liver diseases have a wide spectrum of severity and symptomatology and a close correlation between the two.
The laboratory in some situations it may be diagnostic, in others it is less useful.
imaging is therefore a key point in diagnosing hepatology, particularly with the advent of ultrasound.
Ultrasound in fact, thanks to its:
· no-invasive
· Diffusion
· Low cost
appears to be the first survey carried out in cases of suspected liver disease, reserving other techniques
any subsequent stages. Nor can we forget how examinations performed for other reasons or for no reason often lead to random changes in liver reflected that sometimes mislead even the doctor. The assumption is to consider ultrasound examination as first level, according to which set further investigation.
Certainly, ultrasound is the diagnostic method that does not include waiting times dizzying
(at least if one considers the privately!).
The problem is to streamline the diagnostic process for both operators and the users, in order to improve the diagnostic efficacy and avoid the waste of money and unnecessary distress to the patient.
Given the significant increase in Italy of primary liver cancer (HCC) and liver metastases secondary to other cancers (especially colorectal cancer and breast cancer), I will focus on the role of diagnostic ultrasonography in the detection.
The HCC shows great diversity in the aspects detectable by imaging techniques, reflecting the variability in the presentation at both the macroscopic and microscopic. The diagnosis is particularly difficult for the association of cancer with liver cirrhosis. Typical expressions of nodular cirrhosis, such as dysplastic nodule, it can simulate the presence of a tumor in an early stage. One of the
più importanti per la diagnosi differenziale, che può essere analizzato in modo accurato dalle tecniche per immagine, è la tipologia della vascolarizzazione. Nella transizione da nodulo di rigenerazione, a nodulo displasico a basso grado, a nodulo displasico ad alto grado, ad epatocarcinoma, esiste infatti una progressiva scomparsa degli spazi portali associata allo sviluppo di un neocircolo arterioso. Tale ipervascolarizzazione arteriosa costituisce l'elemento chiave per la diagnosi di epatocarcinoma mediante tecniche per immagine.
L'applicazione delle tecnologie color e power Doppler consente frequentemente di svelare i segni diretti ed indiretti della tipica ipervascolarizzazione tumorale, solitamente inversamente proporzionale al grado di differenziazione of cancer, and consists of vascular structures that are particularly numerous at the periphery of nodular lesions with thin walls and irregular course without a muscular coat. It can often prove so large, tortuous vessels around the wound with aspects of "basket-like", or signs of invasion with infiltration and / or venous thrombosis neoplasticheQuesto type of tumor vasculature is very different from that of benign lesions that, despite different and sometimes typical, has a constantly high "regular".
L 'Doppler allows us, therefore, a morphological evaluation of the liver and spleen, a functional assessment of the portal vein (AP diameter> 12mm) Of v.splenica (AP diameter> 10 mm) of any collateral circulation, ascites, free fluid in the abdominal cavity top (and perihepatitis perisplenica) and lower (excavation of Douglas).
The examination is completed and then with the study of:
° Distribution of flows that may appear epatopeti (point to the liver) and portal epatofughi axis (moving away from the liver) in the hepatic level.
· presence of turbulence in the signal or no signal in the presence of vascular thrombosis, partial or complete axis spleno-portal or its intrahepatic branches.
· study hepatic artery (at on the bifurcation of the left portal branches, disease resistance index> 0.70),
· splenic artery (resistance index normal <0.60),
So less than CT and MRI and ultrasonography in primary and secondary prevention!
Ultrasound in fact, thanks to its:
· no-invasive
· Diffusion
· Low cost
appears to be the first survey carried out in cases of suspected liver disease, reserving other techniques
any subsequent stages. Nor can we forget how examinations performed for other reasons or for no reason often lead to random changes in liver reflected that sometimes mislead even the doctor. The assumption is to consider ultrasound examination as first level, according to which set further investigation.
Certainly, ultrasound is the diagnostic method that does not include waiting times dizzying
(at least if one considers the privately!).
The problem is to streamline the diagnostic process for both operators and the users, in order to improve the diagnostic efficacy and avoid the waste of money and unnecessary distress to the patient.
Given the significant increase in Italy of primary liver cancer (HCC) and liver metastases secondary to other cancers (especially colorectal cancer and breast cancer), I will focus on the role of diagnostic ultrasonography in the detection.
The HCC shows great diversity in the aspects detectable by imaging techniques, reflecting the variability in the presentation at both the macroscopic and microscopic. The diagnosis is particularly difficult for the association of cancer with liver cirrhosis. Typical expressions of nodular cirrhosis, such as dysplastic nodule, it can simulate the presence of a tumor in an early stage. One of the
più importanti per la diagnosi differenziale, che può essere analizzato in modo accurato dalle tecniche per immagine, è la tipologia della vascolarizzazione. Nella transizione da nodulo di rigenerazione, a nodulo displasico a basso grado, a nodulo displasico ad alto grado, ad epatocarcinoma, esiste infatti una progressiva scomparsa degli spazi portali associata allo sviluppo di un neocircolo arterioso. Tale ipervascolarizzazione arteriosa costituisce l'elemento chiave per la diagnosi di epatocarcinoma mediante tecniche per immagine.
L'applicazione delle tecnologie color e power Doppler consente frequentemente di svelare i segni diretti ed indiretti della tipica ipervascolarizzazione tumorale, solitamente inversamente proporzionale al grado di differenziazione of cancer, and consists of vascular structures that are particularly numerous at the periphery of nodular lesions with thin walls and irregular course without a muscular coat. It can often prove so large, tortuous vessels around the wound with aspects of "basket-like", or signs of invasion with infiltration and / or venous thrombosis neoplasticheQuesto type of tumor vasculature is very different from that of benign lesions that, despite different and sometimes typical, has a constantly high "regular".
L 'Doppler allows us, therefore, a morphological evaluation of the liver and spleen, a functional assessment of the portal vein (AP diameter> 12mm) Of v.splenica (AP diameter> 10 mm) of any collateral circulation, ascites, free fluid in the abdominal cavity top (and perihepatitis perisplenica) and lower (excavation of Douglas).
The examination is completed and then with the study of:
° Distribution of flows that may appear epatopeti (point to the liver) and portal epatofughi axis (moving away from the liver) in the hepatic level.
· presence of turbulence in the signal or no signal in the presence of vascular thrombosis, partial or complete axis spleno-portal or its intrahepatic branches.
· study hepatic artery (at on the bifurcation of the left portal branches, disease resistance index> 0.70),
· splenic artery (resistance index normal <0.60),
So less than CT and MRI and ultrasonography in primary and secondary prevention!
Text kindly provided by Dr. MC Morsellino
For Info: maria.morsellino @ virgilio.it
