EXAM: Complete Abdominal Ultrasound with elastography of the liver
INDICATION:
COMPARISON:
TECHNIQUE: Transverse and longitudinal images of the upper abdomen were obtained.
elastography of the liver was performed using a General Electric Logic 10 ultrasound machine, 2D SWE technique by placing the C1-6 curvilinear probe over the center of the liver parenchyma and mechanically inducing shear wave. At least 8 separate measurements of the liver parenchyma were obtained.
FINDINGS:
Liver:
Size: cm: normal
Parenchymal: Normal echogenicity with normal echotexture
Surface: smooth contour
Mass: No focal masses.
Elastography:
The median liver stiffness is kPa ( ) with IQR/Median percentage of % (more than 30% the accuracy of the technique is reduced).
The median liver velocity is m/sec ( )with the IQR/median value is % (more than 15% the accuracy of the technique is reduced).
Liver Fibrosis Staging:
Ultrasound-guided attenuation parameter (UGAP) liver steatosis measurements:
Attenuation coefficient cutoff value (dB/cm/MHz):
Attenuation rate cutoff value (dB/m):
Calculated (UGAP) liver steatosis grading:
Ultrasound-guided attenuation parameter (UGAP) liver steatosis measurements:
Attenuation coefficient cutoff value (dB/cm/MHz):
Attenuation rate cutoff value (dB/m):
Calculated (UGAP) liver steatosis grading:
Liver:
Size: cm in the right midclavicular line: normal
Parenchymal: Normal echogenicity with normal echotexture
Surface: smooth contour
Mass: No focal masses.
Spleen:
Size: cm in length, normal
Echogenicity: Normal
Mass: No focal masses.
Gallbladder:
Stones/Sludge: None
Wall: cm: Normal
Appearance: No pericholecystic fluid or hydrops.
Sonographic Murphy's Sign: Negative
Bile Ducts:
Intrahepatic Ducts: No dilatation
Extrahepatic Ducts: Common bile duct measures cm, no dilatation
Pancreas:
Visualized portions of the pancreatic head, neck and proximal body are normal.
Right Kidney:
Size: cm
Echogenicity: Normal
Parenchymal thickness: Normal
Collecting system: No hydronephrosis
Stones: None
Cyst/Mass: None.
Left Kidney:
Size: cm
Echogenicity: Normal
Parenchymal thickness: Normal
Collecting system: No hydronephrosis
Stones: None
Cyst/Mass: None.
Vessels:
Aorta: Visualized portions are normal in caliber.
Inferior Vena Cava: Visualized portions are normal
Main Portal Vein: cm, normal in caliber with normal hepatopetal flow.
Free Fluid:
No ascites or pleural effusion
IMPRESSION:
Liver Fibrosis Staging:
Calculated (UGAP) liver steatosis grading:
Liver Fibrosis Staging:
Normal: "Metavir Score F0" (stiffness < 5.48kPa), (velocity < 1.35m/s)
Absent or mild fibrosis: "Metavir Score F1" (stiffness 5.48–8.29 kPa), (velocity 1.35–1.66 m/s)
Significant fibrosis: "Metavir Score F2" (stiffness 8.29–9.40 kPa), (velocity 1.66–1.77 m/s)
Severe fibrosis: "Metavir Score F3" (stiffness 9.40–11.9 kPa), (velocity 1.77–1.99 m/s)
Cirrhosis: "Metavir Score F1" (stiffness > 11.9 kPa), (velocity > 1.99 m/s)
IQR/Median suggests variability between consecutive liver stiffness acquisitions and should be less than 30% for stiffness and less than 15% for velocity, otherwise the accuracy of the technique is reduced.