Classification of liver cirrhosis based on parenchymal echo patterns and its clinical usefulness for diagnosis of liver cirrhosis

Abstract

Owing to the recent advancement of ultrasonographic instruments, we can now easily detect variously sized hypoechoic nodules as well as coarse echo pattern in cirrhotic liver.
Based on the size and distribution of such hypoechoic nodules, we classified echo patterns of liver parenchyma into four types as follows.
Type 0: Homogeneous echo pattern.
Type I: Coarse echo pattern with no distinct hypoechoic nodules.
Type II: Echo pattern showing scattered hypoechoic nodules sized 3-5mm.
Type III: Echo pattern showing scattered hypoechoic nodules sized more than 5mm.
In the present study, all the 25 patients of normal liver showed type 0, 29 of 42 patients with chronic hepatitis showed type 0 and the remained 13 type I. In 65 patients with liver cirrhosis, 54 (83.1%) were classified as type I, II, or III.
The grade of parenchymal echo pattern was significantly correlated with the severity of liver cirrhosis. In addition, the parenchymal patterns proved to be very useful in diagnosis of liver cirrhosis, presenting overall accuracy value of 81.8%. The value was the highest compared with those of other diagnostic factors on ultrasonograms.
Immersion experiment with autopsied liver specimens evidenced that hypoechoic nodules on ultrasonogram represent regenerative nodules of cirrhotic liver. It was also revealed that the parenchymal echo patterns closely corresponded to gross or histologoic findings of the liver.