Abstract
Background
Cirrhosis of liver is often a silent disease and need early diagnosis for effective treatment strategy.
Objectives
The present article aims to describe new imaging signs for early diagnosis of cirrhosis on routine CT. These are ‘hepato-diaphragmatic fat interposition’ (HDFI) and ‘increased right hemi-diaphragmatic thickness’ (increased r-DT sign).
Materials and methods
This was a retrospective study based on the presence or absence of cirrhosis of liver (n = 100). ‘HDFI sign’ was labeled as positive if F is more than 50% of D; where F is the medio-lateral extent of the intra-abdominal fat along the postero-medial margin of liver and D is the distance from the lateral vertebral margin to the medial margin of the outer-most rib in the same axial image. Increased ‘r-DT sign’ is labeled when the dimension on right side exceeds left side by at least 0.2 cm. Pearson χ2 was performed to calculate the p value. A p value of < 0.05 was considered to indicate a significant difference.
Results
There was a significant difference between cirrhotic and normal group, The sensitivity, specificity, positive predictive value and the negative predictive value of HDFI sign was found to be 94%, 62%, 71.21% and 91.17%, while that of increased r-DT sign was found to be 96%,52%, 66.66% and 92.85%. The area under the ROC curve for the HDFI sign was found to be 0.78 as compared to 0.74 for the increased r-DT sign.
Conclusion
Both these new signs should be used as additional imaging signs for early diagnosis of cirrhosis.
Similar content being viewed by others
References
Friedman S, Schiano T. Cirrhosis and its sequelae. In: Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. 22nd ed. Philadelphia, Pa.: Saunders, 2004:936–44.
Heidelbaugh J.J and Bruderly M. Cirrhosis and Chronic Liver Failure: Part I. Diagnosis and Evaluation. American Family Physician 2006, 74(5); 756-62.
Yee HF, Lidofsky SD. Acute liver failure. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 7th ed. Philadelphia, Pa.: Saunders, 2002:1567-74.
Brancatellia G, Federlec MP, Ambrosinid R, Lagallab R, Carrierod A, Midirib M et al. Cirrhosis: CT and MR imaging evaluation. European Journal of Radiology 61 (2007) 57–69.
Ito K, Mitchell DG, Gabata T, Hussain SM. Expanded gallbladder fossa: simple MR imaging sign of cirrhosis. Radiology. 1999 Jun;211(3):723-6
Ito K, Mitchell DG, Gabata T. Enlargement of hilar periportal space: a sign of early cirrhosis at MR imaging. J Magn Reson Imaging. 2000 Feb;11(2):136-40.
Ito K, Mitchell DG, Kim MJ, Awaya H, Koike S, Matsunaga N. Right posterior hepatic notch sign: a simple diagnostic MR finding of cirrhosis. J Magn Reson Imaging. 2003 Nov;18(5):561-6.
Okazaki H, Ito K, Fujita T. Discrimination of alcoholic from virus-induced cirrhosis on MR imaging. AJR Am J Roentgenol 2000;175:1677–1681.
Harbin WP, Robert NJ, Ferrucci JJ. Diagnosis of cirrhosis based on regional changes in hepatic morphology: a radiological and pathological analysis. Radiology 1980;135:273–83.
Awaya H, Mitchell DG, Kamishima T, Holland G, Ito K, Matsumoto T. Cirrhosis: modified caudate-right lobe ratio. Radiology 2002; 224:769–74.
David J. Brenner, and Eric J. Hall. Computed Tomography - An Increasing Source of Radiation Exposure. N Engl J Med 2007; 357:2277-2284.
Semelka RC, Armao DM, Elias J Jr, Huda W. Imaging strategies to reduce the risk of radiation in CT studies, including selective substitution with MRI. J Magn Reson Imaging 2007; 25:900-909.
Lafortune M, Matricardi L, Denys A, Favret M, Dery R, Pomier-Layrargues G. Segment 4 (the quadrate lobe): a barometer of cirrhotic liver disease at US. Radiology 1998;206:157–60.
Yu JS, Shim JH, Chung JJ, Kim JH and Kim KW. Double contrast-enhanced MRI of viral hepatitis-induced cirrhosis: Correlation of gross morphological signs with hepatic fibrosis. The British Journal of Radiology, 83 (2010), 212–217.
Brown JJ, Naylor MJ, Yagan N. Imaging of hepatic cirrhosis. Radiology 1997;202:1–16.
Gupta AA, Kim DC, Krinsky GA, Lee VS. CT and MRI of Cirrhosis and its Mimics. AJR 2004;183:1595–1601.
Hillaire S, Bonte E, Denninger MH, Casadevall N, Cadranel JF, Lebrec D, et al. Idiopathic non-cirrhotic intrahepatic portal hypertension in the West: a re-evaluation in 28 patients. Gut. 2002 August; 51(2): 275–280.
Dhiman RK, Chawla Y, Vasishta RK, Kakkar N, Dilawari JB, Trehan MS et al. Non-cirrhotic portal fibrosis (idiopathic portal hypertension): Experience with 151 patients & the review of literature. Gastroenterol Hepatol. 2002 Jan;17(1):6-16.
Daniel T. Boll, Elmar M. Merkle. Diffuse Liver Disease: Strategies for Hepatic CT and MR Imaging. RadioGraphics 2009; 29:1591–161.
Flohr TG, McCollough CH, Bruder H, et al. First performance evaluation of a dual-source CT(DSCT) system. Eur Radiol 2006;16:256–268.
Sahani DV and Kalva SP. Imaging the Liver. The Oncologist July 2004 vol. 9, no. 4 385-397
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This study was approved by the Ethical Committee of Indraprastha Apollo Hospitals, Sarita Vihar; New Delhi-76.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ghonge, N.P., Sahu, A. ‘Hepato-diaphragmatic fat interposition’ and ‘increased right hemi-diaphragmatic thickness’: new imaging signs for early diagnosis of hepatic cirrhosis on routine CT abdomen. Abdom Radiol 45, 153–160 (2020). https://doi.org/10.1007/s00261-019-02230-w
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-019-02230-w