Nagata Naruhiko, Miyachi Hayato, Nakano Atsushi, Nanri Kazuhide, Kobayashi Hisao, Matsuzaki Shohei
Department of Internal Medicine, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan.
J Clin Ultrasound. 2003 Oct;31(8):393-400. doi: 10.1002/jcu.10195.
We studied the sonographic appearance of the anterior liver surface using an ultrasound scanner equipped with a 7.5-MHz annular-array transducer to determine the accuracy of this imaging modality in monitoring the course of chronic liver diseases.
We prospectively evaluated patterns of the liver surface in the sonograms of 77 consecutive patients with chronic liver diseases who had undergone sonographic examination with a 7.5-MHz annular-array transducer and a 3.75-MHz convex-array transducer over a 2-year period and compared these findings with those of laparoscopy (using previously described categories) and histopathology.
Histopathologically confirmed disease prevalences for inactive chronic hepatitis, active chronic hepatitis, liver cirrhosis, and others were 10% (8/77), 56% (43/77), 29% (22/77), and 5% (4/77), respectively. The sonographic appearance of the liver surface with the 3.75-MHz transducer was classified as either a regular or an irregular pattern. The regular pattern corresponded to 69% (34/50) of the cases in laparoscopic category 200 or 300 and the irregular pattern with 85% (23/27) of the cases in category 400 or 500. The sonographic appearance of the liver surface with the 7.5-MHz transducer was classified as regular, unevenly irregular, diffusely irregular, or nodular. These 4 patterns detected 75% (24/32), 78% (14/18), 52% (12/23), and 75% (3/4) of the cases of laparoscopic categories 200, 300, 400, and 500, respectively. In a comparison of the sonographic patterns of the liver surface with the differential histopathologic findings, the regular sonographic pattern corresponded to 88% (7/8) of the cases of inactive chronic hepatitis, the unevenly irregular pattern with 35% (15/43) of the cases of active chronic hepatitis, and the diffusely irregular and nodular patterns (considered as 1 group) with 68% (15/22) of the cases of liver cirrhosis.
Our results suggest that sonographic evaluation of the liver surface with a 7.5-MHz annular-array transducer using this classification provides detailed information on the evolution of chronic liver diseases that correlates with the laparoscopic and histopathologic findings and thus is a useful noninvasive method for monitoring the disease course to cirrhosis.
我们使用配备7.5MHz环形阵列换能器的超声扫描仪研究肝脏前表面的超声表现，以确定这种成像方式在监测慢性肝病病程中的准确性。
我们前瞻性评估了77例连续慢性肝病患者的肝脏表面超声图像模式，这些患者在两年期间使用7.5MHz环形阵列换能器和3.75MHz凸阵换能器进行了超声检查，并将这些结果与腹腔镜检查（使用先前描述的分类）和组织病理学结果进行比较。
组织病理学确诊的非活动性慢性肝炎、活动性慢性肝炎、肝硬化及其他疾病的患病率分别为10%（8/77）、56%（43/77）、29%（22/77）和5%（4/77）。3.75MHz换能器显示的肝脏表面超声表现分为规则或不规则模式。规则模式对应腹腔镜200或300类病例的69%（34/50），不规则模式对应400或500类病例的85%（23/27）。7.5MHz换能器显示的肝脏表面超声表现分为规则、不均匀不规则、弥漫性不规则或结节状。这四种模式分别检测到腹腔镜200、300、400和500类病例的75%（24/32）、78%（14/18）、52%（12/23）和75%（3/4）。在比较肝脏表面超声模式与不同组织病理学结果时，规则超声模式对应88%（7/8）的非活动性慢性肝炎病例，不均匀不规则模式对应35%（15/43）的活动性慢性肝炎病例，弥漫性不规则和结节状模式（视为一组）对应68%（15/22）的肝硬化病例。
我们的结果表明，使用这种分类方法，用7.5MHz环形阵列换能器对肝脏表面进行超声评估可提供有关慢性肝病演变的详细信息，这些信息与腹腔镜检查和组织病理学结果相关，因此是监测疾病发展至肝硬化的一种有用的非侵入性方法。
