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Kelly EMM, Feldstein VA, Parks M, et al. An Assessment of the Clinical Accuracy of Ultrasound in Diagnosing Cirrhosis in the Absence of Portal Hypertension. Gastroenterol Hepatol (N Y). 2018;14(6):367-373
Kelly, E. M. M., Feldstein, V. A., Parks, M., Hudock, R., Etheridge, D., & Peters, M. G. (2018). An Assessment of the Clinical Accuracy of Ultrasound in Diagnosing Cirrhosis in the Absence of Portal Hypertension. Gastroenterology & hepatology, 14(6), 367-373.
Kelly, Erin M M, et al. "An Assessment of the Clinical Accuracy of Ultrasound in Diagnosing Cirrhosis in the Absence of Portal Hypertension." Gastroenterology & hepatology vol. 14,6 (2018): 367-373.
Kelly EMM, Feldstein VA, Parks M, Hudock R, Etheridge D, Peters MG. An Assessment of the Clinical Accuracy of Ultrasound in Diagnosing Cirrhosis in the Absence of Portal Hypertension. Gastroenterol Hepatol (N Y). 2018 Jun;14(6):367-373. PMID: 30166950; PMCID: PMC6111505.
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Gastroenterol Hepatol (N Y). 2018 Jun;14(6):367-373.

An Assessment of the Clinical Accuracy of Ultrasound in Diagnosing Cirrhosis in the Absence of Portal Hypertension.

Gastroenterology & hepatology

Erin M M Kelly, Vickie A Feldstein, Monica Parks, Rebecca Hudock, Dustin Etheridge, Marion G Peters

Affiliations

  1. Dr Kelly is an assistant professor of medicine in the Division of Gastroenterology and Hepatology at the University of Ottawa in Ottawa, Canada.
  2. Dr Feldstein is a professor of clinical radiology in the Department of Radiology & Biomedical Imaging at the University of California, San Francisco in San Francisco, California.
  3. Ms Parks is a medical student at the University of California, San Francisco.
  4. Ms Hudock is a pharmacy student in the Division of Pharmacy at the University of California, San Francisco.
  5. Mr Etheridge is an independent statistician in Ottawa, Canada.
  6. Dr Peters is a professor of medicine in the Division of Gastroenterology and Hepatology at the University of California, San Francisco.

PMID: 30166950 PMCID: PMC6111505

Abstract

Ultrasound is an invaluable tool for the diagnosis of hepatocellular carcinoma and portal hypertension. However, the accuracy of ultrasound in diagnosing cirrhosis in the absence of portal hypertension has not been well studied. Using the specific terms cirrhosis or nodular(ity), a retrospective evaluation was conducted on abdominal ultrasounds performed between 2008 and 2013. Patients with evidence of portal hypertension were excluded from the evaluation. Charts were reviewed for evidence of cirrhosis on liver biopsy performed within 1 year of the ultrasound. Of the 69 patients whose ultrasound findings reported cirrhosis without portal hypertension who underwent liver biopsy, 47 (68%) had histologic evidence of cirrhosis. When patients with advanced fibrosis (F3 or F4) on liver biopsy were included, the sensitivity of the ultrasound improved to 80%. One in 5 biopsies showed only mild to moderate or no fibrosis (F0-F2). Sonographic assessment by experts may falsely suggest or overestimate cirrhosis. In the absence of objective evidence of portal hypertension, caution should be taken in diagnosing cirrhosis based on sonographic interpretation alone.

Keywords: Cirrhosis; fibrosis; liver biopsy; nodular; ultrasound

Conflict of interest statement

The authors have no relevant conflicts of interest to disclose.

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