essential, current diagnostic tests have not kept pace with the progression of this new paradigm. There are unmet needs in primary care centers with respect to patients with cirrhosis. Liver biopsy and measurement of hepatic venous pressure gradient in patients with cirrhosis are the gold standards for the estimation of hepatic fibrosis, and they have diagnostic and prognostic value. However, both approaches are invasive and cannot be used repeatedly in clinical practice. Ultrasonography (US) is safe, easy to perform, inexpensive, and yields numerical and accurate results. Conventionally, the size of the liver and spleen, bluntness of the liver edge, nodularity of the liver surface, and coarseness of the liver parenchyma have been known as useful parameters for hepatic fibrosis or portal hypertension (PHT) in chronic liver disease. Additionally, some functional US indices including Doppler and CEUS-based examination have been suggested as promising markers for diagnosing cirrhosis and PHT. Identification of the reproducibility and long-term prognostic value through further investigations can demonstrate the clinical usefulness of functional US indices, which are characterized as quantitative parameters for hepatic fibrosis and PHT.

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Abbreviations

3D:

Three dimensional

AUROC:

Area under the receiver operating characteristic

BMI:

Body mass index

CD-EUS:

Color Doppler endoscopic ultrasound

CEUS:

Contrast-enhanced ultrasonography

CSPH:

Clinically significant portal hypertension

CT:

Computed tomography

DI:

Damping index

FDA:

Food and drug administration

EV:

Esophageal varix

GV:

Gastric varix

HCC:

Hepatocellular carcinoma

HV:

Hepatic vein

HVPG:

Hepatic vein pressure gradient

HVATT:

Hepatic vein arrival transit time

HVTT:

Hepatic vein transit time

IP:

Iliopsoas

IPH:

Idiopathic portal hypertension

LC:

Liver cirrhosis

LGV:

Left gastric vein

MRE:

Magnetic resonance elastography

MRI:

Magnetic resonance imaging

NAFLD:

Non-alcoholic fatty liver disease

NFPF:

Non-forward portal flow

NPV:

Negative predictive value

PHT:

Portal hypertension

PV:

Portal vein

PVV:

Portal vein velocity

RHP:

Regional hepatic perfusion

TIPS:

Trans-jugular intrahepatic shunt

US:

Ultrasound

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Acknowledgements

The authors acknowledge the assistance of the Regeneration Medicine Research Center and Mitohormesis Research Center of Yonsei University Wonju College of Medicine, as well as the study participants.

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  1. Han Seul Ki and Moon Young Kim contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsanro, Wonju, 220-701, Republic of Korea

    Seul Ki Han, Moon Young Kim, Seong Hee Kang & Soon Koo Baik

  2. Regeneration Medicine Research Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea

    Moon Young Kim, Seong Hee Kang & Soon Koo Baik

  3. Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea

    Moon Young Kim & Soon Koo Baik

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  1. Seul Ki Han
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All authors contributed to the study conception and design, material preparation, and data collection. The first draft of the manuscript was written by SKH and MYK. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Soon Koo Baik.

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Han, S.K., Kim, M.Y., Kang, S.H. et al. Application of ultrasound for the diagnosis of cirrhosis/portal hypertension. J Med Ultrasonics 49, 321–331 (2022). https://doi.org/10.1007/s10396-022-01191-w

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