Skip to main content
Log in

Acoustic Liver Biopsy Using Endoscopic Ultrasound

  • Original Paper
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript


Background Transabdominal ultrasound cannot be used to quantitate fibrosis in patients with cirrhosis because of variability in the abdominal wall thickness and variability in the components of the abdominal wall (fat versus muscle). Endoscopic ultrasound through the gastric wall is always at a constant distance, approximately 3 mm, away from the liver when the transducer is just below the gastroesophageal junction, thereby eliminating this variability. Purpose To differentiate between cirrhotic and noncirrhotic liver using endoluminal ultrasound. Methods Eleven patients without known liver disease and eight patients with cirrhosis underwent endoscopic ultrasound using an Olympus linear ultrasound scope. The gain, contrast, frequency, and acoustic power were kept constant on the Aloka ultrasound processor. Videotaped images of the liver were recorded and then digitized on Image-Pro Plus software. The brightness of the image was adjusted to a standard brightness for each image and an area of interest was chosen using Photoshop 7.0. Vessels and artifacts were eliminated digitally and a histogram was produced using Photoshop to quantitate the pixel density for the area of interest from 0 (black) to 255 (white). Approximately 250,000 pixels were evaluated for each subject. The mean ± standard deviation (SD) pixel density of the noncirrhotic subjects was evaluated against the cirrhotic patients using a Student unpaired t-test. Results The mean echogenecity in patients with cirrhosis was 116.85 and the mean echogenecity in patients without cirrhosis was 92.75 (P < 0.002). The mean standard deviation of the pixel density in patients with cirrhosis was 19.08 and the mean standard deviation of the pixel density in patients without cirrhosis was 13.25 (P < 0.0004). Using these criteria the subjects with cirrhosis were segregated from the noncirrhotic subjects (normal subjects and the subjects with steatosis) with 100% sensitivity and 100% specificity. Conclusion A new method of evaluating the liver parenchyma (acoustic liver biopsy) that takes advantage of the proximity of the endoscopic ultrasound transducer to the liver and uses commercial image analysis technology that is inexpensive and widely available was developed. This is a preliminary study of this new technology, which demonstrates that endoscopic ultrasound, can be standardized in order to image, analyze, and compare the mean echogenecity and mean standard deviation of the pixel density in the liver in order to distinguish cirrhotic patients from patients without cirrhosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


  1. Brown JJ, Naylor MJ, Yagan N (1997) Imaging of hepatic cirrhosis. Radiology 202:1–16

    PubMed  CAS  Google Scholar 

  2. Mergo PJ, Ros PR (1998) Imaging of diffuse liver disease. Radiol Clin North Am 36:365–375

    Article  PubMed  CAS  Google Scholar 

  3. Zwiebel WJ (1995) Sonographic diagnosis of diffuse liver disease. Semin ultrasound CT MR 16:8–15

    Article  PubMed  CAS  Google Scholar 

  4. Taylor HM, Ros PR (1998) Hepatic imaging: an overview. Radiol Clin North Am 36:237–245

    Article  PubMed  CAS  Google Scholar 

  5. Harbin WP, Robert NJ, Ferrucci JT Jr (1980) Diagnosis of cirrhosis based on regional changes in hepatic morphology: a radiological and pathological analysis. Radiology 135:273–283

    PubMed  CAS  Google Scholar 

  6. Hulcrantz R, Gabrielson N (1993) Patients with persistent elevation of aminotransferases: Investigation with ultrasonography, radionuclide imaging and liver biopsy. J Intern Med 233:7–12

    Article  Google Scholar 

  7. Aube C, Oberti F, Korali N et al (1999) Ultrasonographic diagnosis of hepatic fibrosis or cirrhosis. J Hepatol 30(3):427–428

    Article  Google Scholar 

  8. Hirata M, Akbar SM, Horiike N, Onji M (2001) Noninvasive diagnosis of the degree of hepatic fibrosis using ultrasonography in patients with chronic liver disease due to hepatitis C virus. Eur J Clin Invest 31(6):528–535

    Article  PubMed  CAS  Google Scholar 

  9. Zheng RQ, Wang QH, Lu MD et al (2003) Liver fibrosis in chronic viral hepatitis: an ultrasonographic study. World J Gastroenterol 9(11):2484–2489

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Larry Miller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Andanappa, H.K., Dai, Q., Korimilli, A. et al. Acoustic Liver Biopsy Using Endoscopic Ultrasound. Dig Dis Sci 53, 1078–1083 (2008).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: