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.